Lynne A. Valenti
Cabinet Secretary

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1Edit Recipient Forms: HIPAA Privacy Consent FormDelete
1EditBRO/DSS6Filing a Discrimination Complaint Brochure and FormDelete
1EditBRO/EA14Medical Assistance for Children and FamiliesDelete
1EditPosterConstituent Liaison Services PosterDelete
1EditCPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)Delete
1EditCPSICPC Financial and Medical PlanDelete
1EditBH-17Prevention - Accreditation ApplicationDelete
1EditDSSPsychiatric Residential Treatment Facility Referral FormDelete
1EditEA-260Statement of EarningsDelete
1EditBH-02Financial Eligibility FormDelete
1EditCPS-566Foster Parent EvaluationDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditBH-11Behavioral Health Treatment Outcomes Program ManualDelete
1EditBH-03102a Hardship Considerations Delete
1EditEA-307GSNAP Group Home Exit FormDelete
1EditCPSIndependent Living Program Education and Training Voucher Delete
1EditBRO/MS3Well-Child Care BrochureDelete
1EditEA-301SNAP ApplicationDelete
1EditDSS-W9W-9 FormDelete
1EditBRO/CPS2Common Sense Parenting BrochureDelete
1EditPAPrior Authorization ManualDelete
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditCCSPathways to Professional Development - Renewal ApplicationDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditBRO/EA11Weatherization Assistance BrochureDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditEA-307SNAP Exit FormDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditSE-415Petition for Modification FormDelete
1EditPAPrior Authorization Forms: Private Duty Nursing & Extended Home Health ServicesDelete
1EditBRO/CCS3Registration & Licensure of Child Care EnvironmentsDelete
1EditBRO/EA1Energy Saving TipsDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditCPS-500Newborn Medical Report for Voluntary Termination of Parental RightsDelete
1EditBH-11cAdult SUD Discharge Outcome Tool Delete
1EditBH-04102b Hardship ConsiderationsDelete
1EditMSProviders: Adult Services & Aging Provider AgreementDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditBRO/DSS9DSS HandbookDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditEA-320Self-Employment LedgerDelete
1EditPAPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditBRO/EA4TANF Work Program BrochureDelete
1EditEA-305Boarding School-Institution DocumentationDelete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
1EditBRO/DCS8Child Support Parent HandbookDelete
1EditBH-11eAdult MH Update Outcome ToolDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditDSS-ORFI-831Estate Recovery Notification of Death FormDelete
1EditEA-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditCPS-533Adoption Registry FormDelete
1EditBRO/MS4Title XIX Medical Transportation BrochureDelete