Laurie Gill
Cabinet Secretary

DSS Mobile Logo Mobile Menu Button

Order Forms and Publications

Ready to Check Out?

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.

All fields are required.

The information being sent to you is free.

If you want to continue looking for more forms and/or publications, click here.

When entering the number of copies - use only numbers, no commas.

CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditBRO/RE1Stop Benefit Fraud BrochureDelete
1EditBRO/BH4Substance Use Disorder Involuntary Commitment ProcessDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditEA-324Wage VerificationDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditPAPrior Authorization Form: Incontinence Supply CHOICES WaiverDelete
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
1EditBRO/CPS17Family Group Conferencing – Parents Guide Delete
1EditFACISInterstate Compact: Report on Child PlacementDelete
1EditBRO/CPS4Mandatory Reporting of Child Abuse & Neglect BrochureDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditCPS-566Foster Parent EvaluationDelete
1EditPosterConstituent Liaison Services PosterDelete
1EditBRO/EA16Medical Assistance for Children and Families: IHS SpecificDelete
1EditBH-13aFamily SUD Initial Outcome ToolDelete
1EditBH-11cAdult SUD Discharge Outcome Tool Delete
1EditBRO/CPS1Child Protection Services BookletDelete
1EditPosterCHIP PosterDelete
1EditBRO/EA2SNAP BrochureDelete
1EditCCSOrientation Training Verification FormDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditBRO/CPS7Independent Living Program Education and Training Voucher BrochureDelete
1EditBRO/EA8Medicaid Spousal Care HandbookDelete
1EditBH-17Prevention - Accreditation ApplicationDelete
1EditBRO/DCS8Child Support Parent HandbookDelete
1EditCCSElectronic Payment ExemptionsDelete
1EditBH-12aYouth SUD Initial Outcome ToolDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditEA-320Self-Employment LedgerDelete
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
1EditBRO/DSS2Constituent Liaison Services BrochureDelete
1EditDSS-CPSSafe Havens PosterDelete
1EditCCS-964Child Care Declaration of Prior Criminal Conviction and Military HistoryDelete
1EditBH-12cYouth SUD Discharge Outcome ToolDelete
1EditBRO/EA12Energy Assistance BrochureDelete
1EditBRO/RE3Estate Recovery Program BrochureDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditBRO/CPS2Common Sense Parenting BrochureDelete
1EditBRO/EA4TANF Work Program BrochureDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditBH-13eFamily MH Update Outcome ToolDelete
1EditEA-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditPosterCHIP PosterDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditBH-04102b Hardship ConsiderationsDelete
1EditBRO/DCS4National Medical Support Notice Brochure - An Employers GuideDelete
1EditCPSProvider Mileage RequestDelete
1EditPosterReportable Disease List PosterDelete
1EditBRO/DSS3Administrative Hearings BrochureDelete
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
1EditPAPrior Authorization Form: Incontinence Supply Family Support 360 WaiverDelete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditBRO/EACommunity Action Agency HandoutDelete
1EditDSS-CCSRate Declaration FormDelete
1EditSE-406Application for Location Only ServicesDelete
1EditMSTransportation Exceptions FormDelete
1EditMSProviders: NEMT Provider AgreementDelete
1EditBRO/EA11Weatherization Assistance BrochureDelete
1EditBH-18Substance Use Disorder High Intensity Referral FormDelete
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
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditBH-063rd Party Release of Information (ROI)Delete
1EditBRO/DCS6Voluntary Paternity Establishment Handbook and FormDelete
1EditBRO/CCS3Registration & Licensure of Child Care EnvironmentsDelete
1EditBRO/EA14Medical Assistance for Children and FamiliesDelete
1EditCPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)Delete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditPAPrior Authorization Form: Incontinence Supply ADLS Support 360 WaiverDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditCPS-522Request for PaymentDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditEA-297Energy Assistance ApplicationDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 0-4Delete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
1EditBH-12fYouth MH Discharge Outcome ToolDelete
1EditOS-964Non-Emergency Medical Travel HIPAA AuthorizationDelete
1EditEA-298Weatherization ApplicationDelete
1EditBRO/EA18Long-Term Care Partnership BrochureDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditPAPrior Authorization Forms: Genetic Testing Delete
1EditDSS-ORFI-831Estate Recovery Notification of Death FormDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditEA-301SNAP ApplicationDelete
1Edit Recipient Forms: HIPAA Privacy Consent FormDelete