Lynne A. Valenti
Cabinet Secretary

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Forms and Publications

The Department of Social Services has free forms and publications that can provide you with information and guidance in a number of important areas.

This page can help you find the information you need in the following ways:

  Order Online Some forms are available to fill out and submit online. The remaining online forms can be filled out on your computer, printed and mailed.
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  Add to Cart There’s a simple “Shopping Cart” that allows you to place an order for free forms and publications. These documents will then be mailed to you at no cost.
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If you would like to order any form or publication in Spanish, please click on Documentos en Español. You will find both forms and publication in Spanish in this section. The shopping cart will automatically default to the Spanish version of the form or publication.

Note: Some documents are PDF files and require Adobe Acrobat to open them. If you don’t have Adobe Acrobat, click here to download the latest version.


Forms and Publications Filter:

Document Type: Forms Only | Publications Only | Documentos en Español | All

Service Area:

Abuse and Neglect

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
CPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)n/aonline versionn/aenglish versionadd to cart
CPS-593Permission to Screen for Reports of Abuse or Neglectn/aonline versionspanish versionenglish versionadd to cart

Administrative Hearings

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
EA-319Request for Administrative Hearingn/an/an/aenglish versionadd to cart

Adoption and Foster Care

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
CPSBackground Information for Voluntary Termination of Parental Rightsn/an/an/aenglish versionadd to cart
CPS-506Foster/Adoptive Parent Health Reportn/an/an/aenglish versionadd to cart
CPS-508Reference Form - Adoption / Foster / Kinship Caren/aonline versionn/aenglish versionadd to cart
CPS-533Adoption Registry Forminstructionsonline versionn/aenglish versionadd to cart
CPS-565Foster Parent Training & Self-Instructionn/aonline versionspanish versionenglish versionadd to cart
CPS-566Foster Parent Evaluationn/aonline versionspanish versionenglish versionadd to cart
CPS-594Declaration of Prior Criminal Conviction & Military Historyn/aonline versionn/aenglish versionadd to cart

Behavioral Health

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BH-01Federal Poverty Level Guidelinesn/aonline versionn/aenglish versionadd to cart
BH-02Financial Eligibility Formn/aonline versionn/aenglish versionadd to cart
BH-03102a Hardship Considerations n/aonline versionn/aenglish versionadd to cart
BH-04102b Hardship Considerationsn/aonline versionn/aenglish versionadd to cart
BH-05Hardship Considerations Refusaln/aonline versionn/aenglish versionadd to cart
BH-063rd Party Release of Information (ROI)n/aonline versionn/aenglish versionadd to cart
BH-07Mental Health - Accreditation Applicationn/aonline versionn/aenglish versionadd to cart
BH-08Mental Health - IMPACT Applicationn/aonline versionn/aenglish versionadd to cart
BH-09Mental Health - Indigent Medication Applicationn/aonline versionn/aenglish versionadd to cart
BH-11Mental Health - Adult Outcome Toolinstructionsn/an/aenglish versionadd to cart
BH-11aAdult SUD Initial Outcome Tooln/an/an/aenglish versionadd to cart
BH-11bAdult SUD Update Outcome Tooln/an/an/aenglish versionadd to cart
BH-11cAdult SUD Discharge Outcome Tool n/an/an/aenglish versionadd to cart
BH-11dAdult MH Initial Outcome Tooln/an/an/aenglish versionadd to cart
BH-11eAdult MH Update Outcome Tooln/an/an/aenglish versionadd to cart
BH-11fAdult MH Discharge Outcome Tooln/an/an/aenglish versionadd to cart
BH-12Mental Health - Youth Outcome Toolinstructionsonline versionn/aenglish versionadd to cart
BH-13Mental Health - Family Outcome Toolinstructionsn/an/aenglish versionadd to cart
BH-14Substance Abuse - Accreditation Applicationn/aonline versionn/aenglish versionadd to cart
BH-17Prevention - Accreditation Applicationn/aonline versionn/aenglish versionadd to cart
BH-18Mental Health - Indigent Medication Update - Extension Form 1.0n/aonline versionn/aenglish versionadd to cart
BH-19Substance Use Disorder High Intensity Referral Formn/aonline versionn/aenglish versionadd to cart

