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
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditBRO/CPS7Independent Living Program Education and Training Voucher BrochureDelete
1EditPosterCHIP PosterDelete
1EditMSPrior Authorization ManualDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
1EditBRO/CPS16Family Group Conferencing – Family Group Decision Making Delete
1EditBH-04102b Hardship ConsiderationsDelete
1EditBRO/EA10SNAP for StudentsDelete
1EditCPSDesignated Tribal Agent Request FormDelete
1EditDSS-W9W-9 FormDelete
1EditCPSPotential Placement StatementDelete
1Edit Recipient Forms: HIPAA Privacy Consent FormDelete
1EditMSPharmacy Billing ManualDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete
1EditEA-270Medical Savings Program ApplicationDelete
1EditRec and FraudCasualty Settlement Report FormDelete
1EditEA-301SNAP ApplicationDelete
1EditBH-11cAdult SUD Discharge Outcome Tool Delete
1EditEA-269Child Care Expense Billing InformationDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 0-4Delete