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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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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For Long Term Services and Supports forms and publications (formerly Adult Services and Aging), please click here.

For Victim Services, please click here.

Abuse and Neglect

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/CPS11	Central Registry of Child Abuse & Neglect	n/a	n/a
BRO/CPS4	Mandatory Reporting of Child Abuse & Neglect Brochure	n/a	n/a
CPS-549	Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)	n/a		n/a
CPS-593	Permission to Screen for Reports of Abuse or Neglect	n/a

Administrative Hearings

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/DSS3	Administrative Hearings Brochure	n/a	n/a	n/a
DSS	Guide to Administrative Hearings Procedure	n/a	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
BRO/CPS5	What I Should Know About Foster Care	n/a	n/a
BRO/CPS9	Adoption Subsidy Handbook	n/a	n/a	n/a
CPS	Background Information for Voluntary Termination of Parental Rights	n/a	n/a	n/a
CPS	Foster Parent Handbook	n/a		n/a	n/a	n/a
CPS-506	Foster/Adoptive Parent Health Report	n/a	n/a	n/a
CPS-508	Reference Form - Adoption / Foster / Kinship Care	n/a		n/a
CPS-533	Adoption Registry Form			n/a
CPS-565	Foster Parent Training & Self-Instruction	n/a
CPS-566	Foster Parent Evaluation	n/a
CPS-594	Declaration of Prior Criminal Conviction & Military History	n/a		n/a

Behavioral Health

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BH-01	Federal Poverty Level Guidelines	n/a	n/a	n/a
BH-02	Financial Eligibility Form	n/a	n/a	n/a
BH-03	102a Hardship Considerations	n/a	n/a	n/a
BH-04	102b Hardship Considerations	n/a	n/a	n/a
BH-05	Hardship Considerations Refusal	n/a	n/a	n/a
BH-06	3rd Party Release of Information (ROI)	n/a		n/a
BH-07	Mental Health - Accreditation Application	n/a		n/a
BH-08	Mental Health - IMPACT Application	n/a	n/a	n/a
BH-09	Indigent Medication Application	n/a	n/a	n/a
BH-09a	Indigent Medication Update-Extension Application	n/a	n/a	n/a
BH-11	Behavioral Health Treatment Outcomes Program Manual	n/a	n/a	n/a
BH-11a	Adult SUD Initial Outcome Tool	n/a	n/a	n/a
BH-11b	Adult SUD Update Outcome Tool	n/a	n/a	n/a
BH-11c	Adult SUD Discharge Outcome Tool	n/a	n/a	n/a
BH-11d	Adult MH Initial Outcome Tool	n/a	n/a	n/a
BH-11e	Adult MH Update Outcome Tool	n/a	n/a	n/a
BH-11f	Adult MH Discharge Outcome Tool	n/a	n/a	n/a
BH-12a	Youth SUD Initial Outcome Tool	n/a	n/a	n/a
BH-12b	Youth SUD Update Outcome Tool	n/a	n/a	n/a
BH-12c	Youth SUD Discharge Outcome Tool	n/a	n/a	n/a
BH-12d	Youth MH Initial Outcome Tool	n/a	n/a	n/a
BH-12e	Youth MH Update Outcome Tool	n/a	n/a	n/a
BH-12f	Youth MH Discharge Outcome Tool	n/a	n/a	n/a
BH-13a	Family SUD Initial Outcome Tool	n/a	n/a	n/a
BH-13b	Family SUD Update Outcome Tool	n/a	n/a	n/a
BH-13c	Family SUD Discharge Outcome Tool	n/a	n/a	n/a
BH-13d	Family MH Initial Outcome Tool	n/a	n/a	n/a
BH-13e	Family MH Update Outcome Tool	n/a	n/a	n/a
BH-13f	Family MH Discharge Outcome Tool	n/a	n/a	n/a
BH-14	Substance Abuse - Accreditation Application	n/a		n/a
BH-17	Prevention - Accreditation Application	n/a		n/a
BH-18	Substance Use Disorder High Intensity Referral Form	n/a		n/a
BRO/BH1	Substance Use Disorder Services Brochure	n/a	n/a	n/a
BRO/BH2	Mental Health Services Brochure	n/a	n/a	n/a
BRO/BH3	Quick Reference Guide	n/a		n/a	n/a	n/a
BRO/BH4	Substance Use Disorder Involuntary Commitment Process	n/a	n/a	n/a
MISC/BH1	South Dakota Community Mental Health Center Flyer	n/a	n/a	n/a
MISC/BH2	Suicide Provention Poster	n/a	n/a	n/a
MISC/BH3	Substance Use Disorder Services Flyer	n/a	n/a	n/a

Child Care Services

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/CCS14	Choosing Child Care Handbook	n/a	n/a
BRO/CCS3	Registration & Licensure of Child Care Environments	n/a	n/a
BRO/CCS6	Child Care Assistance Program Brochure	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	Orientation Training Verification Form	n/a	n/a	n/a
CCS	South Dakota Child Safety Seat Distribution Program	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	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	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
Poster	Recommendations for Exclusion from the Child Care Setting Poster	n/a	n/a	n/a
Poster	Reportable Disease List Poster	n/a	n/a	n/a

