Forms & Publications :: SD Dept. of Social Services

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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Copies	Edit the Number of Copies	Document Number	Document Name	Delete
1	Edit	BH-07	Mental Health - Accreditation Application	Delete
1	Edit	BRO/RE1	Stop Benefit Fraud Brochure	Delete
1	Edit	FACIS	Interstate Compact: Report on Child Placement	Delete
1	Edit	CPS	Placement Resource Monthly Reporting Form Ages 14 and older	Delete
1	Edit	CPS-566	Foster Parent Evaluation	Delete
1	Edit	Poster	Constituent Liaison Services Poster	Delete
1	Edit	Poster	CHIP Poster	Delete
1	Edit	CCS	Orientation Training Verification Form	Delete
1	Edit	BRO/EA8	Medicaid Spousal Care Handbook	Delete
1	Edit	BRO/DCS8	Child Support Parent Handbook	Delete
1	Edit	Rec and Fraud	Report Benefit Fraud	Delete
1	Edit	CCS	Electronic Payment Exemptions	Delete
1	Edit	EA-320	Self-Employment Ledger	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	EA-319	Request for Administrative Hearing	Delete
1	Edit	BH-02	Financial Eligibility Form	Delete
1	Edit	DSS-CPS	Safe Havens Poster	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	BRO/CPS2	Common Sense Parenting Brochure	Delete
1	Edit	BRO/EA4	TANF Work Program Brochure	Delete
1	Edit	OS-954	Client Authorized Debit for Repayment of Overissuance	Delete
1	Edit	BH-04	102b Hardship Considerations	Delete
1	Edit	DSS	Psychiatric Residential Treatment Facility Referral Form	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	SE-415	Petition for Modification Form	Delete
1	Edit	FACIS	Interstate Compact: Placement Request Form	Delete
1	Edit	SE-406	Application for Location Only Services	Delete
1	Edit	BRO/EA11	Weatherization Assistance Brochure	Delete
1	Edit	PA	Prior Authorization Forms: Durable Medical Equipment and Nutrition	Delete
1	Edit	CPS	Background Information for Voluntary Termination of Parental Rights	Delete
1	Edit	EA-307	SNAP Exit Form	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	PA	Prior Authorization Forms: Private Duty Nursing & Extended Home Health Services	Delete
1	Edit	DSS-W9	W-9 Form	Delete
1	Edit	BRO/CCS3	Registration & Licensure of Child Care Environments	Delete
1	Edit	CPS-549	Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)	Delete
1	Edit	EA-297	Energy Assistance Application	Delete
1	Edit	EA-269	Child Care Expense Billing Information	Delete
1	Edit	BH-08	Mental Health - IMPACT Application	Delete
1	Edit	BH-11b	Adult SUD Update Outcome Tool	Delete
1	Edit	DSS-ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	EA-301	SNAP Application	Delete
1	Edit		Recipient Forms: HIPAA Privacy Consent Form	Delete
1	Edit	BRO/MS3	Well-Child Care Brochure	Delete
1	Edit	BRO/CPS3	Safe Havens Brochure	Delete
1	Edit	BRO/DSS9	DSS Handbook	Delete
1	Edit	BRO/EA10	SNAP for Students	Delete
1	Edit	BRO/DCS1	Child Support Modification Handbook	Delete
1	Edit	MS-102	Provider Selection Form	Delete
1	Edit	EA-214	SNAP 6 Month Report Form	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA-260	Statement of Earnings	Delete
1	Edit	EA-269	Child Care Expense Billing Information	Delete
1	Edit	BH-03	102a Hardship Considerations	Delete
1	Edit	BRO/DCS3	Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Income	Delete
1	Edit	MS-146	Sterilization Consent Form	Delete
1	Edit	BRO/EA1	Energy Saving Tips	Delete
