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	EA 14	CHIP Rack Card	Delete
1	Edit	NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	Delete
1	Edit	CPS-100A	FACIS Interstate Compact: Placement Request Form	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	MS-100	Recipient Forms: HIPAA Privacy Consent Form	Delete
1	Edit	RE 04	Medicaid Liens Brochure	Delete
1	Edit	EA-270	Medicare Savings Program Application	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	CPS 05	Positive Indian Parenting Brochure	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	EA-301	Economic Assistance Application	Delete
1	Edit	EA 01	Energy Saving Tips	Delete
1	Edit	EA 19	Guide to Assistance Handbook	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	PA-108	Prior Authorization Form: Incontinence Supply All Waivers	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	CPS 22	Foster Care Handbook	Delete
1	Edit	DCS 08	Child Support Parent Handbook	Delete
1	Edit	CPS-522	Request for Payment	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	BH 16	Pregnancy Alcohol Flyer	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	BH 24	Behavioral Health Resources Flyer	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	CPS 22	Foster Care Handbook	Delete
1	Edit	DCS 08	Child Support Parent Handbook	Delete
1	Edit	CPS-522	Request for Payment	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	PA-108	Prior Authorization Form: Incontinence Supply All Waivers	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	BH 10	South Dakota Community Mental Health Center Flyer	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	BH 16	Pregnancy Alcohol Flyer	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	CCS-970	Child Care Services Request For Payment	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	EA 09	SNAP Shoppers Guide	Delete