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

= Instructions are available (Click on icon to view)

Abuse and Neglect

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/ASA2		Abuse, Neglect & Exploitation of Elders or Adults with Disabilities	n/a	n/a
BRO/CPS11		Central Registry of Child Abuse & Neglect	n/a
BRO/CPS8		Help Stop Child Abuse & Neglect Insert	n/a
BRO/CPS4		Mandatory Reporting of Child Abuse & 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		n/a
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		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/CCS6		Child Care Assistance Program Brochure	n/a	n/a
CCS-970		Child Care Services Request For Payment	n/a	n/a
BRO/CCS10		Child Development Associate Training Project	n/a	n/a
BRO/CCS14		Choosing Child Care Handbook	n/a	n/a
CCS		Electronic Payment Exemptions	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
CCS		Payment Authorization Form	n/a	n/a
CCS		Payment Authorization Form for Direct Deposit	n/a	n/a
Project 8		Project 8 Brochure	n/a
Poster		Project 8 Poster	n/a
DSS-CCS		Rate Declaration Form	n/a	n/a
Poster		Recommendations for Exclusion from the Child Care Setting Poster	n/a	n/a
BRO/CCS		Registration & Licensure of Child Care Environments	n/a	n/a
Poster		Reportable Disease List Poster	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
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		Provider Mileage Request	n/a	n/a
CPS-522		Request for Payment		n/a
CPS		Residential Care Directory		n/a	n/a	n/a
BRO/CPS3		Safe Havens Brochure	n/a
DSS-CPS		Safe Havens Poster	n/a	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	n/a
SE408NCP		Application and Agreement for Services - Non-Custodial Parent	n/a
SE-406		Application for Location Only Services	n/a	n/a
SE-405		Application for Wage Withholding Only Services	n/a	n/a
BRO/DCS1		Child Support Modification Handbook	n/a
BRO/DCS8		Child Support Parent Handbook	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

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 Elders or Adults with Disabilities	n/a	n/a
BRO/ASA3		Adult Services and Aging Programs Handbook	n/a
ASA		Aging & Disability Resource Connections (ADRC)	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	n/a
BRO/ASA		Helping You Understand Medicare & Your Benefits	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
BRO/ASA		Long-Term Care Partnership Brochure	n/a	n/a
BRO/ASA		Long-Term Care Partnership Fact Sheet	n/a	n/a
BRO/ASA		Long-Term Care Partnership Stuffer	n/a	n/a
ASA		Make a Referral		n/a	n/a	n/a
EA-240		Medical Assistance for Individuals in Adult Foster Care Facilities		n/a
ASA-659		Physician Report - Order	n/a	n/a
ASA-634		Provider Forms: Initial and Continuing Need for Care Report		n/a

Energy Assistance

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
EA-297		Energy Assistance Application	n/a
BRO/EA12		Energy Assistance Brochure	n/a	n/a
ENERGY		Vendor Information: Direct Deposit		n/a
ENERGY-927		Vendor Information: Vendor Claim Form		n/a	n/a	n/a
EA		Weatherization Application	n/a
BRO/EA11		Weatherization Assistance Brochure	n/a	n/a

General Social Service Documents

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/EA		Community Action Agency Handout	n/a	n/a
BRO/DSS2		Constituent Liaison Services Brochure	n/a	n/a
Poster		Constituent Liaison Services Poster	n/a	n/a
BRO/DSS1		DSS Employment Brochure	n/a	n/a
BRO/DSS9		DSS Handbook	n/a	n/a
EA-301		Economic Assistance Application	n/a
DSS		Filing a Discrimination Complaint Form	n/a	n/a
EA-310		Form for Reporting Changes	n/a	n/a
BRO/DSS8		Notice of Privacy Brochure	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
EA-208		Authorization to Furnish / Release Information	n/a
EA-269		Child Care Expense Billing Information	n/a	n/a
EA-301M		Children and Family Medical Assistance Application
BRO/EA3		CHIP Brochure	n/a
Poster		CHIP Poster	n/a	n/a
Poster		CHIP Poster	n/a	n/a
BRO/EA8		Medicaid Spousal Care Handbook	n/a	n/a
BRO/EA14		Medical Assistance for Children and Families	n/a	n/a
BRO/EA16		Medical Assistance for Children and Families: IHS Specific	n/a	n/a
BRO/MS1		Medical Assistance Program Recipient Handbook	n/a
EA-270		Medical Savings Program Application	n/a
BRO/EA5		Medicare Savings Program Brochure	n/a	n/a
EA-320		Self-Employment Ledger	n/a