Child Care Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
CCSOrientation Training Verification Formn/an/an/aenglish versionadd to cart
CCSElectronic Payment Exemptionsn/an/an/aenglish versionadd to cart
CCSPayment Authorization Formn/an/an/aenglish versionadd to cart
CCSFoster Care Child Care Applicationn/aonline versionn/an/an/a
CCSPathways to Professional Developmentn/an/an/aenglish versionadd to cart
CCSPathways to Professional Development - Career Lattice Application Formn/an/an/aenglish versionadd to cart
CCS-950Child Care Assistance Applicationn/aonline versionn/aenglish versionadd to cart
CCS-964Child Care Declaration of Prior Criminal Conviction and Military Historyn/an/an/aenglish versionadd to cart
CCS-970Child Care Services Request For Paymentn/an/an/aenglish versionadd to cart
DSS-CCSRate Declaration Formn/an/an/aenglish versionadd to cart
EA-269Child Care Expense Billing Informationn/an/an/aenglish versionadd to cart

Child Protection Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
CPSProvider Mileage Requestn/an/an/aenglish versionadd to cart
CPSIndependent Living Program Education and Training Voucher instructionsn/an/aenglish versionadd to cart
CPSBackground Information for Voluntary Termination of Parental Rightsn/an/an/aenglish versionadd to cart
CPSICPC Financial and Medical Plann/an/an/aenglish versionadd to cart
CPSPotential Placement Statementn/an/an/aenglish versionadd to cart
CPSPlacement Resource Monthly Reporting Form Ages 0-4n/an/an/aenglish versionadd to cart
CPSPlacement Resource Monthly Reporting Form Ages 14 and oldern/an/an/aenglish versionadd to cart
CPSPlacement Resource Monthly Reporting Form Ages 5-13n/an/an/aenglish versionadd to cart
CPSDesignated Tribal Agent Request Formn/an/an/aenglish versionadd to cart
CPSDesignated Tribal Agent Request for Change of Addressn/an/an/aenglish versionadd to cart
CPS-500Newborn Medical Report for Voluntary Termination of Parental Rightsn/aonline versionn/aenglish versionadd to cart
CPS-522Request for Paymentn/aonline versionn/aenglish versionadd to cart
FACISInterstate Compact: Placement Request Forminstructionsonline versionn/aenglish versionadd to cart
FACISInterstate Compact: Report on Child Placementinstructionsonline versionn/aenglish versionadd to cart

Child Support

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
SE-405Application for Income Withholding Only Servicen/an/an/aenglish versionadd to cart
SE-406Application for Location Only Servicesn/an/an/aenglish versionadd to cart
SE408CPApplication and Agreement for Services - Custodial Parent and/or Caretakern/an/an/aenglish versionadd to cart
SE408NCPApplication and Agreement for Services - Non-Custodial Parent n/an/an/aenglish versionadd to cart
SE-415Petition for Modification Formn/an/an/aenglish versionadd to cart
SE-431AChild Support Payment Authorization Formn/an/an/aenglish versionadd to cart
SE-492Notice of Shared Medical Expensesn/an/an/aenglish versionadd to cart

General

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
EAWeatherization Applicationn/an/aspanish versionenglish versionadd to cart
EA-297Energy Assistance Applicationinstructionsonline versionspanish versionenglish versionadd to cart
EA-301MAChildren and Family Medical Assistance Supplemental Application n/an/aspanish versionenglish versionadd to cart
ENERGYVendor Information: Direct Depositinstructionsonline versionn/aenglish versionadd to cart
ENERGY-927Vendor Information: Vendor Claim Forminstructionsonline versionn/an/an/a

General Social Service Documents

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRO/EA1Energy Saving Tipsn/an/an/aenglish versionadd to cart
DSS-W9W-9 Formn/an/an/aenglish versionadd to cart
EA-301Economic Assistance Applicationn/aonline versionspanish versionenglish versionadd to cart
EA-310Form for Reporting Changesn/an/aspanish versionenglish versionadd to cart

Medical Eligiblity

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
EA-208Authorization to Furnish / Release Informationn/an/aspanish versionenglish versionadd to cart
EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistancen/an/an/aenglish versionadd to cart
EA-265Request for Long-Term Care or Home Community Based Services Waiver Assistancen/an/an/aenglish versionadd to cart
EA-270Medical Savings Program Applicationn/an/aspanish versionenglish versionadd to cart
EA-320Self-Employment Ledgern/an/aspanish versionenglish versionadd to cart
FSSAChildren and Family Medical Assistance Applicationn/an/an/aenglish versionadd to cart