Child Protection Services

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/CPS1	Child Protection Services Booklet	n/a	n/a
BRO/CPS15	Family Group Conferencing – My Family Meeting	n/a	n/a	n/a
BRO/CPS16	Family Group Conferencing – Family Group Decision Making	n/a	n/a	n/a
BRO/CPS17	Family Group Conferencing – Parents Guide	n/a	n/a	n/a
BRO/CPS18	Family Group Conferencing – Provider Guide	n/a	n/a	n/a
BRO/CPS3	Safe Havens Brochure	n/a	n/a
BRO/CPS7	Independent Living Program Education and Training Voucher Brochure	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	Independent Living Program 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	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
DSS-CPS	Safe Havens Poster	n/a	n/a	n/a
FACIS	Interstate Compact: Placement Request Form			n/a
FACIS	Interstate Compact: Report on Child Placement			n/a

Child Support

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/DCS1	Child Support Modification Handbook	n/a	n/a	n/a
BRO/DCS2	Teenage Parents Guide - How to Establish Paternity and Financial Support for your Child	n/a	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	n/a
BRO/DCS4	National Medical Support Notice Brochure - An Employers Guide	n/a	n/a	n/a
BRO/DCS6	Voluntary Paternity Establishment Handbook and Form	n/a	n/a
BRO/DCS8	Child Support Parent Handbook	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
BRO/EA11	Weatherization Assistance Brochure	n/a	n/a
BRO/EA12	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
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	English Version	Add to Cart
BRO/DSS2	Constituent Liaison Services Brochure	n/a	n/a	n/a
BRO/DSS6	Filing a Discrimination Complaint Brochure and Form	n/a	n/a	n/a
BRO/DSS8	Notice of Privacy Brochure	n/a	n/a
BRO/DSS9	DSS Handbook	n/a	n/a	n/a
BRO/EA	Community Action Agency Handout	n/a	n/a	n/a
BRO/EA1	Energy Saving Tips	n/a	n/a	n/a
BRO/EA18	Long-Term Care Partnership Brochure	n/a	n/a	n/a
BRO/EA19	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
POS/EA02	Long-Term Care Partnership Fact Sheet	n/a	n/a	n/a
Poster	Constituent Liaison Services Poster	n/a	n/a	n/a

Medical Eligibility

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/EA14	Medical Assistance for Children and Families	n/a	n/a	n/a
BRO/EA16	Medical Assistance for Children and Families: IHS Specific	n/a	n/a	n/a
BRO/EA5	Medicare Savings Program Brochure	n/a	n/a	n/a
BRO/EA8	Medicaid Spousal Care Handbook	n/a	n/a	n/a
BRO/MS1	Medical Assistance Program Recipient Handbook	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-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
Poster	CHIP Poster	n/a	n/a	n/a
Poster	CHIP Poster	n/a	n/a	n/a

Medical Services

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
	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
BRO/MS1	Medical Assistance Program Recipient Handbook	n/a	n/a
BRO/MS3	Well-Child Care Brochure	n/a	n/a
BRO/MS4	Medicaid Non-Emergency Medical Travel Brochure	n/a	n/a	n/a
BRO/MS6	Health Home Brochure	n/a	n/a	n/a
MS	Medicaid Transportation Documentation Form	n/a	n/a	n/a
MS	Hysterectomy Acknowledgement of Information	n/a	n/a	n/a
MS	Hospice Notification	n/a	n/a	n/a
MS	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	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	Providers: Adult Services & Aging Provider Agreement		n/a	n/a
MS	Medicaid Credit Balance Report Form	n/a		n/a	n/a	n/a
MS	Providers: NEMT Provider Agreement			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	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: BRCA	n/a	n/a	n/a
PA	Prior Authorization Forms: Synagis	n/a	n/a	n/a
PA	Prior Authorization Forms: Applied Behavior Analysis Therapy	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

Parent Education

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/CPS2	Common Sense Parenting Brochure	n/a	n/a
CPS	Common Sense Parenting Annual Report Form	n/a		n/a	n/a	n/a
CPS	Common Sense Parenting Program Voucher	n/a		n/a	n/a	n/a

Psychiatric Residential Treatment

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
DSS	Psychiatric Residential Treatment Facility Referral Form	n/a	n/a	n/a

Recoveries and Fraud

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/RE1	Stop Benefit Fraud Brochure	n/a	n/a
BRO/RE3	Estate Recovery Program Brochure	n/a	n/a	n/a
BRO/RE4	Medicaid Liens Brochure	n/a	n/a	n/a
DSS-ORFI-831	Estate Recovery Notification of Death Form	n/a	n/a	n/a
Rec and Fraud	Estate Recovery Program Petition for Limitation	n/a		n/a
Rec and Fraud	Report Benefit Fraud	n/a		n/a
Rec and Fraud	Casualty Settlement Report Form	n/a		n/a
Rec and Fraud	Stop Benefit Fraud Insert	n/a	n/a	n/a

SNAP (Food Stamps)

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/EA10	SNAP for Students	n/a	n/a	n/a
BRO/EA2	SNAP Brochure	n/a	n/a
BRO/EA9	SNAP Shoppers Guide	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

South Dakota EBT

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
BRO/DSS4	Direct Deposit Brochure	n/a	n/a	n/a
BRO/EBT1	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
BRO/EA4	TANF Work Program 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
EA-320	Self-Employment Ledger	n/a