Forms & Publications :: SD Dept. of Social Services

M. Greg DeSautel, MD
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	BRO/RE1	Stop Benefit Fraud Brochure	Delete
1	Edit	SE408NCP	Application and Agreement for Services - Non-Custodial Parent	Delete
1	Edit	BRO/CPS17	Family Group Conferencing – Parents Guide	Delete
1	Edit	FACIS	Interstate Compact: Report on Child Placement	Delete
1	Edit	BRO/CPS4	Mandatory Reporting of Child Abuse & Neglect Brochure	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	BRO/EA16	Medical Assistance for Children and Families: IHS Specific	Delete
1	Edit	BRO/CPS1	Child Protection Services Booklet	Delete
1	Edit	Poster	CHIP Poster	Delete
1	Edit	BRO/EA2	SNAP Brochure	Delete
1	Edit	BRO/CPS7	Independent Living Program Education and Training Voucher Brochure	Delete
1	Edit	BRO/EA8	Medicaid Spousal Care Handbook	Delete
1	Edit	BH-17	Prevention - Accreditation Application	Delete
1	Edit	BRO/DCS8	Child Support Parent Handbook	Delete
1	Edit	Rec and Fraud	Report Benefit Fraud	Delete
1	Edit	MS-103	Provider Change Form	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	BRO/DSS8	Notice of Privacy Brochure	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	BRO/DSS2	Constituent Liaison Services Brochure	Delete
1	Edit	BH-02	Financial Eligibility Form	Delete
1	Edit	DSS-CPS	Safe Havens Poster	Delete
1	Edit	BRO/EA12	Energy Assistance Brochure	Delete
1	Edit	BRO/RE3	Estate Recovery Program Brochure	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	EA-270	Medical Savings Program Application	Delete
1	Edit	BRO/RE4	Medicaid Liens Brochure	Delete
1	Edit	EA-265	Request for Long-Term Care or Home Community Based Services Waiver Assistance	Delete
1	Edit	Poster	CHIP Poster	Delete
1	Edit	BRO/DCS4	National Medical Support Notice Brochure - An Employers Guide	Delete
1	Edit	Poster	Reportable Disease List Poster	Delete
1	Edit	BRO/DSS3	Administrative Hearings Brochure	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	FACIS	Interstate Compact: Placement Request Form	Delete
1	Edit	BRO/EA	Community Action Agency Handout	Delete
1	Edit	MS	Providers: NEMT Provider Agreement	Delete
1	Edit	BRO/EA11	Weatherization Assistance Brochure	Delete
1	Edit	CPS	Background Information for Voluntary Termination of Parental Rights	Delete
1	Edit	EA-345A	Affidavit for SNAP Work Registrants (Employment & Training)	Delete
1	Edit	BRO/DCS6	Voluntary Paternity Establishment Handbook and Form	Delete
1	Edit	BRO/CCS3	Registration & Licensure of Child Care Environments	Delete
1	Edit	BRO/EA14	Medical Assistance for Children and Families	Delete
1	Edit	EA-301MA	Children and Family Medical Assistance Supplemental Application	Delete
1	Edit	BH-14	Substance Abuse - Accreditation Application	Delete
1	Edit	CPS-522	Request for Payment	Delete
1	Edit	MS	Hysterectomy Acknowledgement of Information	Delete
1	Edit	Rec and Fraud	Estate Recovery Program Petition for Limitation	Delete
1	Edit	BH-08	Mental Health - IMPACT Application	Delete
1	Edit	BRO/EA18	Long-Term Care Partnership Brochure	Delete
1	Edit	BRO/EA9	SNAP Shoppers Guide	Delete
1	Edit	CPS	Designated Tribal Agent Request Form	Delete
1	Edit	BRO/MS1	Medical Assistance Program Recipient Handbook	Delete
1	Edit	BRO/MS3	Well-Child Care Brochure	Delete
1	Edit	BRO/CPS18	Family Group Conferencing – Provider Guide	Delete
1	Edit	CPS	Placement Resource Monthly Reporting Form Ages 5-13	Delete
1	Edit	BRO/CPS3	Safe Havens Brochure	Delete
1	Edit	BH-11d	Adult MH Initial Outcome Tool	Delete
1	Edit	BRO/EBT1	EBT Client Handbook	Delete