Forms & Publications :: SD Dept. of Social Services

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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Copies	Edit the Number of Copies	Document Number	Document Name	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	BH-02	Financial Eligibility Form	Delete
1	Edit	CCS	Pathways to Professional Development - Renewal Application	Delete
1	Edit	EA-270	Medical Savings Program Application	Delete
1	Edit	SE408CP	Application and Agreement for Services - Custodial Parent and/or Caretaker	Delete
1	Edit	EA-301MA	Children and Family Medical Assistance Supplemental Application	Delete
1	Edit	BRO/DSS8	Notice of Privacy Brochure	Delete
1	Edit	DSS	Psychiatric Residential Treatment Facility Referral Form	Delete
1	Edit	Poster	Recommendations for Exclusion from the Child Care Setting Poster	Delete
1	Edit	BRO/EA9	SNAP Shoppers Guide	Delete
1	Edit	EA-260	Statement of Earnings	Delete
1	Edit	EA-307G	SNAP Group Home Exit Form	Delete
1	Edit	BRO/EA18	Long-Term Care Partnership Brochure	Delete
1	Edit	BRO/MS4	Title XIX Medical Transportation Brochure	Delete
1	Edit	EA-269	Child Care Expense Billing Information	Delete
1	Edit	BRO/RE4	Medicaid Liens Brochure	Delete
1	Edit	BRO/CPS17	Family Group Conferencing – Parents Guide	Delete
1	Edit	BRO/DCS2	Teenage Parents Guide - How to Establish Paternity and Financial Support for your Child	Delete
1	Edit	BRO/DSS6	Filing a Discrimination Complaint Brochure and Form	Delete
1	Edit	BRO/DSS2	Constituent Liaison Services Brochure	Delete
1	Edit	MS-102	Provider Selection Form	Delete
1	Edit	BRO/CCS14	Choosing Child Care Handbook	Delete
1	Edit	BRO/BH1	Substance Use Disorder Services Brochure	Delete
1	Edit	CPS	Background Information for Voluntary Termination of Parental Rights	Delete
1	Edit	BRO/EA1	Energy Saving Tips	Delete
1	Edit	CPS	Placement Resource Monthly Reporting Form Ages 5-13	Delete
1	Edit	BRO/EA3	CHIP Brochure	Delete
1	Edit	MS	Title XIX Non-Emergency Transportation Payment Authorization Form	Delete
1	Edit	BH-11d	Adult MH Initial Outcome Tool	Delete
1	Edit	CCS	South Dakota Child Safety Seat Distribution Program	Delete
1	Edit	BRO/EA9	SNAP Shoppers Guide	Delete
1	Edit	OS-950	Recipient Forms: Title XIX Medical Transportation Reimbursement	Delete
1	Edit	BRO/VS1	Sexual Assault Brochure	Delete
1	Edit	MS	Providers: NEMT Provider Agreement	Delete
1	Edit	Rec and Fraud	Casualty Settlement Report Form	Delete
1	Edit	Poster	Reportable Disease List Poster	Delete
1	Edit	EA-345A	Affidavit for SNAP Work Registrants (Employment & Training)	Delete
1	Edit	BRO/EA2	SNAP Brochure	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA-310	Form for Reporting Changes	Delete
1	Edit	BRO/CPS7	Independent Living Program Education and Training Voucher Brochure	Delete
1	Edit	PA	Prior Authorization Forms: General	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	Rec and Fraud	Stop Benefit Fraud Insert	Delete
1	Edit	BRO/CCS6	Child Care Assistance Program Brochure	Delete
1	Edit	BRO/EBT1	EBT Client Handbook	Delete
1	Edit	CPS	Foster Parent Handbook	Delete
1	Edit	EA-345	Affidavit for SNAP Work Registrants	Delete
1	Edit	BRO/EA	Community Action Agency Handout	Delete
1	Edit	PA	Prior Authorization Forms: Synagis	Delete
1	Edit	BRO/CPS15	Family Group Conferencing – My Family Meeting	Delete
1	Edit	BH-06	3rd Party Release of Information (ROI)	Delete
1	Edit	BRO/CPS11	Central Registry of Child Abuse & Neglect	Delete
1	Edit	MS-103	Provider Change Form	Delete
1	Edit	CPS	Potential Placement Statement	Delete
1	Edit	BRO/DCS2	Teenage Parents Guide - How to Establish Paternity and Financial Support for your Child	Delete
1	Edit	CPS-594	Declaration of Prior Criminal Conviction & Military History	Delete
1	Edit	SE408NCP	Application and Agreement for Services - Non-Custodial Parent	Delete
1	Edit	BH-09	Mental Health - Indigent Medication Application	Delete
1	Edit	BRO/RE3	Estate Recovery Program Brochure	Delete
1	Edit	CPS	Provider Mileage Request	Delete
1	Edit	PA	Prior Authorization Forms: Out-of State Services	Delete