Mobile Menu Button

Checkout Information

Please complete the below information so the order can be processed. All fields below are required.

Contact Information

Name: *
Address: *
City: *
State: *
Zip: *
Phone: *
--
Email: *


List of Documents to be Ordered

CopiesDocument NumberDocument Name
1CPS-100Independent Living Program Education and Training Voucher
1CPSPotential Placement Statement
1DCS 06Voluntary Paternity Establishment Handbook and Form
1MS 07Premium Assistance Rack Card
1EA-307SNAP Exit Form
1BH 24Behavioral Health Resources Flyer
1-To Order Let’s Be Clear Materials
1CPS 22Foster Care Handbook
1MS 18Constituent Liaison Services Poster
1EA-208Authorization to Furnish / Release Information
1BH 16Pregnancy Alcohol Flyer
1EA-208Authorization to Furnish / Release Information
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1CPS 05Positive Indian Parenting Brochure
1EAFSSAChildren and Family Medical Assistance Application
1EA-270Medicare Savings Program Application
1RE 04Medicaid Liens Brochure
1CCS-970Child Care Services Request For Payment
1MS-146Sterilization Consent Form
1EA-301Economic Assistance Application
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1MS 02Provider Selection Rack Card
1PA-102Prior Authorization Forms: Applied Behavior Analysis Therapy
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1ORFI-831Estate Recovery Notification of Death Form
1CPS-100Independent Living Program Education and Training Voucher
1CPS-565Foster Parent Training & Self-Instruction
1DCS 06Voluntary Paternity Establishment Handbook and Form
1MS 18Constituent Liaison Services Poster
1MS 07Premium Assistance Rack Card
1MS 26BabyReady Poster
1EA-208Authorization to Furnish / Release Information
1BH 16Pregnancy Alcohol Flyer
1CPS 22Foster Care Handbook
1BH 15Criminal Justice Initiative Flyer
1CPSPotential Placement Statement
1EA-208Authorization to Furnish / Release Information
1CPS-100AFACIS Interstate Compact: Placement Request Form
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1CPS 05Positive Indian Parenting Brochure
1OLA 03Office of Licensing and Accreditation Brochure
1EA-270Medicare Savings Program Application
1CCS-970Child Care Services Request For Payment
1CPS-522Request for Payment
1MS-146Sterilization Consent Form
1EAFSSAChildren and Family Medical Assistance Application
1RE 04Medicaid Liens Brochure
1CPS 20Foster Care Realities
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1EA 23CHIP Poster
1CPSICPC Financial and Medical Plan
1EA-301Economic Assistance Application
1-To Order Let’s Be Clear Materials
1PA-106Prior Authorization Forms: Genetic Testing
1DCS 06Voluntary Paternity Establishment Handbook and Form
1MS 07Premium Assistance Rack Card
1MS 18Constituent Liaison Services Poster
1BH 16Pregnancy Alcohol Flyer
1BH 15Criminal Justice Initiative Flyer
1CPS-100Independent Living Program Education and Training Voucher
1EA-208Authorization to Furnish / Release Information
1PA-100Prior Authorization Forms: General
1EA-208Authorization to Furnish / Release Information
1EA-270Medicare Savings Program Application
1DSS 08Notice of Privacy Brochure
1CPS 22Foster Care Handbook
1PA-100Prior Authorization Forms: General
1CPS 05Positive Indian Parenting Brochure
1EAFSSAChildren and Family Medical Assistance Application
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1RE 04Medicaid Liens Brochure
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1EA 23CHIP Poster
1CPS-100AFACIS Interstate Compact: Placement Request Form
1MS 07Premium Assistance Rack Card
1MS 26BabyReady Poster
1MS 18Constituent Liaison Services Poster
1BH 16Pregnancy Alcohol Flyer
1CPSPotential Placement Statement
1DSS-CCSRate Declaration Form
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1CPS-100Independent Living Program Education and Training Voucher
