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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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditMISC/BH1South Dakota Community Mental Health Center FlyerDelete
1EditCCS-964Child Care Declaration of Prior Criminal Conviction and Military HistoryDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditBH-063rd Party Release of Information (ROI)Delete
1EditEA-231Child Support Enforcement ReferralDelete
1EditRec and FraudCasualty Settlement Report FormDelete
1EditMSMedicaid Transportation Documentation FormDelete
1EditBH-17Prevention - Accreditation ApplicationDelete
1EditEA-347Application for Social Security NumberDelete
1EditEA-310Form for Reporting ChangesDelete
1EditBRO/EACommunity Action Agency HandoutDelete
1EditPAPrior Authorization Forms: GeneralDelete
1EditSE-406Application for Location Only ServicesDelete