Laurie Gill
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
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