Forms & Publications :: SD Dept. of Social Services

Cabinet Secretary
Laurie R. Gill

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Below you will find the selected forms and/or publications for this order. You will need to indicate the quantity you want to receive in the box next to the document number. After you have entered the quantity, click "Update" in the previous box. If you wish to remove a form or publication, simply click on the link that states "Delete." Once you have entered the quantity for each form or publication, click the "Proceed" button at the bottom.

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Copies	Edit the Number of Copies	Document Number	Document Name	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA-265	Request for Long-Term Care or Home Community Based Services Waiver Assistance	Delete
1	Edit	BRODSS08	Notice of Privacy Brochure	Delete
1	Edit	POSMS05	Well Visit Poster	Delete
1	Edit	EA-214	TANF 6 Month Report Form	Delete
1	Edit	CCS	Electronic Payment Exemptions	Delete
1	Edit	BRODSS03	Administrative Hearings Brochure	Delete
1	Edit	FLYRBH01	South Dakota Community Mental Health Center Flyer	Delete
1	Edit	BROMS05	Well Visit Rack Card	Delete
1	Edit	MS-146	Sterilization Consent Form	Delete
1	Edit	BROEA01	Energy Saving Tips	Delete
1	Edit	FLYREA15	Emergency Services for SD Flyer	Delete
1	Edit	CCS	Payment Authorization Form	Delete
1	Edit	EA-345A	Affidavit for SNAP Work Registrants (Employment & Training)	Delete
1	Edit	CCS-950	Child Care Assistance Application	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	EA-260	Statement of Earnings	Delete
1	Edit	BROCPS03	Safe Havens Brochure	Delete
1	Edit	BROCPS13	Young Voices Brochure	Delete
1	Edit	BROCCS06	Child Care Assistance Program Brochure	Delete
1	Edit	BROEA04	TANF Brochure	Delete
1	Edit	HDBKCPS01	Child Protection Services Booklet	Delete
1	Edit	FLYRBH04	Juvenile Justice Reinvestment Initiative Flyer	Delete
1	Edit	POSEA03	CHIP Poster	Delete
1	Edit	BROEA16	Medical Assistance for Children and Families: IHS Specific	Delete
1	Edit	BROBH04	Substance Use Disorder Involuntary Commitment Process	Delete
1	Edit	EA-249	Disabled Children's Program Application	Delete
1	Edit	HDBKDSS09	DSS Handbook	Delete
1	Edit	FLYRBH05	Substance Use Prevention Services Flyer	Delete
1	Edit	EA-347	Application for Social Security Number	Delete
1	Edit	FLYRBH06	Criminal Justice Initiative Flyer	Delete
1	Edit	SE408NCP	Application and Agreement for Services - Non-Custodial Parent	Delete
1	Edit	BROMS02	Provider Selection Rack Card	Delete
1	Edit	CPS-522	Request for Payment	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	BROHSC01	Mental Health Wellness and Recovery Phone Apps Brochure	Delete
1	Edit	EA-305	Boarding School-Institution Documentation	Delete
1	Edit	HDBKMS01	Medical Assistance Program Recipient Handbook	Delete
1	Edit	EA-301	SNAP Application	Delete
1	Edit	EA-298	Weatherization Application	Delete
1	Edit	BROEA11	Weatherization Assistance Brochure	Delete
1	Edit	SE-415	Petition for Modification Form	Delete
1	Edit	EA-270	Medical Savings Program Application	Delete