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:

		Some forms are available to fill out and submit online. The remaining online forms can be filled out on your computer, printed and mailed.
		You can download any form or publication on this page by clicking on the download button.
		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.

If you would like to order any form or publication in English, please click on Forms Only, Publications Only or All. The shopping cart will automatically default to the English version of the form or publication.

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::	- View All - Abuse and NeglectAdministrative HearingsAdoption and Foster CareAssisted Living and Nursing HomesChild Care ServicesChild Protection ServicesChild SupportDomestic ViolenceEldery ServicesEnergy AssistanceGeneral Social Service DocumentsMedical AssistanceMedical EligibilityMedical ServicesNutritionParent EducationProvider Reimbursements and AuditsPsychiatric Residential TreatmentRecoveries and FraudSales Tax on Food Refund ProgramSNAP (Food Stamps)South Dakota EBTTemporary Assistance for Needy Families

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Abuse and Neglect

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/CPS8		Help Stop Child Abuse and Neglect Brochure	n/a
BRO/CPS4		Mandatory Reporting of Child Abuse and Neglect Brochure	n/a
CPS-593		Permission to Screen for Reports of Abuse or Neglect
CPS-549		Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)		n/a

Administrative Hearings

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/DSS3		Administrative Hearings Brochure	n/a	n/a
DSS		Guide to Administrative Hearings Procedure	n/a	n/a
EA-319		Request for Administrative Hearing	n/a	n/a

Adoption and Foster Care

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
CPS-533		Adoption Registry Form
BRO/CPS9		Adoption Subsidy Handbook	n/a	n/a
CPS		Background Information for Voluntary Termination of Parental Rights	n/a	n/a
CPS-594		Declaration of Prior Criminal Conviction & Military History
CPS-566		Foster Parent Evaluation
CPS-565		Foster Parent Training & Self-Instruction
CPS-506		Foster/Adoptive Parent Health Report	n/a	n/a
CPS-508		Reference Form - Adoption / Foster / Kinship Care
BRO/CPS6		They Need Someone on Their Side	n/a
BRO/CPS5		What I Should Know About Foster Care	n/a

Assisted Living and Nursing Homes

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/ASA8		Assisted Living Centers: Residents Bill of Rights Handbook	n/a	n/a
MISC/ASA6		Assisted Living in SD: A Consumers Guide	n/a	n/a
MISC/ASA8		Long-Term Care Facilities: Residents Bill of Rights Handbook	n/a	n/a
BRO/ASA7		Ombudsman Services Brochure	n/a	n/a

Child Care Services

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
CCS-950		Child Care Assistance Application		n/a
BRO/CCS-15		Child Care Assistance for Dislocated Workers	n/a	n/a
BRO/CCS6		Child Care Assistance Program Brochure	n/a
CCS-970		Child Care Services Request For Payment		n/a
BRO/CCS10		Child Development Associate Training Project	n/a	n/a
BRO/CCS14		Choosing Child Care Handbook	n/a	n/a
CCS		Foster Care Child Care Application		n/a	n/a	n/a
BRO/CCS1		Infant Toddler Training Program Brochure	n/a	n/a
CCS		Pathways to Professional Development - Career Lattice Form	n/a	n/a
Project 8		Project 8 Brochure	n/a
Poster		Project 8 Poster	n/a
Poster		Quality Child Care Poster	n/a	n/a
Poster		Recommendations for Exclusion from the Child Care Setting Poster	n/a	n/a
Poster		Reportable Disease List Poster	n/a	n/a
BRO/CCS3		Sudden Infant Death Syndrome Brochure	n/a	n/a
BRO/CCS13		Would You Trust Anyone to Care for Your Child	n/a	n/a

Child Protection Services

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
CPS		Background Information for Voluntary Termination of Parental Rights	n/a	n/a
BRO/CPS1		Child Protection Services Booklet	n/a
CPS		Designated Tribal Agent Request for Change of Address	n/a	n/a
CPS		Designated Tribal Agent Request Form	n/a	n/a
CPS		Independent Living Program Brochure	n/a	n/a
CPS		Independent Living Program: Education and Training Voucher	n/a	n/a
BRO/CPS7		Independent Living Program: Education and Training Voucher Brochure	n/a	n/a
CPS		Independent Living Program: Stat Data Sheet		n/a
FACIS		Interstate Compact: Placement Request Form		n/a
FACIS		Interstate Compact: Report on Child Placement		n/a
CPS-500		Newborn Medical Report for Voluntary Termination of Parental Rights		n/a
CPS		Placement Resource Monthly Reporting Form		n/a
CPS-522		Request for Payment		n/a
CPS		Residential Care Directory		n/a	n/a	n/a
BRO/CPS3		Safe Places in South Dakota Brochure	n/a

