Forms & Publications :: SD Dept. of Social Services

Lynne A. Valenti
Cabinet Secretary

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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-320	Self-Employment Ledger	Delete
1	Edit	SE-406	Application for Location Only Services	Delete
1	Edit	BRO/CCS6	Child Care Assistance Program Brochure	Delete
1	Edit	VS-695	Crime Victims Compensation Secondary Application	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	MS	Transportation Exceptions Form	Delete
1	Edit	EA-297	Energy Assistance Application	Delete
1	Edit	BH-06	3rd Party Release of Information (ROI)	Delete
1	Edit	EA-265	Request for Long-Term Care or Home Community Based Services Waiver Assistance	Delete
1	Edit	EA-240	Application for Resource Assessment, Long Term Care or Related Medical Assistance	Delete
1	Edit	BH-14	Substance Abuse - Accreditation Application	Delete
1	Edit	EA-307	SNAP Exit Form	Delete
1	Edit	BRO/BH2	Mental Health Services Brochure	Delete
1	Edit	EA-324	Wage Verification	Delete
1	Edit	OS-954	Client Authorized Debit for Repayment of Overissuance	Delete
1	Edit	BRO/VS3	Crime Victims Compensation Program Brochure	Delete
1	Edit	BRO/CPS16	Family Group Conferencing – Family Group Decision Making	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	PA	Prior Authorization Forms: General	Delete
1	Edit	BH-09	Indigent Medication Application	Delete
1	Edit	PA	Prior Authorization Forms: Synagis	Delete
1	Edit	Rec and Fraud	Stop Benefit Fraud Insert	Delete
1	Edit	CCS	Pathways to Professional Development - Career Lattice Application Form	Delete
1	Edit	OS-950	Recipient Forms: Title XIX Medical Transportation Reimbursement	Delete
1	Edit	EA-301	SNAP Application	Delete
1	Edit	MS	Medicaid Transportation Documentation Form	Delete
1	Edit	MS	Providers: Adult Services & Aging Provider Agreement	Delete
1	Edit	BH-11b	Adult SUD Update Outcome Tool	Delete
1	Edit	EA-301	Economic Assistance Application	Delete
1	Edit	VS-694	Crime Victims Compensation Primary Application	Delete
1	Edit	BRO/CCS3	Registration & Licensure of Child Care Environments	Delete
1	Edit	BRO/RE3	Estate Recovery Program Brochure	Delete
1	Edit	BRO/EA16	Medical Assistance for Children and Families: IHS Specific	Delete
1	Edit	SE-431A	Child Support Payment Authorization Form	Delete
1	Edit	PA	Prior Authorization Forms: Private Duty Nursing & Extended Home Health Services	Delete
1	Edit	VS-695	Crime Victims Compensation Secondary Application	Delete
1	Edit	PA	Prior Authorization Forms: Genetic Testing	Delete
1	Edit	VS-694	Crime Victims Compensation Primary Application	Delete
1	Edit	MS	Title XIX Non-Emergency Transportation Payment Authorization Form	Delete
1	Edit	BRO/CPS18	Family Group Conferencing – Provider Guide	Delete
1	Edit	CPS-594	Declaration of Prior Criminal Conviction & Military History	Delete
1	Edit	BH-11a	Adult SUD Initial Outcome Tool	Delete
1	Edit	BRO/EA3	CHIP Brochure	Delete
1	Edit	BRO/CPS4	Mandatory Reporting of Child Abuse & Neglect Brochure	Delete