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-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditBRO/DSS3Administrative Hearings BrochureDelete
1EditEA-324Wage VerificationDelete
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditBRO/CPS17Family Group Conferencing – Parents Guide Delete
1EditEA-214TANF 6 Month Report FormDelete
1EditBH-063rd Party Release of Information (ROI)Delete
1EditMSTitle XIX Non-Emergency Transportation Payment Authorization FormDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditOS-950Recipient Forms: Title XIX Medical Transportation ReimbursementDelete
1EditBH-09Indigent Medication ApplicationDelete
1EditBRO/CPS3Safe Havens BrochureDelete
1EditPosterCHIP PosterDelete
1EditBRO/CPS1Child Protection Services BookletDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditEA-324Wage VerificationDelete
1EditBRO/VS3Crime Victims Compensation Program BrochureDelete
1EditVS-694Crime Victims Compensation Primary ApplicationDelete
1EditBRO/DSS9DSS HandbookDelete
1EditSE-405Application for Income Withholding Only ServiceDelete
1EditBRO/CCS3Registration & Licensure of Child Care EnvironmentsDelete
1EditDSS-CCSRate Declaration FormDelete
1EditEA-347Application for Social Security NumberDelete
1EditBH-18Substance Use Disorder High Intensity Referral FormDelete
1EditVS-694Crime Victims Compensation Primary ApplicationDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditVS-695Crime Victims Compensation Secondary ApplicationDelete
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete
1EditEA-320Self-Employment LedgerDelete
1EditEA-310Form for Reporting ChangesDelete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditEA-301SNAP ApplicationDelete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditSE-415Petition for Modification FormDelete