1DCS 06Voluntary Paternity Establishment Handbook and Form
1BH 15Criminal Justice Initiative Flyer
1CPSPotential Placement Statement
1CPS-522Request for Payment
1RE 04Medicaid Liens Brochure
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1CPSICPC Financial and Medical Plan
1-To Order Let’s Be Clear Materials
1EA-301Economic Assistance Application
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1MS 07Premium Assistance Rack Card
1MS 18Constituent Liaison Services Poster
1ORFI-832Estate Recovery Program Petition for Limitation
1CPS-100Independent Living Program Education and Training Voucher
1DCS 06Voluntary Paternity Establishment Handbook and Form
1EA-208Authorization to Furnish / Release Information
1ENERGYVendor Information: Direct Deposit
1CPS 22Foster Care Handbook
1PA-102Prior Authorization Forms: Applied Behavior Analysis Therapy
1CPS 05Positive Indian Parenting Brochure
1EA-208Authorization to Furnish / Release Information
1CPS-522Request for Payment
1RE 04Medicaid Liens Brochure
1ORFI-832Estate Recovery Program Petition for Limitation
1EA-270Medicare Savings Program Application
1CPS-565Foster Parent Training & Self-Instruction
1EA 23CHIP Poster
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1CPSICPC Financial and Medical Plan
1EA-301Economic Assistance Application
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1BH 16Pregnancy Alcohol Flyer
1CPS-100AFACIS Interstate Compact: Placement Request Form
1CPSPotential Placement Statement
1MS 26BabyReady Poster
1OLA 03Office of Licensing and Accreditation Brochure
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1BH 15Criminal Justice Initiative Flyer
1MS 18Constituent Liaison Services Poster
1MS-146Sterilization Consent Form
1EA-208Authorization to Furnish / Release Information
1CPS 05Positive Indian Parenting Brochure
1EA-208Authorization to Furnish / Release Information
1CPS 20Foster Care Realities
1BH 10South Dakota Community Mental Health Center Flyer
1RE 04Medicaid Liens Brochure
1EA-270Medicare Savings Program Application
1CPS 10Independent Living Program Brochure
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1CPS-522Request for Payment
1EA 09SNAP Shoppers Guide
1EA 23CHIP Poster
1MS 07Premium Assistance Rack Card
1CPS 07Independent Living Program Education and Training Voucher Brochure
1MS 26BabyReady Poster
1CPS-100Independent Living Program Education and Training Voucher
1CPSICPC Financial and Medical Plan
1DCS 06Voluntary Paternity Establishment Handbook and Form
1BH 15Criminal Justice Initiative Flyer
1MS 18Constituent Liaison Services Poster
1MS-146Sterilization Consent Form
1CPS 22Foster Care Handbook
1CPS 05Positive Indian Parenting Brochure
1CPS-100AFACIS Interstate Compact: Placement Request Form
1RE 04Medicaid Liens Brochure
1EA-270Medicare Savings Program Application
1CPS-522Request for Payment
1EA 23CHIP Poster
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1DCS 06Voluntary Paternity Establishment Handbook and Form
1MS 07Premium Assistance Rack Card
1BH 16Pregnancy Alcohol Flyer
1CPSICPC Financial and Medical Plan
1EAFSSAChildren and Family Medical Assistance Application
1CPSPotential Placement Statement
1MS 26BabyReady Poster
1DSS-CCSRate Declaration Form
1BH 15Criminal Justice Initiative Flyer
1EA 19Guide to Assistance Handbook
1MS-146Sterilization Consent Form
1MS 18Constituent Liaison Services Poster
1EA-301Economic Assistance Application
1CCS-970Child Care Services Request For Payment
1EA-208Authorization to Furnish / Release Information
1EA-208Authorization to Furnish / Release Information
1-To Order Let’s Be Clear Materials
1EA-270Medicare Savings Program Application
1EA 09SNAP Shoppers Guide
1RE 04Medicaid Liens Brochure
1CPS 20Foster Care Realities
1EA 23CHIP Poster
1DCS 08Child Support Parent Handbook
