Forms & Publications :: SD Dept. of Social Services

Cabinet Secretary
Matt Althoff

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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	MS 26	BabyReady Poster	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	CCS-970	Child Care Services Request For Payment	Delete
1	Edit	PA-100	Prior Authorization Forms: General	Delete
1	Edit	PA-100	Prior Authorization Forms: General	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	BH 24	Behavioral Health Resources Flyer	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	MS 02	Provider Selection Rack Card	Delete
1	Edit	ORFI-832	Estate Recovery Program Petition for Limitation	Delete
1	Edit	PA-108	Prior Authorization Form: Incontinence Supply All Waivers	Delete
1	Edit	MS 26	BabyReady Poster	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	MS 07	Premium Assistance Rack Card	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	ENERGY	Vendor Information: Direct Deposit	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	PA-103	Prior Authorization Forms: Synagis	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	Delete
1	Edit	SE-431A	Child Support Payment Authorization Form	Delete
1	Edit	MS-146	Sterilization Consent Form	Delete
1	Edit	MS 07	Premium Assistance Rack Card	Delete
1	Edit	EA 01	Energy Saving Tips	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	CPS 11	Central Registry Brochure	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	ENERGY	Vendor Information: Direct Deposit	Delete
1	Edit	BH 10	South Dakota Community Mental Health Center Flyer	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	EA-270	Medicare Savings Program Application	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	EA-307G	SNAP Group Home Exit Form	Delete
1	Edit	DSS-CCS	Rate Declaration Form	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	Delete
1	Edit	ENERGY	Vendor Information: Direct Deposit	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	ORFI-832	Estate Recovery Program Petition for Limitation	Delete
1	Edit	MS 02	Provider Selection Rack Card	Delete
1	Edit	BH 15	Criminal Justice Initiative Flyer	Delete
1	Edit	SE-431A	Child Support Payment Authorization Form	Delete
1	Edit	PA-108	Prior Authorization Form: Incontinence Supply All Waivers	Delete
1	Edit	MS 26	BabyReady Poster	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	CPS 20	Foster Care Realities	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	RE 04	Medicaid Liens Brochure	Delete
1	Edit	OLA-103	Child Care Declaration of Prior Criminal Conviction and Military History	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	DCS 06	Voluntary Paternity Establishment Handbook and Form	Delete
1	Edit	DCS 05	Payment Options Brochure	Delete
1	Edit	MS 18	Constituent Liaison Services Poster	Delete
1	Edit	DSS 06	Discrimination Complaint Brochure	Delete
1	Edit	EA-330	Self-Employment Ledger	Delete
1	Edit	EA-214	SNAP 6 Month Report Form	Delete
1	Edit	CPS 03	Safe Havens Brochure	Delete
1	Edit	EA 05	Medicare Savings Program Brochure	Delete
1	Edit	CPS 19	Foster Care Brochure	Delete
1	Edit	BH 01	Substance Use Disorder Services	Delete
1	Edit	CCS 09	SD Child Safety Seat Brochure	Delete
1	Edit	EA-265	Request for Long-Term Care or Home Community Based Services Waiver Assistance	Delete
1	Edit	CPS 21N	Foster Care Myths & Facts (Native American Theme)	Delete
1	Edit	EA-298	Weatherization Application	Delete
1	Edit	EA 08	Medicaid Spousal Care Handbook	Delete
1	Edit	EAFSSA	Children and Family Medical Assistance Application	Delete
1	Edit	EA-214	TANF 6 Month Report Form	Delete
1	Edit	CCS-950	Child Care Assistance Application	Delete
1	Edit	EA-297	Energy Assistance Application	Delete
1	Edit	EA 22	SNAP Notice of Rights Poster	Delete
1	Edit	DSS 07	Discrimination Complaint Poster	Delete
1	Edit	BH 02	Mental Health Services Brochure	Delete
1	Edit	BH 12	Substance Use Disorder Services Flyer	Delete
1	Edit	CPS 04	Mandatory Reporting Brochure	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete