M. Greg DeSautel, MD
Cabinet Secretary

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditOS-950Recipient Forms: Title XIX Medical Transportation ReimbursementDelete
1EditEA-324Wage VerificationDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditCPS-508Reference Form - Adoption / Foster / Kinship CareDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1EditBRO/CPS17Family Group Conferencing – Parents Guide Delete
1EditBRO/CPS4Mandatory Reporting of Child Abuse & Neglect BrochureDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditBRO/EA16Medical Assistance for Children and Families: IHS SpecificDelete
1EditBH-11cAdult SUD Discharge Outcome Tool Delete
1EditBRO/CPS1Child Protection Services BookletDelete
1EditPosterCHIP PosterDelete
1EditCCSOrientation Training Verification FormDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditBRO/CPS7Independent Living Program Education and Training Voucher BrochureDelete
1EditBH-17Prevention - Accreditation ApplicationDelete
1EditCCSElectronic Payment ExemptionsDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditEA-320Self-Employment LedgerDelete
1EditBH-11eAdult MH Update Outcome ToolDelete
1EditBRO/EA12Energy Assistance BrochureDelete
1EditBRO/CPS2Common Sense Parenting BrochureDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditBH-13eFamily MH Update Outcome ToolDelete
1EditEA-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditBH-04102b Hardship ConsiderationsDelete
1EditCPSProvider Mileage RequestDelete
1EditCPS-533Adoption Registry FormDelete
1EditPosterReportable Disease List PosterDelete
1EditDSSPsychiatric Residential Treatment Facility Referral FormDelete
1EditBRO/DSS3Administrative Hearings BrochureDelete
1EditMSTitle XIX Non-Emergency Transportation Payment Authorization FormDelete
1EditEA-347Application for Social Security NumberDelete
1EditSE-415Petition for Modification FormDelete
1EditBRO/EACommunity Action Agency HandoutDelete
1EditDSS-CCSRate Declaration FormDelete
1EditSE-406Application for Location Only ServicesDelete
1EditBH-18Substance Use Disorder High Intensity Referral FormDelete
1EditPAPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditEA-307SNAP Exit FormDelete
1EditCPSICPC Financial and Medical PlanDelete
1EditPAPrior Authorization Forms: Private Duty Nursing & Extended Home Health ServicesDelete
1EditDSS-W9W-9 FormDelete
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
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete
1EditCPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)Delete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditCPS-522Request for PaymentDelete
1EditEA-297Energy Assistance ApplicationDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 0-4Delete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
1EditSE-405Application for Income Withholding Only ServiceDelete
1EditEA-298Weatherization ApplicationDelete
1EditBRO/EA18Long-Term Care Partnership BrochureDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditDSS-ORFI-831Estate Recovery Notification of Death FormDelete
1EditEA-301SNAP ApplicationDelete
1Edit Recipient Forms: HIPAA Privacy Consent FormDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditBRO/MS3Well-Child Care BrochureDelete
1EditBRO/CPS18Family Group Conferencing – Provider Guide Delete
1EditEA-301Economic Assistance ApplicationDelete
1EditBRO/CPS3Safe Havens BrochureDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditBRO/DSS9DSS HandbookDelete
1EditCPSIndependent Living Program Education and Training Voucher Delete
1EditEA-305Boarding School-Institution DocumentationDelete
1EditBRO/EA10SNAP for StudentsDelete
1EditBRO/DSS6Filing a Discrimination Complaint Brochure and FormDelete
1EditBRO/EA5Medicare Savings Program BrochureDelete
1EditBH-09aIndigent Medication Update-Extension ApplicationDelete
1EditBRO/DCS1Child Support Modification HandbookDelete
1EditRec and FraudCasualty Settlement Report FormDelete
1EditBRO/CPS11Central Registry of Child Abuse & NeglectDelete
1EditCCSPayment Authorization FormDelete
1EditMS-102Provider Selection FormDelete
1EditEA-214SNAP 6 Month Report FormDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditEA-260Statement of EarningsDelete
1EditBH-09Indigent Medication ApplicationDelete
1EditEA-310Form for Reporting ChangesDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditBH-03102a Hardship Considerations Delete
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditBRO/CCS6Child Care Assistance Program BrochureDelete
1EditBRO/DSS4Direct Deposit BrochureDelete
1EditEA-320Self-Employment LedgerDelete
1EditMS-146Sterilization Consent FormDelete
1EditBRO/EA1Energy Saving TipsDelete
1EditEA-345Affidavit for SNAP Work RegistrantsDelete
1EditBH-11Behavioral Health Treatment Outcomes Program ManualDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditMSProviders: Adult Services & Aging Provider AgreementDelete
1EditPAPrior Authorization Forms: BRCADelete
1EditBRO/MS4Title XIX Medical Transportation BrochureDelete
1EditCCSPathways to Professional Development - Renewal ApplicationDelete
1EditFSSAChildren and Family Medical Assistance ApplicationDelete
1EditCCSSouth Dakota Child Safety Seat Distribution ProgramDelete
1EditBH-05Hardship Considerations RefusalDelete