Child Support

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
SE408CP		Application and Agreement for Services - Custodial Parent and/or Relative Caretaker Application	n/a	n/a
SE408NCP		Application and Agreement for Services - Non-Custodial Parent Application	n/a	n/a
SE-406		Application for Location Only Services		n/a
SE-405		Application for Wage Withholding Only Services		n/a
BRO/DCS1		Child Support Modification Handbook	n/a	n/a
BRO/DCS8		Child Support Parent Handbook	n/a	n/a
BRO/DCS5		Electronic Payment of Child Support Brochure and Direct Deposit Form	n/a	n/a
BRO/DCS3		Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Income	n/a	n/a
BRO/DCS4		National Medical Support Notice Brochure - An Employers Guide	n/a	n/a
SE-492		Notice of Shared Medical Expenses	n/a	n/a
SE-415		Petition for Modification Form	n/a	n/a
BRO/DCS2		Teenage Parents Guide - How to Establish Paternity and Financial Support for your Child	n/a	n/a
BRO/DCS6		Voluntary Paternity Establishment Handbook and Form	n/a	n/a

Domestic Violence

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/ASA9		Domestic Violence Brochure	n/a	n/a
BRO/ASA4		Sexual Assault Brochure	n/a	n/a

Eldery Services

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/ASA2		Abuse, Neglect, Exploitation of Elder or Disabled Adults Brochure	n/a	n/a
BRO/ASA3		Adult Services and Aging Programs Handbook	n/a	n/a
ASA-677		Application Assistance Form for Medications		n/a	n/a	n/a
ASA		Caregiver Self Assessment	n/a	n/a
ASA-694		Crime Victims Compensation Application	n/a	n/a
BRO/ASA11		Crime Victims Compensation Brochure	n/a	n/a
ASA		Guide to Medicare, Medicare Supp Insurance and Beneficiary Resources	n/a	n/a
ASA-668		Homemaker Services Report	n/a	n/a
BRO/ASA5		Legal Services for the Elderly Brochure	n/a	n/a
ASA-625		Make a Referral		n/a
EA-240		Medical Assistance for Individuals in Adult Foster Care Facilities
ASA-659		Physician Report - Order		n/a
ASA-634		Provider Forms: Initial and Continuing Need for Care Report		n/a
ASA-643		Provider Forms: Nursing Facility Adult Day Care Agreement		n/a

Energy Assistance

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
ENERGY		Application for Energy Assistance	n/a
BRO/EA12		Energy Assistance for South Dakotans	n/a	n/a
ENERGY		Vendor Information: Direct Deposit		n/a
ENERGY-927		Vendor Information: Vendor Claim Form		n/a
		Weatherization Application	n/a	n/a
BRO/EA11		Weatherization Assistance Program	n/a	n/a

General Social Service Documents

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/DSS2		Constituent Liaison Services Brochure	n/a	n/a
Poster		Constituent Liaison Services Poster	n/a	n/a
BRO/DSS9		Department of Social Services Handbook	n/a	n/a
BRO/DSS1		DSS Employment Brochure	n/a	n/a
EA-301		Economic Assistance Application	n/a
BRO/DSS6		Filing a Discrimination Complaint	n/a	n/a
EA-310		Form for Reporting Changes	n/a	n/a
BRO/DSS8		Notice of Privacy Brochure	n/a	n/a
DSS-W9		W-9 Form	n/a	n/a

Medical Assistance

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
ASA-677		Application Assistance (Medication Assistance)		n/a
BRO/ASA10		RxAccess Brochure	n/a	n/a

Medical Eligibility

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
EA-240		Application for Long Term Care or Related Medical Assistance	n/a	n/a
Poster		CHIP Poster	n/a	n/a
Poster		CHIP Poster	n/a	n/a
BRO/EA3		CHIP: Brochure	n/a
EA-301M		CHIP: Medical Assistance Application	n/a
		CHIP: Medical Benefits for Children and Families	n/a	n/a
BRO/EA8		Medicaid Spousal Care Handbook	n/a	n/a
EA-208		Medical Assistance Authorization to Furnish / Release Information		n/a
EA-269		Medical Assistance Child Care Expense Billing Verification		n/a
EA-320		Medical Assistance Self-Employment Ledger	n/a	n/a
EA-270		Medical Savings Program Application	n/a
BRO/EA5		Medicare Savings Program Brochure	n/a	n/a
BRO/EA1		Parents By Choice Brochure	n/a	n/a