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1CPS-522Request for Payment
1CPS-100Independent Living Program Education and Training Voucher
1MS 07Premium Assistance Rack Card
1ENERGYVendor Information: Direct Deposit
1MS 26BabyReady Poster
1BH 15Criminal Justice Initiative Flyer
1BH 16Pregnancy Alcohol Flyer
1MS-146Sterilization Consent Form
1EA 01Energy Saving Tips
1CPS 05Positive Indian Parenting Brochure
1DSS-CCSRate Declaration Form
1CPS 22Foster Care Handbook
1CPS-533Adoption Registry Form
1RE 04Medicaid Liens Brochure
1CPS-522Request for Payment
1CPS-100AFACIS Interstate Compact: Placement Request Form
1DCS 06Voluntary Paternity Establishment Handbook and Form
1EA 23CHIP Poster
1EA-301Economic Assistance Application
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1CPSICPC Financial and Medical Plan
1CPSPotential Placement Statement
1EAFSSAChildren and Family Medical Assistance Application
1MS 07Premium Assistance Rack Card
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1CPS-100AFACIS Interstate Compact: Placement Request Form
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1MS 18Constituent Liaison Services Poster
1MS 26BabyReady Poster
1EA-208Authorization to Furnish / Release Information
1MS-146Sterilization Consent Form
1EA-270Medicare Savings Program Application
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1CPS 20Foster Care Realities
1BH 16Pregnancy Alcohol Flyer
1EA-208Authorization to Furnish / Release Information
1DSS-CCSRate Declaration Form
1CPS-506Foster/Adoptive Parent Health Report
1CPS 22Foster Care Handbook
1DCS 08Child Support Parent Handbook
1BH 15Criminal Justice Initiative Flyer
1RE 04Medicaid Liens Brochure
1CPS-522Request for Payment
1EA-301Economic Assistance Application
1ENERGYVendor Information: Direct Deposit
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1MS 26BabyReady Poster
1CPS 05Positive Indian Parenting Brochure
1CPSPotential Placement Statement
1EA 19Guide to Assistance Handbook
1CPSICPC Financial and Medical Plan
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1EAFSSAChildren and Family Medical Assistance Application
1CCS-970Child Care Services Request For Payment
1-To Order Let’s Be Clear Materials
1EA 23CHIP Poster
1MS 26BabyReady Poster
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1EA-301Economic Assistance Application
1EA 09SNAP Shoppers Guide
1CPS 22Foster Care Handbook
1DCS 08Child Support Parent Handbook
1DSS-CCSRate Declaration Form
1CPS-100Independent Living Program Education and Training Voucher
1MS 01Medical Assistance Program Recipient Handbook
1RE 04Medicaid Liens Brochure
1ENERGYVendor Information: Direct Deposit
1CPS 20Foster Care Realities
1CPSICPC Financial and Medical Plan
1CPS-522Request for Payment
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1CPS-533Adoption Registry Form
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1MS 26BabyReady Poster
1EA 01Energy Saving Tips
1EA 09SNAP Shoppers Guide
1EA-301Economic Assistance Application
1EA 14CHIP Rack Card
1MS 07Premium Assistance Rack Card
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1CCS-970Child Care Services Request For Payment
1DCS 06Voluntary Paternity Establishment Handbook and Form
1CPS 20Foster Care Realities
1BH 16Pregnancy Alcohol Flyer
1EAFSSAChildren and Family Medical Assistance Application
1CPS-100AFACIS Interstate Compact: Placement Request Form
1EA 23CHIP Poster
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1CPS-100AFACIS Interstate Compact: Placement Request Form
1EA-208Authorization to Furnish / Release Information
1CPSICPC Financial and Medical Plan
1EA-270Medicare Savings Program Application
1CPS-533Adoption Registry Form
1CPS-506Foster/Adoptive Parent Health Report
1CPS-522Request for Payment
1BH 15Criminal Justice Initiative Flyer
1CPS 22Foster Care Handbook
