Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BROBH01 | Substance Use Disorder Services Brochure | n/a | n/a | n/a |  |  |
BROBH02 | Mental Health Services Brochure | n/a | n/a | n/a |  |  |
BROBH03 | Quick Reference Guide | n/a | n/a | n/a |  |  |
BROBH04 | Substance Use Disorder Involuntary Commitment Process | n/a | n/a | n/a |  |  |
BROBH05 | Intensive Methamphetamine Treatment Services | n/a | n/a | n/a |  |  |
BROHSC01 | Mental Health Wellness and Recovery Phone Apps Brochure | n/a | n/a | n/a |  |  |
FLYRBH01 | South Dakota Community Mental Health Center Flyer | n/a | n/a | n/a |  |  |
FLYRBH02 | Suicide Prevention Flyer | n/a | n/a | n/a |  |  |
FLYRBH03 | Substance Use Disorder Services Flyer | n/a | n/a | n/a |  |  |
FLYRBH04 | Juvenile Justice Reinvestment Initiative Flyer | n/a | n/a | n/a |  |  |
FLYRBH05 | Substance Use Prevention Services Flyer | n/a | n/a | n/a |  |  |
FLYRBH06 | Criminal Justice Initiative Flyer | n/a | n/a | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BROCCS03 | Registration & Licensure of Child Care Environments | n/a | n/a |  |  |  |
BROCCS06 | Child Care Assistance Program Brochure | n/a | n/a |  |  |  |
BROCCS09 | South Dakota Child Safety Seat Distribution Program | n/a | n/a | n/a |  |  |
CC-975 | TANF Child Care Benefits 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 | Orientation Training Verification Form | n/a | n/a | n/a |  |  |
CCS | Foster Care Child Care Application | n/a |  | 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-950 | Child Care Assistance Application | n/a |  | n/a |  |  |
CCS-964 | Child Care Declaration of Prior Criminal Conviction and Military History | n/a | n/a | 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 |  |  |
EA-269 | Child Care Expense Billing Information | n/a | n/a | n/a |  |  |
HDBKCCS14 | Choosing Child Care Handbook | n/a | n/a |  |  |  |
Poster | Recommendations for Exclusion from the Child Care Setting Poster | n/a |  | n/a | n/a | n/a |
Poster | Reportable Disease List Poster | n/a |  | n/a | n/a | n/a |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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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 |  |  |
CPS | Independent Living Program Education and Training Voucher |  | n/a | n/a |  |  |
CPS | Background Information for Voluntary Termination of Parental Rights | n/a | n/a | n/a |  |  |
CPS | ICPC Financial and Medical Plan | n/a | n/a | n/a |  |  |
CPS | Potential Placement Statement | n/a | n/a | n/a |  |  |
CPS | Placement Resource Monthly Reporting Form Ages 0-4 | n/a | n/a | n/a |  |  |
CPS | Placement Resource Monthly Reporting Form Ages 14 and older | n/a | n/a | n/a |  |  |
CPS | Placement Resource Monthly Reporting Form Ages 5-13 | n/a | n/a | n/a |  |  |
CPS | Designated Tribal Agent Request Form | n/a | n/a | n/a |  |  |
CPS | Designated Tribal Agent Request for Change of Address | n/a | n/a | n/a |  |  |
CPS-500 | Newborn Medical Report for Voluntary Termination of Parental Rights | n/a |  | n/a |  |  |
CPS-522 | Request for Payment | n/a |  | n/a |  |  |
FACIS | Interstate Compact: Placement Request Form |  |  | n/a |  |  |
FACIS | Interstate Compact: Report on Child Placement |  |  | 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 |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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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 |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BROEA05 | Medicare Savings Program Brochure | n/a | n/a | n/a |  |  |
BROEA08 | Medicaid Spousal Care Handbook | 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-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 | Medical 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 |  |  |  |
HDBKMS01 | Medical Assistance Program Recipient Handbook | n/a | n/a |  |  |  |
POSEA03 | CHIP Poster | n/a | n/a | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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| Recipient Forms: HIPAA Privacy Consent Form | n/a |  | n/a |  |  |
| Primary Care Provider Program Reminders - Emergency Room | n/a |  | n/a | n/a | n/a |
- | Dental At-Risk Referral Form | n/a | n/a | n/a |  |  |
- | South Dakota Medicaid Pre-Orthodontic Certification Form | n/a | n/a | n/a |  |  |
- | South Dakota Medicaid Handicapping Labio-Langual Deviations Form (HLD Index) | n/a | n/a | n/a |  |  |
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 |  |  |
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 | Hysterectomy Acknowledgement of Information | n/a | n/a | n/a |  |  |
MS | Medicaid Credit Balance Report Form | n/a |  | n/a | n/a | n/a |
MS | Medicaid Transportation Documentation Form | n/a | n/a | n/a |  |  |
MS | Certificate of Medical Necessity | n/a | n/a | n/a |  |  |
MS | Transportation Exceptions Form | n/a | n/a | n/a |  |  |
MS | Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form | n/a | n/a |  |  |  |
MS | Hospice Notification | 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-146 | Sterilization Consent Form | n/a | n/a |  |  |  |
OS-950 | Recipient Forms: Medicaid Non-Emergency Medical Travel Form | n/a | n/a | n/a |  |  |
OS-964 | Non-Emergency Medical Travel HIPAA Authorization | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Durable Medical Equipment and Nutrition |  | n/a | n/a |  |  |
PA | Prior Authorization Forms: General |  | n/a | n/a |  |  |
PA | Prior Authorization Forms: Applied Behavior Analysis Therapy | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Synagis | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Private Duty Nursing & Extended Home Health Services | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Out-of State Services | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Genetic Testing | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: BRCA | n/a | n/a | n/a |  |  |
PA | Prior Authorization Form: Incontinence Supply Family Support 360 Waiver | n/a | n/a | n/a |  |  |
PA | Prior Authorization Form: Incontinence Supply Supply HOPE Waiver | n/a | n/a | n/a |  |  |
PA | Prior Authorization Form: Incontinence Supply ADLS Support 360 Waiver | n/a | n/a | n/a |  |  |
PA | Prior Authorization Form: Incontinence Supply CHOICES Waiver | n/a | n/a | n/a |  |  |
POSMS08 | Constituent Liaison Services Poster | n/a | n/a | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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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 |  |  |
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 |  |  |