Medical Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
Recipient Forms: HIPAA Privacy Consent Formn/aonline versionn/aenglish versionadd to cart
DSSRecipient Forms: Psychiatric Residential Treatment Facility Referral Formn/an/an/aenglish versionadd to cart
EA-231Child Support Enforcement Referraln/an/an/aenglish versionadd to cart
EA-249Disabled Children Application / Eligibility Reviewinstructionsn/an/aenglish versionadd to cart
EA-269Recipient Forms: Child Care Expense Billing Informationn/an/an/aenglish versionadd to cart
EA-270Medical Savings Program Applicationn/an/aspanish versionenglish versionadd to cart
MSProviders: NEMT Provider Agreementinstructionsonline versionn/aenglish versionadd to cart
MSMedicaid Transportation Documentation Formn/an/an/aenglish versionadd to cart
MSHysterectomy Acknowledgement of Informationn/an/an/aenglish versionadd to cart
MSTitle XIX Non-Emergency Transportation Payment Authorization Formn/an/an/aenglish versionadd to cart
MSCertificate of Medical Necessityn/an/an/aenglish versionadd to cart
MSProviders: Adult Services & Aging Provider Agreementinstructionsn/an/aenglish versionadd to cart
MSSelf-Audit Worksheetn/aonline versionn/an/an/a
MSProfessional Services Billing Manualn/an/an/aenglish versionadd to cart
MSInstitutional Billing Manualn/an/an/aenglish versionadd to cart
MSPharmacy Billing Manualn/an/an/aenglish versionadd to cart
MSDental Provider Manualn/an/an/aenglish versionadd to cart
MS-102Provider Selection Formn/aonline versionn/aenglish versionadd to cart
MS-103Provider Change Formn/aonline versionn/aenglish versionadd to cart
MS-146Sterilization Consent Formn/an/an/aenglish versionadd to cart
OS-950Recipient Forms: Title XIX Medical Transportation Reimbursementn/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: Private Duty Nursing & Extended Home Health Servicesn/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: Out-of State Services n/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: Genetic Testing n/an/an/aenglish versionadd to cart
PAPrior Authorization Manualn/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: BRCAn/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: Synagisn/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: Applied Behavior Analysis Therapyn/an/an/aenglish versionadd to cart
PAPrior Authorization Forms: Durable Medical Equipment and Nutritioninstructionsn/an/aenglish versionadd to cart
PAPrior Authorization Forms: Generalinstructionsn/an/aenglish versionadd to cart

Parent Education

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
CPSCommon Sense Parenting Program Vouchern/aonline versionn/an/an/a
CPSCommon Sense Parenting Annual Report Formn/aonline versionn/an/an/a

Psychiatric Residential Treatment

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
DSSPsychiatric Residential Treatment Facility Referral Formn/an/an/aenglish versionadd to cart

Recoveries and Fraud

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
DSS-ORFI-831Estate Recovery Notification of Death Formn/an/an/aenglish versionadd to cart
Rec and FraudEstate Recovery Program Petition for Limitationn/aonline versionn/aenglish versionadd to cart
Rec and FraudReport Benefit Fraudn/aonline versionn/aenglish versionadd to cart
Rec and FraudCasualty Settlement Report Formn/aonline versionn/aenglish versionadd to cart

SNAP (Food Stamps)

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
EA-208Authorization to Furnish / Release Informationn/an/aspanish versionenglish versionadd to cart
EA-214SNAP 6 Month Report Formn/an/aspanish versionenglish versionadd to cart
EA-269Child Care Expense Billing Informationn/an/an/aenglish versionadd to cart
EA-301SNAP Applicationn/aonline versionspanish versionenglish versionadd to cart
EA-305Boarding School-Institution Documentationn/an/an/aenglish versionadd to cart
EA-307SNAP Exit Formn/an/an/aenglish versionadd to cart
EA-307GSNAP Group Home Exit Formn/an/an/aenglish versionadd to cart
EA-320Self-Employment Ledgern/an/aspanish versionenglish versionadd to cart
EA-324Wage Verificationn/an/an/aenglish versionadd to cart
EA-345Affidavit for SNAP Work Registrantsn/an/an/aenglish versionadd to cart
EA-345AAffidavit for SNAP Work Registrants (Employment & Training)n/an/an/aenglish versionadd to cart
EA-347Application for Social Security Numbern/aonline versionn/aenglish versionadd to cart
OS-954Client Authorized Debit for Repayment of Overissuancen/an/an/aenglish versionadd to cart

Temporary Assistance for Needy Families

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
EA-208Authorization to Furnish / Release Informationn/an/aspanish versionenglish versionadd to cart
EA-214TANF 6 Month Report Formn/an/aspanish versionenglish versionadd to cart
EA-231Child Support Enforcement Referraln/an/an/aenglish versionadd to cart
EA-260Statement of Earningsn/aonline versionn/aenglish versionadd to cart
EA-320Self-Employment Ledgern/aonline versionspanish versionenglish versionadd to cart