Lynne A. Valenti
Cabinet Secretary

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditMISC/BH1South Dakota Community Mental Health Center FlyerDelete
1EditBRO/VS1Sexual Assault BrochureDelete
1EditBRO/EA1Energy Saving TipsDelete
1EditCPS-566Foster Parent EvaluationDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditBH-18Substance Use Disorder High Intensity Referral FormDelete
1EditBRO/EA2SNAP BrochureDelete
1EditBRO/CPS7Independent Living Program Education and Training Voucher BrochureDelete
1EditMS-103Provider Change FormDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditEA-260Statement of EarningsDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditCPS-565Foster Parent Training & Self-InstructionDelete
1EditBRO/DSS2Constituent Liaison Services BrochureDelete
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete
1EditBRO/EA12Energy Assistance BrochureDelete
1EditBRO/RE3Estate Recovery Program BrochureDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditPosterCHIP PosterDelete
1EditCPS-533Adoption Registry FormDelete
1EditPosterCHIP PosterDelete
1EditCPSFoster Parent HandbookDelete
1EditEA-345Affidavit for SNAP Work RegistrantsDelete
1EditBH-11Behavioral Health Treatment Outcomes Program ManualDelete
1EditBRO/DCS4National Medical Support Notice Brochure - An Employers GuideDelete
1EditMSProviders: NEMT Provider AgreementDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditCPSDesignated Tribal Agent Request for Change of AddressDelete
1EditEA-305Boarding School-Institution DocumentationDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditBRO/DSS4Direct Deposit BrochureDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditBRO/CPS7Independent Living Program Education and Training Voucher BrochureDelete
1EditBRO/MS6Health Home BrochureDelete
1EditBRO/MS4Title XIX Medical Transportation BrochureDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditBRO/DSS6Filing a Discrimination Complaint Brochure and FormDelete
1EditBH-11dAdult MH Initial Outcome ToolDelete
1EditBRO/EBT1EBT Client HandbookDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditBH-01Federal Poverty Level GuidelinesDelete
1EditBRO/EA8Medicaid Spousal Care HandbookDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditBH-11cAdult SUD Discharge Outcome Tool Delete
1EditBRO/CPS17Family Group Conferencing – Parents Guide Delete
1EditEA-320Self-Employment LedgerDelete
1EditRec and FraudStop Benefit Fraud InsertDelete
1EditDSSGuide to Administrative Hearings ProcedureDelete
1EditEA-310Form for Reporting ChangesDelete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditBRO/RE1Stop Benefit Fraud BrochureDelete
1EditFACISInterstate Compact: Report on Child PlacementDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditCPS-566Foster Parent EvaluationDelete
1EditPosterConstituent Liaison Services PosterDelete
1EditPosterCHIP PosterDelete
1EditCCSOrientation Training Verification FormDelete
1EditBRO/EA8Medicaid Spousal Care HandbookDelete
1EditBRO/DCS8Child Support Parent HandbookDelete
1EditRec and FraudReport Benefit FraudDelete
1EditCCSElectronic Payment ExemptionsDelete
1EditEA-320Self-Employment LedgerDelete
1EditCPS-500Newborn Medical Report for Voluntary Termination of Parental RightsDelete
1EditCPS-593Permission to Screen for Reports of Abuse or NeglectDelete
1EditEA-319Request for Administrative HearingDelete
1EditBH-02Financial Eligibility FormDelete
1EditDSS-CPSSafe Havens PosterDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditBRO/CPS2Common Sense Parenting BrochureDelete
1EditBRO/EA4TANF Work Program BrochureDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditBH-04102b Hardship ConsiderationsDelete
1EditDSSPsychiatric Residential Treatment Facility Referral FormDelete
1EditCPS-506Foster/Adoptive Parent Health ReportDelete
1EditSE-415Petition for Modification FormDelete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditSE-406Application for Location Only ServicesDelete
1EditBRO/EA11Weatherization Assistance BrochureDelete
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
1EditBRO/CCS3Registration & Licensure of Child Care EnvironmentsDelete
1EditCPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)Delete
1EditEA-297Energy Assistance ApplicationDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
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/MS3Well-Child Care BrochureDelete
1EditBRO/CPS3Safe Havens BrochureDelete
1EditBRO/DSS9DSS HandbookDelete
1EditBRO/EA10SNAP for StudentsDelete
1EditBRO/DCS1Child Support Modification HandbookDelete
1EditMS-102Provider Selection FormDelete
1EditEA-214SNAP 6 Month Report FormDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditEA-260Statement of EarningsDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBH-03102a Hardship Considerations Delete
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditMS-146Sterilization Consent FormDelete
1EditBRO/EA1Energy Saving TipsDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditBRO/MS4Title XIX Medical Transportation BrochureDelete
1EditCCSPathways to Professional Development - Renewal ApplicationDelete
1EditFSSAChildren and Family Medical Assistance ApplicationDelete
1EditBH-05Hardship Considerations RefusalDelete
1EditCPSDesignated Tribal Agent Request for Change of AddressDelete
1EditDSSGuide to Administrative Hearings ProcedureDelete
1EditEA-307GSNAP Group Home Exit FormDelete