Lynne A. Valenti
Cabinet Secretary

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditEA-320Self-Employment LedgerDelete
1EditBH-063rd Party Release of Information (ROI)Delete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditOS-950Recipient Forms: Title XIX Medical Transportation ReimbursementDelete
1EditMSTitle XIX Non-Emergency Transportation Payment Authorization FormDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditCPSPotential Placement StatementDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditCPSProvider Mileage RequestDelete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditBRO/DCS2Teenage Parents Guide - How to Establish Paternity and Financial Support for your ChildDelete
1EditBRO/DCS6Voluntary Paternity Establishment Handbook and FormDelete
1EditEA-269Recipient Forms: Child Care Expense Billing InformationDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditEA-310Form for Reporting ChangesDelete
1EditEA-345Affidavit for SNAP Work RegistrantsDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditCPSFoster Parent HandbookDelete
1EditPOS/EA02Long-Term Care Partnership Fact SheetDelete
1EditCPS-522Request for PaymentDelete
1EditBRO/CPS15Family Group Conferencing – My Family Meeting Delete
1EditBH-01Federal Poverty Level GuidelinesDelete
1EditBRO/VS1Sexual Assault BrochureDelete
1EditCPS-565Foster Parent Training & Self-InstructionDelete
1EditBRO/EA2SNAP BrochureDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditBRO/CPS7Independent Living Program Education and Training Voucher BrochureDelete
1EditBRO/EA3CHIP BrochureDelete
1EditBRO/CCS14Choosing Child Care HandbookDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditPAPrior Authorization Forms: Out-of State Services Delete
1EditBH-19Substance Use Disorder High Intensity Referral FormDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditRec and FraudCasualty Settlement Report FormDelete
1EditMSProfessional Services Billing ManualDelete
1EditBRO/CPS17Family Group Conferencing – Parents Guide Delete
1EditEA-324Wage VerificationDelete
1EditMSProviders: NEMT Provider AgreementDelete
1EditRec and FraudStop Benefit Fraud InsertDelete
1EditEA-301Economic Assistance ApplicationDelete
1EditBH-11dAdult MH Initial Outcome ToolDelete
1EditBRO/DSS2Constituent Liaison Services BrochureDelete
1EditBRO/EA12Energy Assistance BrochureDelete
1EditCCSSouth Dakota Child Safety Seat Distribution ProgramDelete
1EditBRO/EA18Long-Term Care Partnership BrochureDelete
1EditPosterReportable Disease List PosterDelete
1EditBRO/RE3Estate Recovery Program BrochureDelete
1EditPAPrior Authorization Forms: BRCADelete
1EditPAPrior Authorization Forms: GeneralDelete
1EditPosterCHIP PosterDelete
1EditDSS-CCSRate Declaration FormDelete
1EditDSSRecipient Forms: Psychiatric Residential Treatment Facility Referral FormDelete
1EditBRO/DSS4Direct Deposit BrochureDelete
1EditPAPrior Authorization Forms: Applied Behavior Analysis TherapyDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditMS-103Provider Change FormDelete
1EditBRO/CPS1Child Protection Services BookletDelete
1EditBRO/EBT1EBT Client HandbookDelete
1EditMSPharmacy Billing ManualDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditBRO/EACommunity Action Agency HandoutDelete
1EditBRO/CPS18Family Group Conferencing – Provider Guide Delete
1EditBH-18Mental Health - Indigent Medication Update - Extension Form 1.0Delete
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete
1EditBRO/CPS11Central Registry of Child Abuse & NeglectDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditBH-09Mental Health - Indigent Medication ApplicationDelete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditCPSIndependent Living Program BrochureDelete
1EditEA-320Self-Employment LedgerDelete
1EditBRO/DCS4National Medical Support Notice Brochure - An Employers GuideDelete
1EditBRO/CCS6Child Care Assistance Program BrochureDelete
1EditCCSPayment Authorization FormDelete
1EditEAWeatherization ApplicationDelete