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-265	Request for Long-Term Care or Home Community Based Services Waiver Assistance	Delete
1	Edit	EA-214	TANF 6 Month Report Form	Delete
1	Edit	BRO/DSS3	Administrative Hearings Brochure	Delete
1	Edit	EA-324	Wage Verification	Delete
1	Edit	BRO/DCS3	Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Income	Delete
1	Edit	PA	Prior Authorization Forms: Synagis	Delete
1	Edit	BRO/CPS17	Family Group Conferencing – Parents Guide	Delete
1	Edit	EA-214	TANF 6 Month Report Form	Delete
1	Edit	BH-06	3rd Party Release of Information (ROI)	Delete
1	Edit	MS	Title XIX Non-Emergency Transportation Payment Authorization Form	Delete
1	Edit	SE-492	Notice of Shared Medical Expenses	Delete
1	Edit	OS-950	Recipient Forms: Title XIX Medical Transportation Reimbursement	Delete
1	Edit	BH-09	Indigent Medication Application	Delete
1	Edit	BRO/CPS3	Safe Havens Brochure	Delete
1	Edit	Poster	CHIP Poster	Delete
1	Edit	BRO/CPS1	Child Protection Services Booklet	Delete
1	Edit	BRO/RE4	Medicaid Liens Brochure	Delete
1	Edit	ENERGY	Vendor Information: Direct Deposit	Delete
1	Edit	EA-324	Wage Verification	Delete
1	Edit	BRO/VS3	Crime Victims Compensation Program Brochure	Delete
1	Edit	VS-694	Crime Victims Compensation Primary Application	Delete
1	Edit	BRO/DSS9	DSS Handbook	Delete
1	Edit	SE-405	Application for Income Withholding Only Service	Delete
1	Edit	BRO/CCS3	Registration & Licensure of Child Care Environments	Delete
1	Edit	DSS-CCS	Rate Declaration Form	Delete
1	Edit	EA-347	Application for Social Security Number	Delete
1	Edit	BH-18	Substance Use Disorder High Intensity Referral Form	Delete
1	Edit	VS-694	Crime Victims Compensation Primary Application	Delete
1	Edit	SE408NCP	Application and Agreement for Services - Non-Custodial Parent	Delete
1	Edit	VS-695	Crime Victims Compensation Secondary Application	Delete
1	Edit	EA-301MA	Children and Family Medical Assistance Supplemental Application	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	EA-310	Form for Reporting Changes	Delete
1	Edit	BH-14	Substance Abuse - Accreditation Application	Delete
1	Edit	BRO/MS1	Medical Assistance Program Recipient Handbook	Delete
1	Edit	EA-301	SNAP Application	Delete
1	Edit	CPS-594	Declaration of Prior Criminal Conviction & Military History	Delete
1	Edit	SE-415	Petition for Modification Form	Delete
1	Edit	MS	Medicaid Transportation Documentation Form	Delete
1	Edit	BRO/EA18	Long-Term Care Partnership Brochure	Delete
1	Edit	FACIS	Interstate Compact: Placement Request Form	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	EA-269	Child Care Expense Billing Information	Delete
1	Edit	BRO/CPS18	Family Group Conferencing – Provider Guide	Delete
1	Edit	MS	Hysterectomy Acknowledgement of Information	Delete
1	Edit	BH-11b	Adult SUD Update Outcome Tool	Delete
1	Edit	BRO/CPS16	Family Group Conferencing – Family Group Decision Making	Delete
1	Edit	OS-954	Client Authorized Debit for Repayment of Overissuance	Delete
1	Edit	EA-231	Child Support Enforcement Referral	Delete
1	Edit	BRO/RE3	Estate Recovery Program Brochure	Delete
1	Edit	EA-319	Request for Administrative Hearing	Delete
1	Edit	CCS	Pathways to Professional Development - Career Lattice Application Form	Delete
1	Edit	BH-09	Indigent Medication Application	Delete
1	Edit	Poster	Reportable Disease List Poster	Delete
1	Edit	BRO/CPS5	What I Should Know About Foster Care	Delete
1	Edit	MS	Certificate of Medical Necessity	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	PA	Prior Authorization Forms: Private Duty Nursing & Extended Home Health Services	Delete
1	Edit	BRO/DCS8	Child Support Parent Handbook	Delete
1	Edit	BH-11e	Adult MH Update Outcome Tool	Delete
1	Edit	PA	Prior Authorization Forms: BRCA	Delete
1	Edit	CCS	South Dakota Child Safety Seat Distribution Program	Delete
1	Edit	VS-695	Crime Victims Compensation Secondary Application	Delete
1	Edit	MS	Providers: Adult Services & Aging Provider Agreement	Delete
1	Edit	EA-214	SNAP 6 Month Report Form	Delete
1	Edit	BRO/CPS4	Mandatory Reporting of Child Abuse & Neglect Brochure	Delete
1	Edit	BH-11f	Adult MH Discharge Outcome Tool	Delete
1	Edit	Rec and Fraud	Casualty Settlement Report Form	Delete
1	Edit	EA-301	Economic Assistance Application	Delete
1	Edit	CPS	Potential Placement Statement	Delete
1	Edit	PA	Prior Authorization Forms: Out-of State Services	Delete