Cabinet Secretary
Laurie R. Gill

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:

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Forms and Publications Filter:

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

Service Area:

Abuse and Neglect

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROCPS04	Mandatory Reporting of Child Abuse & Neglect Brochure	n/a	n/a
BROCPS11	Central Registry of Child Abuse & Neglect	n/a	n/a
CPS-501	Individual: Request for Screening	n/a		n/a	n/a	n/a
CPS-502	Agency: Request for Screening	n/a		n/a	n/a	n/a
CPS-504	Present Danger Plan	n/a		n/a

Administrative Hearings

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRODSS03	Administrative Hearings Brochure		n/a	n/a
EA-319	Request for Administrative Hearing	n/a	n/a	n/a

Adoption and Foster Care

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROCPS09	Adoption Subsidy Handbook	n/a	n/a	n/a	n/a	n/a
BROCPS19	FosterOne Brochure	n/a	n/a	n/a
BROCPS20	FosterOne – Realities	n/a	n/a	n/a
BROCPS21	FosterOne Myth & Fact	n/a	n/a	n/a
CPS	Background Information for Voluntary Termination of Parental Rights	n/a		n/a	n/a	n/a
CPS-506	Foster/Adoptive Parent Health Report	n/a		n/a	n/a	n/a
CPS-508	Reference Form - Adoption / Foster / Kinship Care	n/a		n/a	n/a	n/a
CPS-533	Adoption Registry Form			n/a	n/a	n/a
CPS-565	Foster Parent Training & Self-Instruction	n/a		n/a	n/a	n/a
HDBKCPS22	Foster Parent Handbook	n/a		n/a	n/a	n/a

Behavioral Health

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BH01	Substance Use Disorder Services Brochure	n/a	n/a	n/a
BH02	Mental Health Services Brochure	n/a	n/a	n/a
BH03	Behavioral Health Desk Guide	n/a		n/a	n/a	n/a
BH04	Substance Use Disorder Involuntary Commitment Process	n/a	n/a	n/a
BH05	Intensive Methamphetamine Treatment Services	n/a	n/a	n/a
BH10	South Dakota Community Mental Health Center Flyer	n/a	n/a	n/a
BH11	Suicide Prevention Flyer	n/a	n/a	n/a
BH12	Substance Use Disorder Services Flyer	n/a	n/a	n/a
BH13	Juvenile Justice Reinvestment Initiative Flyer	n/a	n/a	n/a
BH14	Substance Use Prevention Services Flyer	n/a	n/a	n/a
BH15	Criminal Justice Initiative Flyer	n/a	n/a	n/a
BROHSC01	Mental Health Wellness and Recovery Phone Apps Brochure	n/a	n/a	n/a

Child Care Services

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROCCS06	Child Care Assistance Program Brochure	n/a	n/a
BROCCS09	South Dakota Child Safety Seat Distribution Program	n/a	n/a
BROCCS10	SD Child Development Associate Training Program	n/a	n/a	n/a
BROOLA03	Office of Licensing and Accreditation Brochure	n/a	n/a	n/a
CCS	Pathways to Professional Development - Career Lattice Application Form	n/a	n/a	n/a
CCS	Pathways to Professional Development - Renewal Application	n/a	n/a	n/a
CCS	Electronic Payment Exemptions	n/a	n/a	n/a
CCS	Payment Authorization Form	n/a	n/a	n/a
CCS	Foster Care Child Care Application	n/a		n/a	n/a	n/a
CCS-950	Child Care Assistance Application	n/a
CCS-970	Child Care Services Request For Payment	n/a		n/a
DSS-CCS	Rate Declaration Form	n/a	n/a	n/a
HDBKCCS14	Choosing Child Care Handbook	n/a	n/a
OLA-100	Background Screening Information Authorization	n/a		n/a	n/a	n/a
OLA-101	Orientation Training Verification Form	n/a		n/a	n/a	n/a
OLA-102	Application for Admission to Child Care	n/a		n/a	n/a	n/a
OLA-103	Child Care Declaration of Prior Criminal Conviction and Military History	n/a		n/a	n/a	n/a
OLA-104	Daily Attendance Form	n/a		n/a	n/a	n/a
OLA-105	Family Day Care Training Record	n/a		n/a	n/a	n/a
OLA-106	Family Day Care Immunization Affidavit	n/a		n/a	n/a	n/a
OLA-107	Medication Administration Form	n/a		n/a	n/a	n/a
OLA-108	Parent Agreement	n/a		n/a	n/a	n/a
OLA-109	Serious Incident Report Form	n/a		n/a	n/a	n/a
OLA-110	Family Day Care Helper Application	n/a		n/a	n/a	n/a
OLA-111	Family Day Care Helper Reference Form	n/a		n/a	n/a	n/a
OLA-112	Procedures for Identifying CA/N	n/a		n/a	n/a	n/a
OLA-113	FDC Emergency Preparedness Plan	n/a		n/a	n/a	n/a