1DSS-CCSRate Declaration Form
1EA-301Economic Assistance Application
1EA 09SNAP Shoppers Guide
1EA-208Authorization to Furnish / Release Information
1DCS 08Child Support Parent Handbook
1RE 04Medicaid Liens Brochure
1ENERGYVendor Information: Direct Deposit
1CPS 20Foster Care Realities
1CPS 05Positive Indian Parenting Brochure
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1CPSICPC Financial and Medical Plan
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1EA 23CHIP Poster
1MS 26BabyReady Poster
1MS-146Sterilization Consent Form
1CPS-100AFACIS Interstate Compact: Placement Request Form
1EA-240Application for Resource Assessment, Long Term Care or Related Medical Assistance
1CPS-533Adoption Registry Form
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1EA 09SNAP Shoppers Guide
1SE-415Petition for Modification Form
1EA 14CHIP Rack Card
1CPS-506Foster/Adoptive Parent Health Report
1CPSPotential Placement Statement
1EA 19Guide to Assistance Handbook
1CCS-970Child Care Services Request For Payment
1EAFSSAChildren and Family Medical Assistance Application
1BH 16Pregnancy Alcohol Flyer
1-To Order Let’s Be Clear Materials
1CPS 20Foster Care Realities
1CPS 05Positive Indian Parenting Brochure
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1RE 04Medicaid Liens Brochure
1EA 23CHIP Poster
1BH 15Criminal Justice Initiative Flyer
1CPS-522Request for Payment
1EA-301Economic Assistance Application
1DSS-CCSRate Declaration Form
1EA 09SNAP Shoppers Guide
1SE-431AChild Support Payment Authorization Form
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1DCS 08Child Support Parent Handbook
1CPS-533Adoption Registry Form
1CPS-565Foster Parent Training & Self-Instruction
1CCS-970Child Care Services Request For Payment
1PA-102Prior Authorization Forms: Applied Behavior Analysis Therapy
1EAFSSAChildren and Family Medical Assistance Application
1-To Order Let’s Be Clear Materials
1CPS 22Foster Care Handbook
1CPSICPC Financial and Medical Plan
1EA 01Energy Saving Tips
1CPS 20Foster Care Realities
1RE 04Medicaid Liens Brochure
1CPS 05Positive Indian Parenting Brochure
1BH 15Criminal Justice Initiative Flyer
1EA 09SNAP Shoppers Guide
1CPS-506Foster/Adoptive Parent Health Report
1SE-415Petition for Modification Form
1EA 11Weatherization Assistance Brochure
1MS 01Medical Assistance Program Recipient Handbook
1CCS 14Choosing Child Care Handbook
1CPS-504Present Danger Plan
1EBT 01EBT Client Handbook
1CPS 21Foster Care Myths & Facts
1CCS 06Child Care Assistance Program Brochure
1CPS 01Child Protection Services Booklet
1MS 10Medicaid Pregnancy Handbook
1BH 04Substance Use Disorder Involuntary Commitment Process
1RE 03Estate Recovery Program Brochure
1MS 15Well Visit Poster
1MS 04Medicaid Non-Emergency Medical Travel Brochure
1CPS 23Safe Havens Poster
1CPS 20NFoster Care Realities (Native American Theme)
1CPS 02Common Sense Parenting Brochure
1MS 13Behavioral Health Resources
1DCS 01Child Support Modification Handbook
1EA 12Energy Assistance Brochure
1CPS 14Young Voices Handbook
1MS 08Constituent Liaison Services Brochure
1CPS 09Adoption Subsidy Program
1DSS 03Administrative Hearings Brochure
1DCS 04National Medical Support Notice Brochure
1BH 26Working in Behavioral Health
1DCS 03Income & Wage Withholding Brochure
1CCS 10SD Child Development Associate Training Program
1EA 16Medical Assistance for Children and Families: IHS Specific
1BH 14Substance Use Prevention Services Flyer
1EA 18Long-Term Care Partnership Brochure
1CPS 13Young Voices Brochure
1EA 10SNAP for Students
1BH 05Intensive Methamphetamine Treatment Services
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1DCS 08Child Support Parent Handbook
1OLA 03Office of Licensing and Accreditation Brochure
1EA 19Guide to Assistance Handbook
1EA 14CHIP Rack Card
1BH 10South Dakota Community Mental Health Center Flyer
