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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.

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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 NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BROCPS04Mandatory Reporting of Child Abuse & Neglect Brochuren/an/aspanish versionenglish versionadd to cart
BROCPS11Central Registry of Child Abuse & Neglectn/an/aspanish versionenglish versionadd to cart
CPS-501Individual: Request for Screeningn/aonline versionn/an/an/a
CPS-502Agency: Request for Screeningn/aonline versionn/an/an/a
CPS-504Present Danger Plann/aonline versionn/aenglish versionadd to cart

Administrative Hearings

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRODSS03Administrative Hearings Brochureinstructionsn/an/aenglish 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
BROCPS09Adoption Subsidy Handbookn/an/an/an/an/a
BROCPS19FosterOne Brochuren/an/an/aenglish versionadd to cart
BROCPS20FosterOne – Realitiesn/an/an/aenglish versionadd to cart
BROCPS21FosterOne Myth & Factn/an/an/aenglish versionadd to cart
CPSBackground Information for Voluntary Termination of Parental Rightsn/aonline versionn/an/an/a
CPS-506Foster/Adoptive Parent Health Reportn/aonline versionn/an/an/a
CPS-508Reference Form - Adoption / Foster / Kinship Caren/aonline versionn/an/an/a
CPS-533Adoption Registry Forminstructionsonline versionn/an/an/a
CPS-565Foster Parent Training & Self-Instructionn/aonline versionn/an/an/a
HDBKCPS22Foster Parent Handbookn/aonline versionn/an/an/a

Behavioral Health

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BH01Substance Use Disorder Services Brochuren/an/an/aenglish versionadd to cart
BH02Mental Health Services Brochuren/an/an/aenglish versionadd to cart
BH03Behavioral Health Desk Guiden/aonline versionn/an/an/a
BH04Substance Use Disorder Involuntary Commitment Processn/an/an/aenglish versionadd to cart
BH05Intensive Methamphetamine Treatment Servicesn/an/an/aenglish versionadd to cart
BH10South Dakota Community Mental Health Center Flyern/an/an/aenglish versionadd to cart
BH11Suicide Prevention Flyern/an/an/aenglish versionadd to cart
BH12Substance Use Disorder Services Flyern/an/an/aenglish versionadd to cart
BH13Juvenile Justice Reinvestment Initiative Flyern/an/an/aenglish versionadd to cart
BH14Substance Use Prevention Services Flyern/an/an/aenglish versionadd to cart
BH15Criminal Justice Initiative Flyern/an/an/aenglish versionadd to cart
BROHSC01Mental Health Wellness and Recovery Phone Apps Brochuren/an/an/aenglish versionadd to cart

Child Care Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BROCCS06Child Care Assistance Program Brochuren/an/aspanish versionenglish versionadd to cart
BROCCS09South Dakota Child Safety Seat Distribution Programn/an/aspanish versionenglish versionadd to cart
BROCCS10SD Child Development Associate Training Programn/an/an/aenglish versionadd to cart
BROOLA03Office of Licensing and Accreditation Brochuren/an/an/aenglish versionadd to cart
CCSPathways to Professional Development - Career Lattice Application Formn/an/an/aenglish versionadd to cart
CCSPathways to Professional Development - Renewal Applicationn/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
CCS-950Child Care Assistance Applicationn/aonline versionspanish versionenglish versionadd to cart
CCS-970Child Care Services Request For Paymentn/aonline versionn/aenglish versionadd to cart
DSS-CCSRate Declaration Formn/an/an/aenglish versionadd to cart
HDBKCCS14Choosing Child Care Handbookn/an/aspanish versionenglish versionadd to cart
OLA-100Background Screening Information Authorizationn/aonline versionn/an/an/a
OLA-101Orientation Training Verification Formn/aonline versionn/an/an/a
OLA-102Application for Admission to Child Caren/aonline versionn/an/an/a
OLA-103Child Care Declaration of Prior Criminal Conviction and Military Historyn/aonline versionn/an/an/a
OLA-104Daily Attendance Form n/aonline versionn/an/an/a
OLA-105Family Day Care Training Recordn/aonline versionn/an/an/a
OLA-106Family Day Care Immunization Affidavit n/aonline versionn/an/an/a
OLA-107Medication Administration Formn/aonline versionn/an/an/a
OLA-108Parent Agreementn/aonline versionn/an/an/a
OLA-109Serious Incident Report Formn/aonline versionn/an/an/a
OLA-110Family Day Care Helper Application n/aonline versionn/an/an/a
OLA-111Family Day Care Helper Reference Formn/aonline versionn/an/an/a
OLA-112Procedures for Identifying CA/N n/aonline versionn/an/an/a
OLA-113FDC Emergency Preparedness Plann/aonline versionn/an/an/a

