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/ASA2Abuse, Neglect & Exploitation of Elders or Adults with DisabilitiesDelete
1EditBRO/DCS8Child Support Parent HandbookDelete
1EditEA-307SNAP Exit FormDelete
1EditASA-694Crime Victims Compensation ApplicationDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditDSS-CCSRate Declaration FormDelete
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditBH-11dAdult MH Initial Outcome ToolDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditBRO/ASA5Legal Services for the Elderly BrochureDelete
1EditPAPrior Authorization Forms: Private Duty Nursing & Extended Home Health ServicesDelete
1EditBRO/ASALong-Term Care Partnership BrochureDelete
1EditEA-324Wage VerificationDelete
1EditBRO/EBT1EBT Client HandbookDelete
1EditCCS-970Child Care Services Request For PaymentDelete
1EditEA-307GSNAP Group Home Exit FormDelete
1EditEA-301Economic Assistance ApplicationDelete
1EditDSSPsychiatric Residential Treatment Facility Referral FormDelete
1EditBH-03102a Hardship Considerations Delete
1EditASACaregiver Self AssessmentDelete
1EditCPS-533Adoption Registry FormDelete
1EditBRO/MS3Well-Child Care BrochureDelete
1EditBRO/DCS6Voluntary Paternity Establishment Handbook and FormDelete
1EditASAApplication for Guardianship or Conservatorship ServicesDelete
1EditFSSAChildren and Family Medical Assistance ApplicationDelete
1EditBRO/ASA3Adult Services and Aging Programs HandbookDelete
1EditBH-19Substance Use Disorder High Intensity Referral FormDelete
1EditCCSSouth Dakota Child Safety Seat Distribution ProgramDelete
1EditBRO/EA14Medical Assistance for Children and FamiliesDelete
1EditBRO/DCS4National Medical Support Notice Brochure - An Employers GuideDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditMISC/ASA6Assisted Living in SD: A Consumers GuideDelete
1EditPosterRecommendations for Exclusion from the Child Care Setting PosterDelete
1EditASA-522Request for PaymentDelete
1EditBH-18Mental Health - Indigent Medication Update - Extension Form 1.0Delete
1EditBH-12Mental Health - Youth Outcome ToolDelete
1EditBRO/ASA10Planning for Health Care Decisions: Your Right to ChooseDelete
1EditBRO/EA5Medicare Savings Program BrochureDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditPAPrior Authorization Forms: Out-of State Services Delete
1EditBRO/CPS15Family Group Conferencing – My Family Meeting Delete