1BH 16Pregnancy Alcohol Flyer
1CPS 10Independent Living Program Brochure
1EAFSSAChildren and Family Medical Assistance Application
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1EA-270Medicare Savings Program Application
1CPS-533Adoption Registry Form
1CPS 07Independent Living Program Education and Training Voucher Brochure
1CPS 22Foster Care Handbook
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1CPS 05Positive Indian Parenting Brochure
1EA 23CHIP Poster
1CPS-100AFACIS Interstate Compact: Placement Request Form
1RE 04Medicaid Liens Brochure
1CPS-100AFACIS Interstate Compact: Placement Request Form
1BH 15Criminal Justice Initiative Flyer
1-To Order Let’s Be Clear Materials
1DSS-CCSRate Declaration Form
1EA 09SNAP Shoppers Guide
1DCS 08Child Support Parent Handbook
1EA 14CHIP Rack Card
1SE-415Petition for Modification Form
1CPSICPC Financial and Medical Plan
1PA-102Prior Authorization Forms: Applied Behavior Analysis Therapy
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1ENERGYVendor Information: Direct Deposit
1CPS-533Adoption Registry Form
1CPS-533Adoption Registry Form
1MS-146Sterilization Consent Form
1CPS 05Positive Indian Parenting Brochure
1DSS-CCSRate Declaration Form
1CPS 20Foster Care Realities
1RE 04Medicaid Liens Brochure
1-To Order Let’s Be Clear Materials
1CPSPotential Placement Statement
1BH 15Criminal Justice Initiative Flyer
1CPS-506Foster/Adoptive Parent Health Report
1BH 10South Dakota Community Mental Health Center Flyer
1EA 14CHIP Rack Card
1EA 19Guide to Assistance Handbook
1DCS 08Child Support Parent Handbook
1SE-415Petition for Modification Form
1DSS-CCSRate Declaration Form
1BH 16Pregnancy Alcohol Flyer
1OLA 03Office of Licensing and Accreditation Brochure
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1EAFSSAChildren and Family Medical Assistance Application
1CPS 07Independent Living Program Education and Training Voucher Brochure
1PA-108Prior Authorization Form: Incontinence Supply All Waivers
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1CPS 22Foster Care Handbook
1CPS-100AFACIS Interstate Compact: Placement Request Form
1MS-146Sterilization Consent Form
1CPS 05Positive Indian Parenting Brochure
1CPS-522Request for Payment
1EA-270Medicare Savings Program Application
1CPS-100AFACIS Interstate Compact: Placement Request Form
1EA 23CHIP Poster
1CPS-533Adoption Registry Form
1EA-301Economic Assistance Application
1RE 04Medicaid Liens Brochure
1BH 15Criminal Justice Initiative Flyer
1-To Order Let’s Be Clear Materials
1BH 10South Dakota Community Mental Health Center Flyer
1CPS-506Foster/Adoptive Parent Health Report
1DCS 08Child Support Parent Handbook
1BH 16Pregnancy Alcohol Flyer
1EA 14CHIP Rack Card
1CCS-970Child Care Services Request For Payment
1DSS-CCSRate Declaration Form
1EA 09SNAP Shoppers Guide
1CPS-565Foster Parent Training & Self-Instruction
1EA 01Energy Saving Tips
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1OLA 03Office of Licensing and Accreditation Brochure
1CPS 07Independent Living Program Education and Training Voucher Brochure
1PA-102Prior Authorization Forms: Applied Behavior Analysis Therapy
1CPS-533Adoption Registry Form
1CPS 05Positive Indian Parenting Brochure
1MS-100Recipient Forms: HIPAA Privacy Consent Form
1BH 15Criminal Justice Initiative Flyer
1RE 04Medicaid Liens Brochure
1MS-146Sterilization Consent Form
1-To Order Let’s Be Clear Materials
1SE-415Petition for Modification Form
1MS 18Constituent Liaison Services Poster
1EA 19Guide to Assistance Handbook
1CPS-506Foster/Adoptive Parent Health Report
1NEMT-952Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form
1BH 10South Dakota Community Mental Health Center Flyer
1EA 14CHIP Rack Card
1DSS-CCSRate Declaration Form
1PA-108Prior Authorization Form: Incontinence Supply All Waivers