Child Protection Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BROCPS03Safe Havens Brochuren/an/an/aenglish versionadd to cart
BROCPS07Independent Living Program Education and Training Voucher Brochuren/an/aspanish versionenglish versionadd to cart
BROCPS10Independent Living Program Brochuren/an/aspanish versionenglish versionadd to cart
BROCPS13Young Voices Brochuren/an/an/aenglish versionadd to cart
CPSProvider Mileage Requestn/aonline versionn/an/an/a
CPSBackground Information for Voluntary Termination of Parental Rightsn/aonline versionn/an/an/a
CPSICPC Financial and Medical Plann/aonline versionn/an/an/a
CPSPotential Placement Statementn/aonline versionn/an/an/a
CPSDesignated Tribal Agent Request Formn/aonline versionn/an/an/a
CPSDesignated Tribal Agent Request for Change of Addressn/aonline versionn/an/an/a
CPS-100Independent Living Program Education and Training Voucher instructionsonline versionn/an/an/a
CPS-100AFACIS Interstate Compact: Placement Request Forminstructionsonline versionn/an/an/a
CPS-100BFACIS Interstate Compact: Report on Child Placementinstructionsonline versionn/an/an/a
CPS-500Newborn Medical Report for Voluntary Termination of Parental Rightsn/aonline versionn/an/an/a
CPS-522Request for Paymentn/aonline versionn/aenglish versionadd to cart
HDBKCPS01Child Protection Services Bookletn/an/aspanish versionenglish versionadd to cart
HDBKCPS14Young Voices Handbookn/an/an/aenglish versionadd to cart
POSCPS03Safe Havens Postern/an/an/aenglish versionadd to cart

Child Support

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRODCS03Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Incomen/an/an/aenglish versionadd to cart
BRODCS04National Medical Support Notice Brochure - An Employers Guiden/an/an/aenglish versionadd to cart
BRODCS08Child Support Parent Handbookn/an/aspanish versionenglish versionadd to cart
HDBKDCS01Child Support Modification Handbookn/an/an/aenglish versionadd to cart
HDBKDCS06Voluntary Paternity Establishment Handbook and Formn/an/aspanish 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
BROEA11Weatherization Assistance Brochuren/an/aspanish versionenglish versionadd to cart
BROEA12Energy Assistance Brochuren/an/aspanish versionenglish versionadd to cart
EA-297Energy Assistance Applicationinstructionsn/aspanish versionenglish versionadd to cart
EA-298Weatherization Applicationn/an/aspanish versionenglish versionadd to cart
EA-301MAChildren and Family Medical Assistance Supplemental Application n/an/aspanish versionenglish versionadd to cart
ENERGYVendor Information: Direct Depositinstructionsonline versionn/an/an/a
ENERGY-927Vendor Information: Vendor Claim Forminstructionsonline versionn/an/an/a

General Social Service Documents

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRODSS06Filing a Discrimination Complaint Brochure and Formn/an/an/aenglish versionadd to cart
BRODSS08Notice of Privacy Brochuren/an/aspanish versionenglish versionadd to cart
BROEA01Energy Saving Tipsn/an/an/aenglish versionadd to cart
BROEA18Long-Term Care Partnership Brochuren/an/an/aenglish versionadd to cart
BROEA19Guide to Assistance Handbookn/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
FLYREA15Emergency Services for SD Flyern/an/an/aenglish versionadd to cart
HDBKDSS09DSS Handbookn/an/an/aenglish versionadd to cart

Medical Eligibility

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BROEA05Medicare Savings Program Brochuren/an/an/aenglish versionadd to cart
BROEA14CHIP Rack Cardn/an/aspanish versionenglish versionadd to cart
BROEA16Medical Assistance for Children and Families: IHS Specificn/an/an/aenglish 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-240DApplication for Medical Assistance for Workers with Disabilitiesn/an/an/aenglish versionadd to cart
EA-243Application for Chronic Renal Disease Programn/aonline versionn/an/an/a
EA-249Disabled Children's Program Applicationn/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-270Medicare 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/aspanish versionenglish versionadd to cart
HDBKEA08Medicaid Spousal Care Handbookn/an/an/aenglish versionadd to cart
HDBKMS01Medical Assistance Program Recipient Handbookn/an/aspanish versionenglish versionadd to cart
POSEA03CHIP Postern/an/an/aenglish versionadd to cart

Medical Services

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BROMS02Provider Selection Rack Cardn/an/an/aenglish versionadd to cart
BROMS03Well-Child Care Brochuren/an/aspanish versionenglish versionadd to cart
BROMS04Medicaid Non-Emergency Medical Travel Brochuren/an/an/aenglish versionadd to cart
BROMS05Well Visit Rack Card n/an/an/aenglish versionadd to cart
BROMS06Health Home Brochuren/an/an/aenglish versionadd to cart
BROMS08Constituent Liaison Services Brochuren/an/an/aenglish versionadd to cart
HDBKMS01Medical Assistance Program Recipient Handbookn/an/aspanish versionenglish versionadd to cart
MS-100Recipient Forms: HIPAA Privacy Consent Formn/aonline versionn/an/an/a
MS-102Provider Selection Formn/aonline versionn/aenglish versionadd to cart
MS-103Provider Change Formn/aonline versionn/aenglish versionadd to cart
MS-112Primary Care Provider Program Reminders - Emergency Roomn/aonline versionn/an/an/a
MS-113Dental At-Risk Referral Formn/aonline versionn/an/an/a
MS-114South Dakota Medicaid Pre-Orthodontic Certification Formn/aonline versionn/an/an/a
MS-115South Dakota Medicaid Handicapping Labio-Langual Deviations Form (HLD Index)n/aonline versionn/an/an/a
MS-116Medicaid Credit Balance Report Formn/aonline versionn/an/an/a
MS-117Hysterectomy Acknowledgement of Informationn/aonline versionn/an/an/a
MS-118Medicaid Transportation Documentation Formn/aonline versionn/an/an/a
MS-119Certificate of Medical Necessityn/aonline versionn/an/an/a
MS-120Transportation Exceptions Formn/aonline versionn/an/an/a
MS-121Hospice Notificationn/aonline versionn/an/an/a
MS-122Health Home Selection and Change Formn/aonline versionn/an/an/a
MS-123Health Home Decline to Participate Formn/aonline versionn/an/an/a
MS-124Community Mental Health Center Health Home Referral Formn/aonline versionn/an/an/a
MS-125Health Home Referral Formn/aonline versionn/an/an/a
MS-126Health Home Manual Tiering Document n/aonline versionn/an/an/a
MS-127Health Home Applicationn/aonline versionn/an/an/a
MS-128Health Home Application Attestationn/aonline versionn/an/an/a
MS-146Sterilization Consent Formn/aonline versionspanish versionn/an/a
NEMT-950Recipient Forms: Medicaid Non-Emergency Medical Travel (NEMT) Reimbursement Formn/aonline versionn/an/an/a
NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Formn/aonline versionspanish versionn/an/a
NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorizationn/aonline versionn/an/an/a
PA-100Prior Authorization Forms: Generaln/aonline versionn/an/an/a
PA-101Prior Authorization Forms: Durable Medical Equipment and Nutritionn/aonline versionn/an/an/a
PA-102Prior Authorization Forms: Applied Behavior Analysis Therapyn/aonline versionn/an/an/a
PA-103Prior Authorization Forms: Synagisn/aonline versionn/an/an/a
PA-104Prior Authorization Forms: Private Duty Nursing & Extended Home Health Servicesn/aonline versionn/an/an/a
PA-105Prior Authorization Forms: Out-of-State Servicesn/aonline versionn/an/an/a
PA-106Prior Authorization Forms: Genetic Testing n/aonline versionn/an/an/a
PA-107Prior Authorization Forms: BRCAn/aonline versionn/an/an/a
PA-108Prior Authorization Form: Incontinence Supply Family Support 360 Waivern/aonline versionn/an/an/a
PA-109Prior Authorization Form: Incontinence Supply Supply HOPE Waivern/aonline versionn/an/an/a
PA-110Prior Authorization Form: Incontinence Supply ADLS Support 360 Waivern/aonline versionn/an/an/a
PA-111Prior Authorization Form: Incontinence Supply CHOICES Waivern/aonline versionn/an/an/a
PA-112Prior Authorization Form: Long Term Acute Care and Out-of-State Rehabn/aonline versionn/an/an/a
PA-113Prior Authorization Form: Medical Nutritionn/aonline versionn/an/an/a
POSMS02Well Child Postern/an/an/aenglish versionadd to cart
POSMS05Well Visit Postern/an/an/aenglish versionadd to cart
POSMS08Constituent Liaison Services Postern/an/an/aenglish versionadd to cart

Parent Education

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BROCPS02Common Sense Parenting Brochuren/an/aspanish versionenglish versionadd to cart
CPS-1053Common Sense Parenting Annual Report Formn/aonline versionn/an/an/a
CPS-1054Common Sense Parenting Program Vouchern/aonline versionn/an/an/a

Recoveries and Fraud

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BRORE03Estate Recovery Program Brochuren/an/an/aenglish versionadd to cart
BRORE04Medicaid Liens Brochuren/an/an/aenglish versionadd to cart
BRORE05Stop Benefit Fraud Insertn/an/an/aenglish versionadd to cart
ORFI-831Estate Recovery Notification of Death Formn/aonline versionn/an/an/a
ORFI-832Estate Recovery Program Petition for Limitationn/aonline versionn/an/an/a
ORFI-833Report Benefit Fraudn/aonline versionn/an/an/a

SNAP (Food Stamps)

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BROEA02SNAP Brochuren/an/aspanish versionenglish versionadd to cart
BROEA09SNAP Shoppers Guiden/an/an/aenglish versionadd to cart
BROEA10SNAP for Studentsn/an/an/aenglish 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/aonline versionn/an/an/a
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
POSEA02SNAP Notice of Rights Postern/an/an/aenglish versionadd to cart

South Dakota EBT

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
HDBKEBT01EBT Client Handbookn/an/aspanish versionenglish versionadd to cart

Temporary Assistance for Needy Families

Doc #Document NameInstructionsOnline VersionSpanish VersionEnglish VersionAdd to Cart
BROEA04TANF Brochuren/an/aspanish versionenglish versionadd to cart
CC-975TANF Child Care Benefits Applicationn/an/an/aenglish 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/an/an/a
EA-320Self-Employment Ledgern/aonline versionspanish versionenglish versionadd to cart