Lynne A. Valenti
Cabinet Secretary

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Below you will find the selected forms and/or publications for this order. You will need to indicate the quantity you want to receive in the box next to the document number. After you have entered the quantity, click "Update" in the previous box. If you wish to remove a form or publication, simply click on the link that states "Delete." Once you have entered the quantity for each form or publication, click the "Proceed" button at the bottom.

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditBH-02Financial Eligibility FormDelete
1EditCCSPathways to Professional Development - Renewal ApplicationDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditDSSPsychiatric Residential Treatment Facility Referral FormDelete
1EditPosterRecommendations for Exclusion from the Child Care Setting PosterDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditEA-260Statement of EarningsDelete
1EditEA-307GSNAP Group Home Exit FormDelete
1EditBRO/EA18Long-Term Care Partnership BrochureDelete
1EditBRO/MS4Title XIX Medical Transportation BrochureDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditBRO/CPS17Family Group Conferencing – Parents Guide Delete
1EditBRO/DCS2Teenage Parents Guide - How to Establish Paternity and Financial Support for your ChildDelete
1EditBRO/DSS6Filing a Discrimination Complaint Brochure and FormDelete
1EditBRO/DSS2Constituent Liaison Services BrochureDelete
1EditMS-102Provider Selection FormDelete
1EditBRO/CCS14Choosing Child Care HandbookDelete
1EditBRO/BH1Substance Use Disorder Services BrochureDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditBRO/EA1Energy Saving TipsDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditBRO/EA3CHIP BrochureDelete
1EditMSTitle XIX Non-Emergency Transportation Payment Authorization FormDelete
1EditBH-11dAdult MH Initial Outcome ToolDelete
1EditCCSSouth Dakota Child Safety Seat Distribution ProgramDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditOS-950Recipient Forms: Title XIX Medical Transportation ReimbursementDelete
1EditBRO/VS1Sexual Assault BrochureDelete
1EditMSProviders: NEMT Provider AgreementDelete
1EditRec and FraudCasualty Settlement Report FormDelete
1EditPosterReportable Disease List PosterDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditBRO/EA2SNAP BrochureDelete