Child Protection Services

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROCPS03	Safe Havens Brochure	n/a	n/a	n/a
BROCPS07	Independent Living Program Education and Training Voucher Brochure	n/a	n/a
BROCPS10	Independent Living Program Brochure	n/a	n/a
BROCPS13	Young Voices Brochure	n/a	n/a	n/a
CPS	Provider Mileage Request	n/a		n/a	n/a	n/a
CPS	Background Information for Voluntary Termination of Parental Rights	n/a		n/a	n/a	n/a
CPS	ICPC Financial and Medical Plan	n/a		n/a	n/a	n/a
CPS	Potential Placement Statement	n/a		n/a	n/a	n/a
CPS	Designated Tribal Agent Request Form	n/a		n/a	n/a	n/a
CPS	Designated Tribal Agent Request for Change of Address	n/a		n/a	n/a	n/a
CPS-100	Independent Living Program Education and Training Voucher			n/a	n/a	n/a
CPS-100A	FACIS Interstate Compact: Placement Request Form			n/a	n/a	n/a
CPS-100B	FACIS Interstate Compact: Report on Child Placement			n/a	n/a	n/a
CPS-500	Newborn Medical Report for Voluntary Termination of Parental Rights	n/a		n/a	n/a	n/a
CPS-522	Request for Payment	n/a		n/a
HDBKCPS01	Child Protection Services Booklet	n/a	n/a
HDBKCPS14	Young Voices Handbook	n/a	n/a	n/a
POSCPS03	Safe Havens Poster	n/a	n/a	n/a

Child Support

Doc #	Document Name	Instructions	Online Version	Spanish Version
BRODCS03	Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Income	n/a	n/a	n/a
BRODCS04	National Medical Support Notice Brochure - An Employers Guide	n/a	n/a	n/a
BRODCS08	Child Support Parent Handbook	n/a	n/a
HDBKDCS01	Child Support Modification Handbook	n/a	n/a	n/a
HDBKDCS06	Voluntary Paternity Establishment Handbook and Form	n/a	n/a
SE-405	Application for Income Withholding Only Service	n/a	n/a	n/a
SE-406	Application for Location Only Services	n/a	n/a	n/a
SE408CP	Application and Agreement for Services - Custodial Parent and/or Caretaker	n/a	n/a	n/a
SE408NCP	Application and Agreement for Services - Non-Custodial Parent	n/a	n/a	n/a
SE-415	Petition for Modification Form	n/a	n/a	n/a
SE-431A	Child Support Payment Authorization Form	n/a	n/a	n/a
SE-492	Notice of Shared Medical Expenses	n/a	n/a	n/a

General

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROEA11	Weatherization Assistance Brochure	n/a	n/a
BROEA12	Energy Assistance Brochure	n/a	n/a
EA-297	Energy Assistance Application		n/a
EA-298	Weatherization Application	n/a	n/a
EA-301MA	Children and Family Medical Assistance Supplemental Application	n/a	n/a
ENERGY	Vendor Information: Direct Deposit			n/a	n/a	n/a
ENERGY-927	Vendor Information: Vendor Claim Form			n/a	n/a	n/a

General Social Service Documents

Doc #	Document Name	Instructions	Online Version	Spanish Version
BRODSS06	Filing a Discrimination Complaint Brochure and Form	n/a	n/a	n/a
BRODSS08	Notice of Privacy Brochure	n/a	n/a
BROEA01	Energy Saving Tips	n/a	n/a	n/a
BROEA18	Long-Term Care Partnership Brochure	n/a	n/a	n/a
BROEA19	Guide to Assistance Handbook	n/a	n/a	n/a
DSS-W9	W-9 Form	n/a	n/a	n/a
EA-301	Economic Assistance Application	n/a
EA-310	Form for Reporting Changes	n/a	n/a
FLYREA15	Emergency Services for SD Flyer	n/a	n/a	n/a
HDBKDSS09	DSS Handbook	n/a	n/a	n/a

Medical Eligibility

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROEA05	Medicare Savings Program Brochure	n/a	n/a	n/a
BROEA14	CHIP Rack Card	n/a	n/a
BROEA16	Medical Assistance for Children and Families: IHS Specific	n/a	n/a	n/a
EA-208	Authorization to Furnish / Release Information	n/a	n/a
EA-240	Application for Resource Assessment, Long Term Care or Related Medical Assistance	n/a	n/a	n/a
EA-240D	Application for Medical Assistance for Workers with Disabilities	n/a	n/a	n/a
EA-243	Application for Chronic Renal Disease Program	n/a		n/a	n/a	n/a
EA-249	Disabled Children's Program Application	n/a	n/a	n/a
EA-265	Request for Long-Term Care or Home Community Based Services Waiver Assistance	n/a	n/a	n/a
EA-270	Medicare Savings Program Application	n/a	n/a
EA-320	Self-Employment Ledger	n/a	n/a
FSSA	Children and Family Medical Assistance Application	n/a	n/a
HDBKEA08	Medicaid Spousal Care Handbook	n/a	n/a	n/a
HDBKMS01	Medical Assistance Program Recipient Handbook	n/a	n/a
POSEA03	CHIP Poster	n/a	n/a	n/a

Medical Services

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROMS02	Provider Selection Rack Card	n/a	n/a	n/a
BROMS03	Well-Child Care Brochure	n/a	n/a
BROMS04	Medicaid Non-Emergency Medical Travel Brochure	n/a	n/a	n/a
BROMS05	Well Visit Rack Card	n/a	n/a	n/a
BROMS06	Health Home Brochure	n/a	n/a	n/a
BROMS08	Constituent Liaison Services Brochure	n/a	n/a	n/a
HDBKMS01	Medical Assistance Program Recipient Handbook	n/a	n/a
MS-100	Recipient Forms: HIPAA Privacy Consent Form	n/a		n/a	n/a	n/a
MS-102	Provider Selection Form	n/a		n/a
MS-103	Provider Change Form	n/a		n/a
MS-112	Primary Care Provider Program Reminders - Emergency Room	n/a		n/a	n/a	n/a
MS-113	Dental At-Risk Referral Form	n/a		n/a	n/a	n/a
MS-114	South Dakota Medicaid Pre-Orthodontic Certification Form	n/a		n/a	n/a	n/a
MS-115	South Dakota Medicaid Handicapping Labio-Langual Deviations Form (HLD Index)	n/a		n/a	n/a	n/a
MS-116	Medicaid Credit Balance Report Form	n/a		n/a	n/a	n/a
MS-117	Hysterectomy Acknowledgement of Information	n/a		n/a	n/a	n/a
MS-118	Medicaid Transportation Documentation Form	n/a		n/a	n/a	n/a
MS-119	Certificate of Medical Necessity	n/a		n/a	n/a	n/a
MS-120	Transportation Exceptions Form	n/a		n/a	n/a	n/a
MS-121	Hospice Notification	n/a		n/a	n/a	n/a
MS-122	Health Home Selection and Change Form	n/a		n/a	n/a	n/a
MS-123	Health Home Decline to Participate Form	n/a		n/a	n/a	n/a
MS-124	Community Mental Health Center Health Home Referral Form	n/a		n/a	n/a	n/a
MS-125	Health Home Referral Form	n/a		n/a	n/a	n/a
MS-126	Health Home Manual Tiering Document	n/a		n/a	n/a	n/a
MS-127	Health Home Application	n/a		n/a	n/a	n/a
MS-128	Health Home Application Attestation	n/a		n/a	n/a	n/a
MS-146	Sterilization Consent Form	n/a			n/a	n/a
NEMT-950	Recipient Forms: Medicaid Non-Emergency Medical Travel (NEMT) Reimbursement Form	n/a		n/a	n/a	n/a
NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	n/a			n/a	n/a
NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	n/a		n/a	n/a	n/a
PA-100	Prior Authorization Forms: General	n/a		n/a	n/a	n/a
PA-101	Prior Authorization Forms: Durable Medical Equipment and Nutrition	n/a		n/a	n/a	n/a
PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	n/a		n/a	n/a	n/a
PA-103	Prior Authorization Forms: Synagis	n/a		n/a	n/a	n/a
PA-104	Prior Authorization Forms: Private Duty Nursing & Extended Home Health Services	n/a		n/a	n/a	n/a
PA-105	Prior Authorization Forms: Out-of-State Services	n/a		n/a	n/a	n/a
PA-106	Prior Authorization Forms: Genetic Testing	n/a		n/a	n/a	n/a
PA-107	Prior Authorization Forms: BRCA	n/a		n/a	n/a	n/a
PA-108	Prior Authorization Form: Incontinence Supply Family Support 360 Waiver	n/a		n/a	n/a	n/a
PA-109	Prior Authorization Form: Incontinence Supply Supply HOPE Waiver	n/a		n/a	n/a	n/a
PA-110	Prior Authorization Form: Incontinence Supply ADLS Support 360 Waiver	n/a		n/a	n/a	n/a
PA-111	Prior Authorization Form: Incontinence Supply CHOICES Waiver	n/a		n/a	n/a	n/a
PA-112	Prior Authorization Form: Long Term Acute Care and Out-of-State Rehab	n/a		n/a	n/a	n/a
PA-113	Prior Authorization Form: Medical Nutrition	n/a		n/a	n/a	n/a
POSMS02	Well Child Poster	n/a	n/a	n/a
POSMS05	Well Visit Poster	n/a	n/a	n/a
POSMS08	Constituent Liaison Services Poster	n/a	n/a	n/a

Parent Education

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROCPS02	Common Sense Parenting Brochure	n/a	n/a
CPS-1053	Common Sense Parenting Annual Report Form	n/a		n/a	n/a	n/a
CPS-1054	Common Sense Parenting Program Voucher	n/a		n/a	n/a	n/a

Recoveries and Fraud

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRORE03	Estate Recovery Program Brochure	n/a	n/a	n/a
BRORE04	Medicaid Liens Brochure	n/a	n/a	n/a
BRORE05	Stop Benefit Fraud Insert	n/a	n/a	n/a
ORFI-831	Estate Recovery Notification of Death Form	n/a		n/a	n/a	n/a
ORFI-832	Estate Recovery Program Petition for Limitation	n/a		n/a	n/a	n/a
ORFI-833	Report Benefit Fraud	n/a		n/a	n/a	n/a

SNAP (Food Stamps)

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROEA02	SNAP Brochure	n/a	n/a
BROEA09	SNAP Shoppers Guide	n/a	n/a	n/a
BROEA10	SNAP for Students	n/a	n/a	n/a
EA-208	Authorization to Furnish / Release Information	n/a	n/a
EA-214	SNAP 6 Month Report Form	n/a	n/a
EA-269	Child Care Expense Billing Information	n/a		n/a	n/a	n/a
EA-301	SNAP Application	n/a
EA-305	Boarding School-Institution Documentation	n/a	n/a	n/a
EA-307	SNAP Exit Form	n/a	n/a	n/a
EA-307G	SNAP Group Home Exit Form	n/a	n/a	n/a
EA-320	Self-Employment Ledger	n/a	n/a
EA-324	Wage Verification	n/a	n/a	n/a
EA-345	Affidavit for SNAP Work Registrants	n/a	n/a	n/a
EA-345A	Affidavit for SNAP Work Registrants (Employment & Training)	n/a	n/a	n/a
EA-347	Application for Social Security Number	n/a		n/a
OS-954	Client Authorized Debit for Repayment of Overissuance	n/a	n/a	n/a
POSEA02	SNAP Notice of Rights Poster	n/a	n/a	n/a

South Dakota EBT

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
HDBKEBT01	EBT Client Handbook	n/a	n/a

Temporary Assistance for Needy Families

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BROEA04	TANF Brochure	n/a	n/a
CC-975	TANF Child Care Benefits Application	n/a	n/a	n/a
EA-208	Authorization to Furnish / Release Information	n/a	n/a
EA-214	TANF 6 Month Report Form	n/a	n/a
EA-231	Child Support Enforcement Referral	n/a	n/a	n/a
EA-260	Statement of Earnings	n/a		n/a	n/a	n/a
EA-320	Self-Employment Ledger	n/a