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	NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	CPS 04	Mandatory Reporting Brochure	Delete
1	Edit	SE-431A	Child Support Payment Authorization Form	Delete
1	Edit	CPS-500	Newborn Medical Report for Voluntary Termination of Parental Rights	Delete
1	Edit	DSS-CCS	Rate Declaration Form	Delete
1	Edit	EA 08	Medicaid Spousal Care Handbook	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	CPS 11	Central Registry Brochure	Delete
1	Edit	CCS 09	SD Child Safety Seat Brochure	Delete
1	Edit	EA-301	Economic Assistance Application	Delete
1	Edit	CPS 05	Positive Indian Parenting Brochure	Delete
1	Edit	CPS	Potential Placement Statement	Delete
1	Edit	CPS-100	Independent Living Program Education and Training Voucher	Delete
1	Edit	EA 01	Energy Saving Tips	Delete
1	Edit	BH 13	Juvenile Justice Reinvestment Initiative Flyer	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	EA 19	Guide to Assistance Handbook	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	DSS 08	Notice of Privacy Brochure	Delete
1	Edit	DCS 06	Voluntary Paternity Establishment Handbook and Form	Delete
1	Edit	EA-240	Application for Resource Assessment, Long Term Care or Related Medical Assistance	Delete
1	Edit	OLA 03	Office of Licensing and Accreditation Brochure	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	ENERGY	Vendor Information: Direct Deposit	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	CCS-970	Child Care Services Request For Payment	Delete
1	Edit	ORFI-832	Estate Recovery Program Petition for Limitation	Delete
1	Edit	ORFI-832	Estate Recovery Program Petition for Limitation	Delete
1	Edit	BH 16	Pregnancy Alcohol Flyer	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	EAFSSA	Children and Family Medical Assistance Application	Delete
1	Edit	CPS-100A	FACIS Interstate Compact: Placement Request Form	Delete
1	Edit	BH 24	Behavioral Health Resources Flyer	Delete
1	Edit	CPS 22	Foster Care Handbook	Delete
1	Edit	ORFI-832	Estate Recovery Program Petition for Limitation	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	DCS 06	Voluntary Paternity Establishment Handbook and Form	Delete
1	Edit	SE-431A	Child Support Payment Authorization Form	Delete
1	Edit	RE 04	Medicaid Liens Brochure	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	EA-297	Energy Assistance Application	Delete
1	Edit	EA 08	Medicaid Spousal Care Handbook	Delete
1	Edit	CCS-950	Child Care Assistance Application	Delete
1	Edit	BH 02	Mental Health Services Brochure	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete