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List of Documents to be Ordered

CopiesDocument NumberDocument Name
1CPS-533Adoption Registry Form
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1MS-146Sterilization Consent Form
1MS 07Premium Assistance Rack Card
1OLA 03Office of Licensing and Accreditation Brochure
1CPS 20Foster Care Realities
1SE-431AChild Support Payment Authorization Form
1RE 04Medicaid Liens Brochure
1CPS-100AFACIS Interstate Compact: Placement Request Form
1DSS-CCSRate Declaration Form
1BH 15Criminal Justice Initiative Flyer
1BH 16Pregnancy Alcohol Flyer
1EA-301Economic Assistance Application
1ENERGYVendor Information: Direct Deposit
1CPSICPC Financial and Medical Plan
1EA-320Self-Employment Ledger
1EA-214SNAP 6 Month Report Form
1EA-301SNAP Application
1EA 22SNAP Notice of Rights Poster
1MS 03Well-Child Care Brochure
1DCS 08Child Support Parent Handbook
1EA 14CHIP Rack Card
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1CPS 10Independent Living Program Brochure
1CPS-100Independent Living Program Education and Training Voucher
1CPS-522Request for Payment
1CPS-100AFACIS Interstate Compact: Placement Request Form
1EA 09SNAP Shoppers Guide
1-To Order Let’s Be Clear Materials
1CPS 07Independent Living Program Education and Training Voucher Brochure
1CPS-533Adoption Registry Form
1DSS-CCSRate Declaration Form
1PA-100Prior Authorization Forms: General
1EA-301Economic Assistance Application
1OLA 03Office of Licensing and Accreditation Brochure
1MS 26BabyReady Poster
1CPS-506Foster/Adoptive Parent Health Report
1BH 24Behavioral Health Resources Flyer
1BH 16Pregnancy Alcohol Flyer
1EA 19Guide to Assistance Handbook
1CCS-970Child Care Services Request For Payment
1CPS 22Foster Care Handbook
1DCS 06Voluntary Paternity Establishment Handbook and Form
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1CPS-100Independent Living Program Education and Training Voucher
1DCS 08Child Support Parent Handbook
1CPS 05Positive Indian Parenting Brochure
1EA 23CHIP Poster
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1EA-208Authorization to Furnish / Release Information
1CPS-533Adoption Registry Form
1MS-146Sterilization Consent Form
1RE 04Medicaid Liens Brochure
1EA-208Authorization to Furnish / Release Information
1CPSPotential Placement Statement
1EA 01Energy Saving Tips
1DSS-CCSRate Declaration Form
1ORFI-831Estate Recovery Notification of Death Form
1CPS-100AFACIS Interstate Compact: Placement Request Form
1ENERGYVendor Information: Direct Deposit
1CPS-565Foster Parent Training & Self-Instruction
1CPSICPC Financial and Medical Plan
1EAFSSAChildren and Family Medical Assistance Application
1CPS 20Foster Care Realities
1EA-301Economic Assistance Application
1BH 16Pregnancy Alcohol Flyer
1OLA 03Office of Licensing and Accreditation Brochure
1BH 15Criminal Justice Initiative Flyer
1MS 18Constituent Liaison Services Poster
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1PA-100Prior Authorization Forms: General
1CPS 10Independent Living Program Brochure
1EA 09SNAP Shoppers Guide
1CPS-100Independent Living Program Education and Training Voucher
1CPS-100AFACIS Interstate Compact: Placement Request Form
1MS 03Well-Child Care Brochure
1-To Order Let’s Be Clear Materials
1EA 14CHIP Rack Card
1PA-102Prior Authorization Forms: Applied Behavior Analysis Therapy
1CPS 07Independent Living Program Education and Training Voucher Brochure
1EA-270Medicare Savings Program Application
1CPS-533Adoption Registry Form
1CPS-522Request for Payment
1DSS-CCSRate Declaration Form
1SE-415Petition for Modification Form
1DCS 08Child Support Parent Handbook
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1CPS-506Foster/Adoptive Parent Health Report
1EA-301Economic Assistance Application
1BH 10South Dakota Community Mental Health Center Flyer
1CCS-970Child Care Services Request For Payment
1OLA 03Office of Licensing and Accreditation Brochure
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1BH 16Pregnancy Alcohol Flyer
1DCS 06Voluntary Paternity Establishment Handbook and Form
1CPS 05Positive Indian Parenting Brochure
1CPS 22Foster Care Handbook
1CPS-100Independent Living Program Education and Training Voucher
1MS 26BabyReady Poster
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1MS 07Premium Assistance Rack Card
1EA 23CHIP Poster
1CPS-533Adoption Registry Form
1DSS-CCSRate Declaration Form
1RE 04Medicaid Liens Brochure
1MS-146Sterilization Consent Form
1ENERGYVendor Information: Direct Deposit
1DCS 08Child Support Parent Handbook
1CPS 20Foster Care Realities
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1BH 16Pregnancy Alcohol Flyer
1MS 03Well-Child Care Brochure
1EA-301Economic Assistance Application
1CPS-100AFACIS Interstate Compact: Placement Request Form
1CPS-100AFACIS Interstate Compact: Placement Request Form
1EA 14CHIP Rack Card
1OLA 03Office of Licensing and Accreditation Brochure
1BH 15Criminal Justice Initiative Flyer
1EA 09SNAP Shoppers Guide
1CPS 10Independent Living Program Brochure
1CPS 07Independent Living Program Education and Training Voucher Brochure
1CPS-100Independent Living Program Education and Training Voucher
1CPSICPC Financial and Medical Plan
1CPS-522Request for Payment
1DSS-CCSRate Declaration Form
1-To Order Let’s Be Clear Materials
1PA-100Prior Authorization Forms: General
1EA 19Guide to Assistance Handbook
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1CPS-506Foster/Adoptive Parent Health Report
1DCS 08Child Support Parent Handbook
1CCS-970Child Care Services Request For Payment
1CPS-533Adoption Registry Form
1DCS 06Voluntary Paternity Establishment Handbook and Form
1CPS 22Foster Care Handbook
1BH 16Pregnancy Alcohol Flyer
1CPS 05Positive Indian Parenting Brochure
1EA-208Authorization to Furnish / Release Information
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1EA-301Economic Assistance Application
1OLA 03Office of Licensing and Accreditation Brochure
1CPS-100Independent Living Program Education and Training Voucher
1MS 26BabyReady Poster
1EA-208Authorization to Furnish / Release Information
1ORFI-831Estate Recovery Notification of Death Form
1DSS-CCSRate Declaration Form
1RE 04Medicaid Liens Brochure
1CPS-565Foster Parent Training & Self-Instruction
1ENERGYVendor Information: Direct Deposit
1MS-146Sterilization Consent Form
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1DCS 08Child Support Parent Handbook
1EA 23CHIP Poster
1EAFSSAChildren and Family Medical Assistance Application
1CPS 20Foster Care Realities
1CPS-533Adoption Registry Form
1CPS-100AFACIS Interstate Compact: Placement Request Form
1MS 03Well-Child Care Brochure
1PA-100Prior Authorization Forms: General
1CPS-100Independent Living Program Education and Training Voucher
1EA 23CHIP Poster
1PA-103Prior Authorization Forms: Synagis
1PA-102Prior Authorization Forms: Applied Behavior Analysis Therapy
1SE-415Petition for Modification Form
1CPS-533Adoption Registry Form
1PA-100Prior Authorization Forms: General
1EA 09SNAP Shoppers Guide
1CPS-506Foster/Adoptive Parent Health Report
1DSS-CCSRate Declaration Form
1EA-301Economic Assistance Application
1EA 19Guide to Assistance Handbook
1CPS-522Request for Payment
1DCS 08Child Support Parent Handbook
1BH 10South Dakota Community Mental Health Center Flyer
1SE-431AChild Support Payment Authorization Form
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1CPS-100Independent Living Program Education and Training Voucher
1OLA 03Office of Licensing and Accreditation Brochure
1CPS 10Independent Living Program Brochure
1BH 16Pregnancy Alcohol Flyer
1CPS 22Foster Care Handbook
1EA-208Authorization to Furnish / Release Information
1ENERGYVendor Information: Direct Deposit
1CCS-970Child Care Services Request For Payment
1CPS 05Positive Indian Parenting Brochure