Medical Services

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
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	n/a	n/a
MS		Prior Authorization Forms: Nutritional Therapy		n/a
MS		Prior Authorization Forms: Obesity and Gastric Procedures		n/a
MS-146		Prior Authorization Forms: Sterilization	n/a	n/a
MS-103		Provider Change Form		n/a
MS-102		Provider Selection Form		n/a
MS		Providers: Adult Services & Aging Provider Agreement	n/a	n/a
MS		Providers: General Provider Agreement		n/a
MS		Providers: NEMT Provider Agreement		n/a
MS		Providers: Synagis/Respigam Prior Authorization		n/a
EA-208		Recipient Forms: Authorization to Release Information	n/a
EA-269		Recipient Forms: Child Care Expense Billing Information	n/a	n/a
EA-231		Recipient Forms: Child Support Enforcement Referral
EA-270		Recipient Forms: Medical Savings Program Application	n/a
DSS		Recipient Forms: Psychiatric Residential Treatment Facility Referral Form	n/a	n/a
EA-320		Recipient Forms: Self-Employment Ledger		n/a
OS-950		Recipient Forms: Title XIX Medical Transportation Reimbursement	n/a	n/a
BRO/MS4		Title XIX Medical Transportation Brochure	n/a	n/a
BRO/MS3		Well-Child Care Brochure	n/a

Nutrition

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
BRO/ASA		Senior Meals Brochure	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
CPS		Common Sense Parenting Annual Report Form		n/a	n/a	n/a
BRO/CPS2		Common Sense Parenting Brochure	n/a
CPS		Common Sense Parenting Program Voucher		n/a	n/a	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	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		Medicaid Liens Brochure	n/a	n/a
Rec and Fraud		Report Benefit Fraud		n/a
BRO/RE1		Stop Benefit Fraud Brochure	n/a	n/a
Rec and Fraud		Stop Benefit Fraud Insert	n/a	n/a

Sales Tax on Food Refund Program

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

SNAP (Food Stamps)

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
EA-345		Affidavit for SNAP Work Registrants	n/a	n/a
EA-345A		Affidavit for SNAP Work Registrants (Employment & Training)	n/a	n/a
EA-347		Application for Social Security Number		n/a
EA-208		Authorization to Furnish / Release Information	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-320		Self-Employment Ledger	n/a
EA-214		SNAP 6 Month Report Form	n/a
EA-301		SNAP Application	n/a
BRO/EA2		SNAP Brochure	n/a
EA-307		SNAP Exit Form	n/a	n/a
BRO/EA10		SNAP for Students	n/a	n/a
EA-307G		SNAP Group Home Exit Form	n/a	n/a
EA-318		SNAP Income Calendar	n/a	n/a
BRO/EA9		SNAP Shoppers Guide	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		EBT Client Handbook	n/a

Temporary Assistance for Needy Families

Doc #		Document Name	Online Version	Spanish Version	English Version	Add to Cart
EA-208		Authorization to Furnish / Release Information	n/a
EA-231		Child Support Enforcement Referral
EA-217		Dependent Living Agreement		n/a
EA-320		Self-Employment Ledger
EA-260		Statement of Earnings		n/a
EA-214		TANF 6 Month Report Form	n/a
BRO/EA4		TANF Work Program Brochure	n/a