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
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditCPS-533Adoption Registry FormDelete
1EditEA-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditBRO/EA14Medical Assistance for Children and FamiliesDelete
1EditBRO/EA1Energy Saving TipsDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBRO/DSS6Filing a Discrimination Complaint Brochure and FormDelete
1EditBH-11eAdult MH Update Outcome ToolDelete
1EditEA-320Self-Employment LedgerDelete
1EditMS-102Provider Selection FormDelete
1EditBH-02Financial Eligibility FormDelete
1EditEA-305Boarding School-Institution DocumentationDelete
1EditDSS-ORFI-831Estate Recovery Notification of Death FormDelete
1EditBRO/CPS2Common Sense Parenting BrochureDelete
1EditEA-307SNAP Exit FormDelete
1EditBRO/MS4Title XIX Medical Transportation BrochureDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditBH-03102a Hardship Considerations Delete
1EditCPSICPC Financial and Medical PlanDelete
1EditBRO/CCS3Registration & Licensure of Child Care EnvironmentsDelete
1EditCPSIndependent Living Program Education and Training Voucher Delete
1EditPAPrior Authorization Forms: Private Duty Nursing & Extended Home Health ServicesDelete
1EditBRO/CPS9Adoption Subsidy HandbookDelete
1EditPAPrior Authorization ManualDelete
1EditBRO/VS2Domestic Violence BrochureDelete
1EditBH-12Mental Health - Youth Outcome ToolDelete
1EditBRO/EA11Weatherization Assistance BrochureDelete
1Edit Recipient Forms: HIPAA Privacy Consent FormDelete
1EditDSSPsychiatric Residential Treatment Facility Referral FormDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditBRO/CPS16Family Group Conferencing – Family Group Decision Making Delete
1EditBRO/MS3Well-Child Care BrochureDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditEA-307GSNAP Group Home Exit FormDelete
1EditBRO/EA4TANF Work Program BrochureDelete
1EditCPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)Delete
1EditBH-11cAdult SUD Discharge Outcome Tool Delete
1EditEA-301SNAP ApplicationDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditMSProviders: Adult Services & Aging Provider AgreementDelete
1EditCCSPathways to Professional DevelopmentDelete
1EditBH-11Mental Health - Adult Outcome ToolDelete
1EditDSS-W9W-9 FormDelete
1EditBRO/DSS9DSS HandbookDelete
1EditBH-17Prevention - Accreditation ApplicationDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditEA-260Statement of EarningsDelete
1EditCPS-566Foster Parent EvaluationDelete
1EditPAPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditSE-415Petition for Modification FormDelete
1EditCPS-500Newborn Medical Report for Voluntary Termination of Parental RightsDelete
1EditCCS-970Child Care Services Request For PaymentDelete
1EditFACISInterstate Compact: Placement Request FormDelete