1	Edit	BRO/MS1	Medical Assistance Program Recipient Handbook	Delete
1	Edit	BRO/MS4	Title XIX Medical Transportation Brochure	Delete
1	Edit	CCS	Pathways to Professional Development - Renewal Application	Delete
1	Edit	FSSA	Children and Family Medical Assistance Application	Delete
1	Edit	BH-05	Hardship Considerations Refusal	Delete
1	Edit	CPS	Designated Tribal Agent Request for Change of Address	Delete
1	Edit	DSS	Guide to Administrative Hearings Procedure	Delete
1	Edit	EA-307G	SNAP Group Home Exit Form	Delete
1	Edit	SE408NCP	Application and Agreement for Services - Non-Custodial Parent	Delete
1	Edit	MISC/BH1	South Dakota Community Mental Health Center Flyer	Delete
1	Edit	BRO/VS1	Sexual Assault Brochure	Delete
1	Edit	BRO/EA1	Energy Saving Tips	Delete
1	Edit	CPS-566	Foster Parent Evaluation	Delete
1	Edit	CPS	Placement Resource Monthly Reporting Form Ages 5-13	Delete
1	Edit	Rec and Fraud	Estate Recovery Program Petition for Limitation	Delete
1	Edit	EA-345A	Affidavit for SNAP Work Registrants (Employment & Training)	Delete
1	Edit	BH-18	Substance Use Disorder High Intensity Referral Form	Delete
1	Edit	BRO/EA2	SNAP Brochure	Delete
1	Edit	BRO/CPS7	Independent Living Program Education and Training Voucher Brochure	Delete
1	Edit	MS-103	Provider Change Form	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	BH-07	Mental Health - Accreditation Application	Delete
1	Edit	BRO/DSS8	Notice of Privacy Brochure	Delete
1	Edit	EA-260	Statement of Earnings	Delete
1	Edit	EA-269	Child Care Expense Billing Information	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	BRO/DSS2	Constituent Liaison Services Brochure	Delete
1	Edit	EA-301MA	Children and Family Medical Assistance Supplemental Application	Delete
1	Edit	BRO/EA12	Energy Assistance Brochure	Delete
1	Edit	BRO/RE3	Estate Recovery Program Brochure	Delete
1	Edit	EA-270	Medical Savings Program Application	Delete
1	Edit	Poster	CHIP Poster	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	Poster	CHIP Poster	Delete
1	Edit	CPS	Foster Parent Handbook	Delete
1	Edit	EA-345	Affidavit for SNAP Work Registrants	Delete
1	Edit	BH-11	Behavioral Health Treatment Outcomes Program Manual	Delete
1	Edit	BRO/DCS4	National Medical Support Notice Brochure - An Employers Guide	Delete
1	Edit	MS	Providers: NEMT Provider Agreement	Delete
1	Edit	EA-345A	Affidavit for SNAP Work Registrants (Employment & Training)	Delete
1	Edit	CPS	Designated Tribal Agent Request for Change of Address	Delete
1	Edit	EA-305	Boarding School-Institution Documentation	Delete
1	Edit	MS	Hysterectomy Acknowledgement of Information	Delete
1	Edit	Rec and Fraud	Estate Recovery Program Petition for Limitation	Delete
1	Edit	BRO/DSS4	Direct Deposit Brochure	Delete
1	Edit	BRO/RE4	Medicaid Liens Brochure	Delete
1	Edit	BRO/EA9	SNAP Shoppers Guide	Delete
1	Edit	BRO/CPS7	Independent Living Program Education and Training Voucher Brochure	Delete
1	Edit	BRO/MS6	Health Home Brochure	Delete
1	Edit	BRO/MS4	Title XIX Medical Transportation Brochure	Delete
1	Edit	BRO/MS1	Medical Assistance Program Recipient Handbook	Delete
1	Edit	CPS	Placement Resource Monthly Reporting Form Ages 5-13	Delete
1	Edit	BRO/DSS6	Filing a Discrimination Complaint Brochure and Form	Delete
1	Edit	BH-11d	Adult MH Initial Outcome Tool	Delete
1	Edit	BRO/EBT1	EBT Client Handbook	Delete