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
1EditCPSDesignated Tribal Agent Request FormDelete
1EditBRO/MS4Title XIX Medical Transportation BrochureDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditMSProviders: Adult Services & Aging Provider AgreementDelete
1EditEA-231Child Support Enforcement ReferralDelete
1EditBRO/EA8Medicaid Spousal Care HandbookDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 0-4Delete
1EditBRO/DCS1Child Support Modification HandbookDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditBH-04102b Hardship ConsiderationsDelete
1EditMSProviders: NEMT Provider AgreementDelete
1EditEA-249Disabled Children Application / Eligibility ReviewDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditEA-231Recipient Forms: Child Support Enforcement ReferralDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditMSPrior Authorization Forms: General Prior Authorization RequestDelete
1EditBRO/ASA9Domestic Violence BrochureDelete
1EditBH-09Mental Health - Indigent Medication ApplicationDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditBH-17Prevention - Accreditation ApplicationDelete
1EditEA-347Application for Social Security NumberDelete
1EditPosterCHIP PosterDelete
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditPosterCHIP PosterDelete