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
1EditBH-063rd Party Release of Information (ROI)Delete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditOS-950Recipient Forms: Title XIX Medical Transportation ReimbursementDelete
1EditMSTitle XIX Non-Emergency Transportation Payment Authorization FormDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditCPSPotential Placement StatementDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditCPSProvider Mileage RequestDelete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditBRO/DCS2Teenage Parents Guide - How to Establish Paternity and Financial Support for your ChildDelete
1EditBRO/DCS6Voluntary Paternity Establishment Handbook and FormDelete
1EditEA-269Recipient Forms: Child Care Expense Billing InformationDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditEA-310Form for Reporting ChangesDelete
1EditEA-345Affidavit for SNAP Work RegistrantsDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditCPSFoster Parent HandbookDelete
1EditPOS/EA02Long-Term Care Partnership Fact SheetDelete
1EditCPS-522Request for PaymentDelete
1EditBRO/CPS15Family Group Conferencing – My Family Meeting Delete
1EditBH-01Federal Poverty Level GuidelinesDelete
1EditBRO/VS1Sexual Assault BrochureDelete
1EditCPS-565Foster Parent Training & Self-InstructionDelete
1EditBRO/EA2SNAP BrochureDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditBRO/CPS7Independent Living Program Education and Training Voucher BrochureDelete
1EditBRO/EA3CHIP BrochureDelete
1EditBRO/CCS14Choosing Child Care HandbookDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditPAPrior Authorization Forms: Out-of State Services Delete
1EditBH-19Substance Use Disorder High Intensity Referral FormDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditRec and FraudCasualty Settlement Report FormDelete
1EditMSProfessional Services Billing ManualDelete
1EditBRO/CPS17Family Group Conferencing – Parents Guide Delete
1EditEA-324Wage VerificationDelete
1EditMSProviders: NEMT Provider AgreementDelete
1EditRec and FraudStop Benefit Fraud InsertDelete
1EditEA-301Economic Assistance ApplicationDelete
1EditBH-11dAdult MH Initial Outcome ToolDelete
1EditBRO/DSS2Constituent Liaison Services BrochureDelete
1EditBRO/EA12Energy Assistance BrochureDelete
1EditCCSSouth Dakota Child Safety Seat Distribution ProgramDelete
1EditBRO/EA18Long-Term Care Partnership BrochureDelete
1EditPosterReportable Disease List PosterDelete
1EditBRO/RE3Estate Recovery Program BrochureDelete
1EditPAPrior Authorization Forms: BRCADelete
1EditPAPrior Authorization Forms: GeneralDelete
1EditPosterCHIP PosterDelete
1EditDSS-CCSRate Declaration FormDelete
1EditDSSRecipient Forms: Psychiatric Residential Treatment Facility Referral FormDelete
1EditBRO/DSS4Direct Deposit BrochureDelete