Lynne A. Valenti
Cabinet Secretary

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditBH-11Mental Health - Adult Outcome ToolDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditBH-17Prevention - Accreditation ApplicationDelete
1EditBRO/CPS11Central Registry of Child Abuse & NeglectDelete
1EditBRO/MS4Title XIX Medical Transportation BrochureDelete
1EditBRO/CPS4Mandatory Reporting of Child Abuse & Neglect BrochureDelete
1EditPosterCHIP PosterDelete
1EditMSProviders: NEMT Provider AgreementDelete
1EditBRO/ASALong-Term Care Partnership Fact SheetDelete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditSE-415Petition for Modification FormDelete
1EditMSPrior Authorization Forms: General Prior Authorization RequestDelete
1EditBRO/ASA9Domestic Violence BrochureDelete
1EditBRO/ASA11Crime Victims Compensation BrochureDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditEA-319Request for Administrative HearingDelete
1EditBH-11fAdult MH Discharge Outcome ToolDelete
1EditMS-146Sterilization Consent FormDelete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditCCSPathways to Professional DevelopmentDelete
1EditEA-249Disabled Children Application / Eligibility ReviewDelete
1EditBRO/ASA12Helping You Understand Medicare & Your BenefitsDelete
1EditBH-09Mental Health - Indigent Medication ApplicationDelete
1EditCCSElectronic Payment ExemptionsDelete
1EditBRO/EA8Medicaid Spousal Care HandbookDelete
1EditEA-231Child Support Enforcement ReferralDelete
1EditPosterReportable Disease List PosterDelete
1EditBRO/EA11Weatherization Assistance BrochureDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditBRO/CPS3Safe Havens BrochureDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditPosterConstituent Liaison Services PosterDelete
1EditMSInstitutional Billing ManualDelete
1EditCCSOrientation Training Verification FormDelete
1EditEA-347Application for Social Security NumberDelete
1EditBRO/EA3CHIP BrochureDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditEA-231Recipient Forms: Child Support Enforcement ReferralDelete
1EditBH-05Hardship Considerations RefusalDelete
1EditBRO/CPS17Family Group Conferencing – Parents Guide Delete
1EditBRO/DCS1Child Support Modification HandbookDelete
1EditBRO/DSS4Direct Deposit BrochureDelete
1EditEA-310Form for Reporting ChangesDelete
1EditMSProviders: Adult Services & Aging Provider AgreementDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditEA-260Statement of EarningsDelete
1EditBRO/CCS14Choosing Child Care HandbookDelete
1EditEA-301Economic Assistance ApplicationDelete
1EditASAApplication for Guardianship or Conservatorship ServicesDelete
1EditBRO/CPS5What I Should Know About Foster CareDelete
1EditASACaregiver Self AssessmentDelete
1EditEA-307GSNAP Group Home Exit FormDelete
1EditCPSDesignated Tribal Agent Request for Change of AddressDelete
1EditBRO/DCS8Child Support Parent HandbookDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditBRO/ASALong-Term Care Partnership StufferDelete
1EditMSPrior Authorization Forms: BRCA Prior AuthorizationDelete
1EditBRO/DSS3Administrative Hearings BrochureDelete
1EditCCS-970Child Care Services Request For PaymentDelete
1EditFSSAChildren and Family Medical Assistance ApplicationDelete
1EditMSPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditBRO/ASA2Abuse, Neglect & Exploitation of Elders or Adults with DisabilitiesDelete
1EditBH-01Federal Poverty Level GuidelinesDelete
1EditMS-103Provider Change FormDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditSE-405Application for Income Withholding Only ServiceDelete
1EditCPS-533Adoption Registry FormDelete
1EditCPS-506Foster/Adoptive Parent Health ReportDelete
1EditDSS-CPSSafe Havens PosterDelete
1EditEA-214SNAP 6 Month Report FormDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditCPSIndependent Living Program Education and Training Voucher Delete
1EditBH-19Substance Use Disorder High Intensity Referral FormDelete
1EditCCSSouth Dakota Child Safety Seat Distribution ProgramDelete
1EditBRO/ASA7Ombudsman Services BrochureDelete
1EditBRO/ASA5Legal Services for the Elderly BrochureDelete
1EditBRO/DSS9DSS HandbookDelete
1EditASA-668Homemaker Services ReportDelete
1EditRec and FraudReport Benefit FraudDelete
1EditPosterSenior Meals PosterDelete
1EditEA-297Energy Assistance ApplicationDelete
1EditEA-320Self-Employment LedgerDelete
1EditBRO/CCS6Child Care Assistance Program BrochureDelete
1EditCPSICPC Financial and Medical PlanDelete
1EditBH-18Mental Health - Indigent Medication Update - Extension Form 1.0Delete
1EditBRO/ASA3Adult Services and Aging Programs HandbookDelete
1EditASA-677Prescription AssistanceDelete
1EditPosterRecommendations for Exclusion from the Child Care Setting PosterDelete
1EditBRO/MS3Well-Child Care BrochureDelete
1EditBRO/EA14Medical Assistance for Children and FamiliesDelete
1EditBRO/EA16Medical Assistance for Children and Families: IHS SpecificDelete
1EditCPS-593Permission to Screen for Reports of Abuse or NeglectDelete
1EditASA-522Request for PaymentDelete
1EditEA-307SNAP Exit FormDelete
1EditBRO/DCS2Teenage Parents Guide - How to Establish Paternity and Financial Support for your ChildDelete
1EditBRO/DSS6Filing a Discrimination Complaint Brochure and FormDelete
1EditBH-11eAdult MH Update Outcome ToolDelete