Forms & 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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You can download any form or publication on this page by clicking on the download button.
 
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.

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.

DUE TO TECHNICAL DIFFICULTIES PLEASE E-MAIL PUBLICATION ORDERS TO DSS.SUPPLY@state.sd.us

Please include your name, address, brochure number and quantity.

Thank you for your patience.

Forms and Publications Filter:
Document Type ::
Forms Only | Publications Only | Documentos en Español | All
Service Area::
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Abuse and Neglect
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
BRO/ASA2Abuse, Neglect & Exploitation of Elders or Adults with Disabilities
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BRO/CPS11Central Registry of Child Abuse & Neglect
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BRO/CPS8Help Stop Child Abuse & Neglect Insert
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BRO/CPS4Mandatory Reporting of Child Abuse & Neglect Brochure
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CPS-593Permission to Screen for Reports of Abuse or Neglect
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CPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)
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Administrative Hearings
Doc # Document Name
Online Version
Spanish Version
English Version
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BRO/DSS3Administrative Hearings Brochure
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DSSGuide to Administrative Hearings Procedure
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EA-319Request for Administrative Hearing
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Adoption and Foster Care
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
CPS-533Adoption Registry Form
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BRO/CPS9Adoption Subsidy Handbook
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CPSBackground Information for Voluntary Termination of Parental Rights
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CPS-594Declaration of Prior Criminal Conviction & Military History
CPS-566Foster Parent Evaluation
CPS-565Foster Parent Training & Self-Instruction
CPS-506Foster/Adoptive Parent Health Report
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CPS-508Reference Form - Adoption / Foster / Kinship Care
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BRO/CPS5What I Should Know About Foster Care
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Assisted Living and Nursing Homes
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
BRO/ASA8Assisted Living Centers: Residents Bill of Rights Handbook
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MISC/ASA6Assisted Living in SD: A Consumers Guide
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MISC/ASA8Long-Term Care Facilities: Residents Bill of Rights Handbook
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BRO/ASA7Ombudsman Services Brochure
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Child Care Services
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
CCS-950Child Care Assistance Application
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BRO/CCS6Child Care Assistance Program Brochure
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CCS-970Child Care Services Request For Payment
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BRO/CCS14Choosing Child Care Handbook
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CCSElectronic Payment Exemptions
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CCSFoster Care Child Care Application
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CCSPathways to Professional Development - Career Lattice Form
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CCSPayment Authorization Form
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CCSPayment Authorization Form for Direct Deposit
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DSS-CCSRate Declaration Form
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BRO/CCS3Registration & Licensure of Child Care Environments
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PosterReportable Disease List Poster
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BRO/CCSSouth Dakotas Child Safety Seat Distribution Program
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Child Protection Services
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
CPSBackground Information for Voluntary Termination of Parental Rights
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BRO/CPS1Child Protection Services Booklet
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CPSDesignated Tribal Agent Request for Change of Address
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CPSDesignated Tribal Agent Request Form
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CPSIndependent Living Program Brochure
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CPSIndependent Living Program Education and Training Voucher
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BRO/CPS7Independent Living Program Education and Training Voucher Brochure
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FACISInterstate Compact: Placement Request Form
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FACISInterstate Compact: Report on Child Placement
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CPS-500Newborn Medical Report for Voluntary Termination of Parental Rights
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CPSPlacement Resource Monthly Reporting Form Ages 0-4
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CPSPlacement Resource Monthly Reporting Form Ages 14 and older
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CPSPlacement Resource Monthly Reporting Form Ages 5-13
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CPSProvider Mileage Request
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CPS-522Request for Payment
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CPSResidential Care Directory
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BRO/CPS3Safe Havens Brochure
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DSS-CPSSafe Havens Poster
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Child Support
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
SE408CPApplication and Agreement for Services - Custodial Parent and/or Relative Caretaker
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SE408NCPApplication and Agreement for Services - Non-Custodial Parent
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SE-406Application for Location Only Services
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SE-405Application for Wage Withholding Only Services
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BRO/DCS1Child Support Modification Handbook
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BRO/DCS8Child Support Parent Handbook
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BRO/DCS5Electronic Payment of Child Support Brochure and Direct Deposit Form
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BRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Income
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BRO/DCS4National Medical Support Notice Brochure - An Employers Guide
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SE-492Notice of Shared Medical Expenses
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SE-415Petition for Modification Form
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BRO/DCS2Teenage Parents Guide - How to Establish Paternity and Financial Support for your Child
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BRO/DCS6Voluntary Paternity Establishment Handbook and Form
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Domestic Violence
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
BRO/ASA9Domestic Violence Brochure
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BRO/ASA4Sexual Assault Brochure
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Eldery Services
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
BRO/ASA2Abuse, Neglect & Exploitation of Elders or Adults with Disabilities
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BRO/ASA3Adult Services and Aging Programs Handbook
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BRO/ASA1Aging & Disability Resource Connections (ADRC)
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ASACaregiver Self Assessment
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ASA-694Crime Victims Compensation Application
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BRO/ASA11Crime Victims Compensation Brochure
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ASAGuide to Medicare, Medicare Supp Insurance and Beneficiary Resources
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BRO/ASA12Helping You Understand Medicare & Your Benefits
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ASA-668Homemaker Services Report
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BRO/ASA5Legal Services for the Elderly Brochure
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BRO/ASA14Long-Term Care Partnership Brochure
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BRO/ASALong-Term Care Partnership Fact Sheet
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BRO/ASALong-Term Care Partnership Stuffer
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ASAMake a Referral
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EA-240Medical Assistance for Individuals in Adult Foster Care Facilities
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ASA-659Physician Report - Order
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ASA-634Provider Forms: Initial and Continuing Need for Care Report
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ASA-522Request for Payment
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Energy Assistance
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
EA-297Energy Assistance Application
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BRO/EA12Energy Assistance Brochure
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ENERGYVendor Information: Direct Deposit
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ENERGY-927Vendor Information: Vendor Claim Form
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EAWeatherization Application
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BRO/EA11Weatherization Assistance Brochure
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General Social Service Documents
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
BRO/EA15Community Action Agency Handout
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BRO/DSS2Constituent Liaison Services Brochure
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PosterConstituent Liaison Services Poster
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BRO/DSS9DSS Handbook
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EA-301Economic Assistance Application
BRO/DSS6Filing a Discrimination Complaint Form
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EA-310Form for Reporting Changes
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BRO/DSS8Notice of Privacy Brochure
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DSS-W9W-9 Form
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Medical Assistance
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
ASA-677Application Assistance (Medication Assistance)
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BRO/ASA10Planning for Health Care Decisions: Your Right to Choose
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Medical Eligibility
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
EA-240Application for Long Term Care or Related Medical Assistance
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EA-208Authorization to Furnish / Release Information
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EA-269Child Care Expense Billing Information
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EA-301MChildren and Family Medical Assistance Application
PosterCHIP Poster
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PosterCHIP Poster
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BRO/EA8Medicaid Spousal Care Handbook
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BRO/EA14Medical Assistance for Children and Families
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BRO/EA16Medical Assistance for Children and Families: IHS Specific
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BRO/MS1Medical Assistance Program Recipient Handbook
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EA-270Medical Savings Program Application
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BRO/EA5Medicare Savings Program Brochure
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EA-320Self-Employment Ledger
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Medical Services
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
EA-249Disabled Children Application / Eligibility Review
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BRO/MS1Medical Assistance Program Recipient Handbook
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MSPrior Authorization Forms: Durable Medical Equipment
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MSPrior Authorization Forms: Gen. Authorization Request Form
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MSPrior Authorization Forms: Nutritional Therapy
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MSPrior Authorization Forms: Obesity and Gastric Procedures
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MS-146Prior Authorization Forms: Sterilization
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MS-103Provider Change Form
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MS-102Provider Selection Form
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MSProviders: Adult Services & Aging Provider Agreement
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MSProviders: General Provider Agreement
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MSProviders: NEMT Provider Agreement
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MSProviders: Synagis/Respigam Prior Authorization
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EA-208Recipient Forms: Authorization to Release Information
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EA-269Recipient Forms: Child Care Expense Billing Information
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EA-231Recipient Forms: Child Support Enforcement Referral
Recipient Forms: HIPAA Privacy Consent Form
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EA-270Recipient Forms: Medical Savings Program Application
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DSSRecipient Forms: Psychiatric Residential Treatment Facility Referral Form
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EA-320Recipient Forms: Self-Employment Ledger
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OS-950Recipient Forms: Title XIX Medical Transportation Reimbursement
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BRO/MS4Title XIX Medical Transportation Brochure
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BRO/MS3Well-Child Care Brochure
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Nutrition
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
BRO/ASA6Senior Meals Brochure
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PosterSenior Meals Poster
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Parent Education
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
CPSCommon Sense Parenting Annual Report Form
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BRO/CPS2Common Sense Parenting Brochure
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CPSCommon Sense Parenting Program Voucher
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Psychiatric Residential Treatment
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
DSSPsychiatric Residential Treatment Facility Referral Form
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Recoveries and Fraud
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
Rec and FraudCasualty Settlement Report Form
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DSS-ORFI-831Estate Recovery Notification of Death Form
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BRO/RE3Estate Recovery Program Brochure
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Rec and FraudEstate Recovery Program Petition for Limitation
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BRO/RE4Medicaid Liens Brochure
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Rec and FraudReport Benefit Fraud
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BRO/RE1Stop Benefit Fraud Brochure
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Rec and FraudStop Benefit Fraud Insert
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SNAP (Food Stamps)
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
EA-345Affidavit for SNAP Work Registrants
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EA-345AAffidavit for SNAP Work Registrants (Employment & Training)
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EA-347Application for Social Security Number
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EA-208Authorization to Furnish / Release Information
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EA-305Boarding School-Institution Documentation
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EA-269Child Care Expense Billing Information
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OS-954Client Authorized Debit for Repayment of Overissuance
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EA-320Self-Employment Ledger
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EA-214SNAP 6 Month Report Form
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EA-301SNAP Application
BRO/EA2SNAP Brochure
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EA-307SNAP Exit Form
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BRO/EA10SNAP for Students
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EA-307GSNAP Group Home Exit Form
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BRO/EA9SNAP Shoppers Guide
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EA-324Wage Verification
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South Dakota EBT
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
BRO/DSS4Direct Deposit Brochure
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BRO/EBT1EBT Client Handbook
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Temporary Assistance for Needy Families
Doc # Document Name
Online Version
Spanish Version
English Version
Add to Cart
EA-208Authorization to Furnish / Release Information
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EA-231Child Support Enforcement Referral
EA-217Dependent Living Agreement
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EA-320Self-Employment Ledger
EA-260Statement of Earnings
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EA-214TANF 6 Month Report Form
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BRO/EA4TANF Work Program Brochure
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