Forms & Publications :: SD Dept. of Social Services

Laurie Gill
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	BH-07	Mental Health - Accreditation Application	Delete
1	Edit	SE408NCP	Application and Agreement for Services - Non-Custodial Parent	Delete
1	Edit	BH-11a	Adult SUD Initial Outcome Tool	Delete
1	Edit	OS-950	Recipient Forms: Medicaid Non-Emergency Medical Travel Form	Delete
1	Edit	EA-324	Wage Verification	Delete
1	Edit	CCS	Pathways to Professional Development - Career Lattice Application Form	Delete
1	Edit	MISC/BH1	South Dakota Community Mental Health Center Flyer	Delete
1	Edit	CPS-508	Reference Form - Adoption / Foster / Kinship Care	Delete
1	Edit	SE408CP	Application and Agreement for Services - Custodial Parent and/or Caretaker	Delete
1	Edit	FACIS	Interstate Compact: Report on Child Placement	Delete
1	Edit	EA-214	TANF 6 Month Report Form	Delete
1	Edit	CPS	Placement Resource Monthly Reporting Form Ages 14 and older	Delete
1	Edit	CPS-566	Foster Parent Evaluation	Delete
1	Edit	BH-13a	Family SUD Initial Outcome Tool	Delete
1	Edit	BH-11c	Adult SUD Discharge Outcome Tool	Delete
1	Edit	BH-17	Prevention - Accreditation Application	Delete
1	Edit	Rec and Fraud	Report Benefit Fraud	Delete
1	Edit	CCS	Electronic Payment Exemptions	Delete
1	Edit	BH-12a	Youth SUD Initial Outcome Tool	Delete
1	Edit	MS-103	Provider Change Form	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	BH-13c	Family SUD Discharge Outcome Tool	Delete
1	Edit	BH-11e	Adult MH Update Outcome Tool	Delete
1	Edit	CPS-500	Newborn Medical Report for Voluntary Termination of Parental Rights	Delete
1	Edit	CPS-593	Permission to Screen for Reports of Abuse or Neglect	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	EA-319	Request for Administrative Hearing	Delete
1	Edit	BH-02	Financial Eligibility Form	Delete
1	Edit	CCS-964	Child Care Declaration of Prior Criminal Conviction and Military History	Delete
1	Edit	BH-12c	Youth SUD Discharge Outcome Tool	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA-270	Medical Savings Program Application	Delete
1	Edit	BH-13e	Family MH Update Outcome Tool	Delete
1	Edit	EA-265	Request for Long-Term Care or Home Community Based Services Waiver Assistance	Delete
1	Edit	CPS	Provider Mileage Request	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	MS	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	EA-347	Application for Social Security Number	Delete
1	Edit	SE-415	Petition for Modification Form	Delete
1	Edit	FACIS	Interstate Compact: Placement Request Form	Delete