Medical Services

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
MS		Diabetes Management Education Program Provider Agreement		n/a
MS		Diabetes Management Education Program Provider Application	n/a	n/a
EA-249		Disabled Children Application / Eligibility Review	n/a	n/a
BRO/MS1		Medical Assistance Program Recipient Handbook	n/a
MS		Prior Authorization Forms: Durable Medical Equipment		n/a
MS		Prior Authorization Forms: Gen. Authorization Request Form		n/a
MS		Prior Authorization Forms: Hysterectomy	n/a	n/a
MS		Prior Authorization Forms: Neonatal Intensive Care Unit		n/a
MS		Prior Authorization Forms: Nutritional Therapy		n/a
MS		Prior Authorization Forms: Obesity and Gastric Procedures		n/a
MS		Prior Authorization Forms: Residential Treatment Facility Agreement		n/a
MS		Prior Authorization Forms: Residential Treatment Facility Application		n/a
MS-146		Prior Authorization Forms: Sterilization	n/a	n/a
MS-103		Provider Change Form
MS-102		Provider Selection Form
MS		Providers: Addendum to Provider Agreement to Part in SD PRIME Program	n/a	n/a
MS		Providers: Attestation Form	n/a	n/a
MS		Providers: Direct Deposit	n/a	n/a
MS		Providers: Electronic Media Provider Agreement	n/a	n/a
MS		Providers: In-State or Out-of-State Provider Agreement	n/a	n/a
MS		Providers: In-State Provider Enrollment Application	n/a	n/a
MS		Providers: Mental Health Services Addendum	n/a	n/a
MS		Providers: Out-of-State Provider Enrollment Application	n/a	n/a
MS		Providers: School District Addendum	n/a	n/a
MS		Providers: Synagis/Respigam Prior Authorization		n/a
MS		Providers: Trading Partner Agreement	n/a	n/a
MS		Providers: Wheelchair Transportation Addendum	n/a	n/a
EA-208		Recipient Forms: Authorization to Release Information		n/a
EA-269		Recipient Forms: Child Care Expense Billing Verification		n/a
EA-231		Recipient Forms: Child Support Enforcement Referral		n/a
EA-270		Recipient Forms: Medical Savings Program Application
EA-320		Recipient Forms: Self-Employment Ledger		n/a
OS-950		Recipient Forms: Title XIX Medical Transportation Reimbursement	n/a	n/a
OS-957		Recipient Forms: Title XIX Medical Transportation Reimbursement (Multiple Trips)	n/a	n/a
BRO/MS4		Title XIX Medical Transportation Brochure	n/a	n/a
BRO/MS3		Well-Child Care	n/a	n/a

Nutrition

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/ASA1		Nutrition Handout	n/a	n/a
Poster		Senior Meals Poster	n/a	n/a

Parent Education

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/CPS2		Common Sense Parenting Brochure	n/a
CPS		Common Sense Parenting Program Voucher		n/a	n/a	n/a
CPS		Common Sense Parenting Semi-Annual Report Form		n/a

Psychiatric Residential Treatment

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
DSS		Psychiatric Residential Treatment Facility Referral Form		n/a

Recoveries and Fraud

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
Rec and Fraud		Casualty Settlement Report Form		n/a
DSS-ORFI-831		Estate Recovery Notification of Death Form	n/a	n/a
BRO/RE3		Estate Recovery Program Brochure	n/a	n/a
Rec and Fraud		Estate Recovery Program Petition for Limitation		n/a
Rec and Fraud		Report Benefit Fraud		n/a
BRO/RE1		Stop Benefit Fraud Brochure	n/a

Sales Tax on Food Refund Program

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
EA-380		Sales Tax on Food Refund Application		n/a
BRO/EA7		Sales Tax on Food Refund Brochure	n/a
BRO/EA6		Sales Tax on Food Refund Card Brochure	n/a	n/a
Poster		Sales Tax on Food Refund Program Poster	n/a	n/a
Poster		Sales Tax on Food Refund Program Poster with Applicaiton Pad	n/a	n/a

SNAP (Food Stamps)

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
EA-214		6 Month Report Form	n/a	n/a
EA-345		Affidavit for Food Stamp Work Registrants	n/a	n/a
EA-347		Application for Social Security Number		n/a
EA-208		Authorization for Information	n/a	n/a
EA-305		Boarding School-Institution Documentation	n/a	n/a
EA-269		Child Care Expense Billing Information	n/a	n/a
OS-954		Client Authorized Debit for Repayment of Overissuance	n/a	n/a
EA-307		Exit Form	n/a	n/a
		Federal Brochure: Food Stamps Make America Stronger	n/a
EA-301		Food Stamp Application	n/a
EA-307G		Food Stamp Group Home Exit Form	n/a	n/a
EA-318		Income Calendar	n/a	n/a
EA-320		Self-Employment Ledger	n/a	n/a
BRO/EA2		SNAP (Food Stamps) Brochure	n/a	n/a
BRO/EA9		SNAP (Food Stamps) Shoppers Guide	n/a	n/a
BRO/EA10		SNAP for Students	n/a	n/a
BRO-EA-13		SNAP: Putting Healthy Food Within Reach	n/a	n/a	n/a	n/a
BRO-EA-13S		SNAP: Putting Healthy Food Within Reach (Spanish version)	n/a	n/a	n/a	n/a
EA-324		Wage Verification	n/a	n/a

South Dakota EBT

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/DSS4		Direct Deposit Brochure	n/a	n/a
BRO/EBT1		South Dakota EBT Client Handbook	n/a	n/a

Temporary Assistance for Needy Families

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
EA-231		Child Support Enforcement Referral		n/a
EA-217		Dependent Living Agreement		n/a
EA-214		Monthly Report Form	n/a	n/a
EA-320		Self-Employment Ledger		n/a
EA-260		Statement of Earnings		n/a
EA-208		TANF Authorization to Furnish / Release Information		n/a
BRO/EA4		TANF Work Program Brochure	n/a