Laurie Gill
Cabinet Secretary

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditOS-950Recipient Forms: Medicaid Non-Emergency Medical Travel FormDelete
1EditEA-324Wage VerificationDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditMISC/BH1South Dakota Community Mental Health Center FlyerDelete
1EditCPS-508Reference Form - Adoption / Foster / Kinship CareDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1EditFACISInterstate Compact: Report on Child PlacementDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditCPS-566Foster Parent EvaluationDelete
1EditBH-13aFamily SUD Initial Outcome ToolDelete
1EditBH-11cAdult SUD Discharge Outcome Tool Delete
1EditBH-17Prevention - Accreditation ApplicationDelete
1EditRec and FraudReport Benefit FraudDelete
1EditCCSElectronic Payment ExemptionsDelete
1EditBH-12aYouth SUD Initial Outcome ToolDelete
1EditMS-103Provider Change FormDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditBH-13cFamily SUD Discharge Outcome ToolDelete
1EditBH-11eAdult MH Update Outcome ToolDelete
1EditCPS-500Newborn Medical Report for Voluntary Termination of Parental RightsDelete
1EditCPS-593Permission to Screen for Reports of Abuse or NeglectDelete
1EditCPS-565Foster Parent Training & Self-InstructionDelete
1EditEA-319Request for Administrative HearingDelete
1EditBH-02Financial Eligibility FormDelete
1EditCCS-964Child Care Declaration of Prior Criminal Conviction and Military HistoryDelete
1EditBH-12cYouth SUD Discharge Outcome ToolDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditBH-13eFamily MH Update Outcome ToolDelete
1EditEA-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditCPSProvider Mileage RequestDelete
1EditCPS-533Adoption Registry FormDelete
1EditMSMedicaid Non-Emergency Travel (NEMT) Payment Authorization FormDelete
1EditCPS-506Foster/Adoptive Parent Health ReportDelete
1EditEA-347Application for Social Security NumberDelete
1EditSE-415Petition for Modification FormDelete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditMSTransportation Exceptions FormDelete
1EditMSProviders: NEMT Provider AgreementDelete
1EditPAPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditEA-307SNAP Exit FormDelete
1EditCPSICPC Financial and Medical PlanDelete
1EditPAPrior Authorization Forms: Private Duty Nursing & Extended Home Health ServicesDelete
1EditDSS-W9W-9 FormDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditBH-063rd Party Release of Information (ROI)Delete
1EditMSMedicaid Transportation Documentation FormDelete
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditBRO/BH2Mental Health Services BrochureDelete
1EditCPS-522Request for PaymentDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditEA-297Energy Assistance ApplicationDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 0-4Delete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
1EditSE-405Application for Income Withholding Only ServiceDelete
1EditBH-12fYouth MH Discharge Outcome ToolDelete
1EditOS-964Non-Emergency Medical Travel HIPAA AuthorizationDelete
1EditEA-298Weatherization ApplicationDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditPAPrior Authorization Forms: Genetic Testing Delete
1EditDSS-ORFI-831Estate Recovery Notification of Death FormDelete
1EditEA-301SNAP ApplicationDelete
1EditCPSDesignated Tribal Agent Request FormDelete
1EditMISC/BH3Substance Use Disorder Services FlyerDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditBH-13bFamily SUD Update Outcome ToolDelete
1EditCCS-970Child Care Services Request For PaymentDelete
1EditBH-11dAdult MH Initial Outcome ToolDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditEA-305Boarding School-Institution DocumentationDelete
1EditBH-01Federal Poverty Level GuidelinesDelete
1EditBH-09aIndigent Medication Update-Extension ApplicationDelete
1EditRec and FraudCasualty Settlement Report FormDelete
1EditCCSPayment Authorization FormDelete
1EditEA-240Application for Resource Assessment, Long Term Care or Related Medical AssistanceDelete
1EditBH-12bYouth SUD Update Outcome ToolDelete
1EditMS-102Provider Selection FormDelete
1EditEA-214SNAP 6 Month Report FormDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditEA-260Statement of EarningsDelete
1EditBH-09Indigent Medication ApplicationDelete
1EditEA-320Self-Employment LedgerDelete
1EditBH-13dFamily MH Initial Outcome ToolDelete
1EditBH-11fAdult MH Discharge Outcome ToolDelete
1EditEA-310Form for Reporting ChangesDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditBH-03102a Hardship Considerations Delete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditEA-320Self-Employment LedgerDelete
1EditEA-345Affidavit for SNAP Work RegistrantsDelete
1EditBH-11Behavioral Health Treatment Outcomes Program ManualDelete
1EditMSCertificate of Medical NecessityDelete
1EditBH-13fFamily MH Discharge Outcome ToolDelete
1EditMSProviders: Adult Services & Aging Provider AgreementDelete
1EditPAPrior Authorization Forms: BRCADelete
1EditBH-05Hardship Considerations RefusalDelete
1EditPAPrior Authorization Forms: Applied Behavior Analysis TherapyDelete
1EditBRO/BH1Substance Use Disorder Services BrochureDelete
1EditCPSDesignated Tribal Agent Request for Change of AddressDelete
1EditPAPrior Authorization Forms: GeneralDelete
1EditEA-307GSNAP Group Home Exit FormDelete