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
1EditEA-320Self-Employment LedgerDelete
1EditSE-406Application for Location Only ServicesDelete
1EditBRO/CCS6Child Care Assistance Program BrochureDelete
1EditVS-695Crime Victims Compensation Secondary ApplicationDelete
1EditCPS-506Foster/Adoptive Parent Health ReportDelete
1EditMSTransportation Exceptions FormDelete
1EditEA-297Energy Assistance ApplicationDelete
1EditBH-063rd Party Release of Information (ROI)Delete
1EditEA-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditEA-240Application for Resource Assessment, Long Term Care or Related Medical AssistanceDelete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditEA-307SNAP Exit FormDelete
1EditBRO/BH2Mental Health Services BrochureDelete
1EditEA-324Wage VerificationDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditBRO/VS3Crime Victims Compensation Program BrochureDelete
1EditBRO/CPS16Family Group Conferencing – Family Group Decision Making Delete
1EditEA-320Self-Employment LedgerDelete
1EditPAPrior Authorization Forms: GeneralDelete
1EditBH-09Indigent Medication ApplicationDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditRec and FraudStop Benefit Fraud InsertDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditOS-950Recipient Forms: Title XIX Medical Transportation ReimbursementDelete
1EditEA-301SNAP ApplicationDelete
1EditMSMedicaid Transportation Documentation FormDelete
1EditMSProviders: Adult Services & Aging Provider AgreementDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditEA-301Economic Assistance ApplicationDelete
1EditVS-694Crime Victims Compensation Primary ApplicationDelete
1EditBRO/CCS3Registration & Licensure of Child Care EnvironmentsDelete
1EditBRO/RE3Estate Recovery Program BrochureDelete
1EditBRO/EA16Medical Assistance for Children and Families: IHS SpecificDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditPAPrior Authorization Forms: Private Duty Nursing & Extended Home Health ServicesDelete
1EditVS-695Crime Victims Compensation Secondary ApplicationDelete
1EditPAPrior Authorization Forms: Genetic Testing Delete
1EditVS-694Crime Victims Compensation Primary ApplicationDelete
1EditMSTitle XIX Non-Emergency Transportation Payment Authorization FormDelete
1EditBRO/CPS18Family Group Conferencing – Provider Guide Delete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditBRO/EA3CHIP BrochureDelete
1EditBRO/CPS4Mandatory Reporting of Child Abuse & Neglect BrochureDelete
1EditBRO/DCS8Child Support Parent HandbookDelete
1EditBH-05Hardship Considerations RefusalDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditEA-310Form for Reporting ChangesDelete
1EditCPSICPC Financial and Medical PlanDelete
1EditPosterReportable Disease List PosterDelete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditBRO/DSS3Administrative Hearings BrochureDelete
1EditEA-231Child Support Enforcement ReferralDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditBRO/EA11Weatherization Assistance BrochureDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditBH-11fAdult MH Discharge Outcome ToolDelete
1EditCPS-565Foster Parent Training & Self-InstructionDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditEA-214SNAP 6 Month Report FormDelete
1EditPAPrior Authorization Forms: BRCADelete
1EditEA-320Self-Employment LedgerDelete
1EditBRO/MS6Health Home BrochureDelete