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List of Documents to be Ordered

CopiesDocument NumberDocument Name
1EA-301Economic Assistance Application
1SE-415Petition for Modification Form
1CPS-533Adoption Registry Form
1MS 18Constituent Liaison Services Poster
1MS 26BabyReady Poster
1MS-146Sterilization Consent Form
1ORFI-832Estate Recovery Program Petition for Limitation
1CPS-100AFACIS Interstate Compact: Placement Request Form
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1EA 09SNAP Shoppers Guide
1CPS 07Independent Living Program Education and Training Voucher Brochure
1MS 07Premium Assistance Rack Card
1BH 16Pregnancy Alcohol Flyer
1CPS-100AFACIS Interstate Compact: Placement Request Form
1CPS 05Positive Indian Parenting Brochure
1CPS 10Independent Living Program Brochure
1PA-102Prior Authorization Forms: Applied Behavior Analysis Therapy
1ENERGYVendor Information: Direct Deposit
1ORFI-832Estate Recovery Program Petition for Limitation
1OLA 03Office of Licensing and Accreditation Brochure
1CPSICPC Financial and Medical Plan
1CCS-970Child Care Services Request For Payment
1DCS 08Child Support Parent Handbook
1PA-100Prior Authorization Forms: General
1CPS-100Independent Living Program Education and Training Voucher
1EA-301Economic Assistance Application
1CPS 20Foster Care Realities
1BH 10South Dakota Community Mental Health Center Flyer
1CPS-533Adoption Registry Form
1RE 04Medicaid Liens Brochure
1BH 15Criminal Justice Initiative Flyer
1-To Order Let’s Be Clear Materials
1CPS-522Request for Payment
1MS 03Well-Child Care Brochure
1BH 16Pregnancy Alcohol Flyer
1PA-100Prior Authorization Forms: General
1CPS-506Foster/Adoptive Parent Health Report
1DCS 06Voluntary Paternity Establishment Handbook and Form
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1EA 14CHIP Rack Card
1EAFSSAChildren and Family Medical Assistance Application
1EA 23CHIP Poster
1OLA 03Office of Licensing and Accreditation Brochure
1CPS 22Foster Care Handbook
1DCS 08Child Support Parent Handbook
1EA-301Economic Assistance Application
1ORFI-831Estate Recovery Notification of Death Form
1CPS-100Independent Living Program Education and Training Voucher
1PA-108Prior Authorization Form: Incontinence Supply All Waivers
1MS 26BabyReady Poster
1MS-146Sterilization Consent Form
1CPS-533Adoption Registry Form
1CPS-100AFACIS Interstate Compact: Placement Request Form
1CPS 07Independent Living Program Education and Training Voucher Brochure
1CPS 05Positive Indian Parenting Brochure
1CPS 10Independent Living Program Brochure
1EA 09SNAP Shoppers Guide
1CPS-100AFACIS Interstate Compact: Placement Request Form
1BH 16Pregnancy Alcohol Flyer
1SE-431AChild Support Payment Authorization Form
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1ENERGYVendor Information: Direct Deposit
1OLA 03Office of Licensing and Accreditation Brochure
1DCS 08Child Support Parent Handbook
1CPSICPC Financial and Medical Plan
1CCS-970Child Care Services Request For Payment
1PA-103Prior Authorization Forms: Synagis
1EA-208Authorization to Furnish / Release Information
1CPS 20Foster Care Realities
1EA-301Economic Assistance Application
1EA-270Medicare Savings Program Application
1EA 19Guide to Assistance Handbook
1CPS-100Independent Living Program Education and Training Voucher
1EA-208Authorization to Furnish / Release Information
1BH 15Criminal Justice Initiative Flyer
1CPS-533Adoption Registry Form
1MS 03Well-Child Care Brochure
1EA-208Authorization to Furnish / Release Information
1BH 16Pregnancy Alcohol Flyer
1-To Order Let’s Be Clear Materials
1CPS-522Request for Payment
1CPS-506Foster/Adoptive Parent Health Report
1DCS 06Voluntary Paternity Establishment Handbook and Form
1CPS 22Foster Care Handbook
1EA 23CHIP Poster
1NEMT-964Non-Emergency Medical Travel (NEMT) HIPAA Authorization
1OLA-103Child Care Declaration of Prior Criminal Conviction and Military History
1DCS 08Child Support Parent Handbook
1CPS-565Foster Parent Training & Self-Instruction
1OLA 03Office of Licensing and Accreditation Brochure
1SE-415Petition for Modification Form