Copies | Edit the Number of Copies | Document Number | Document Name | Delete |
1 | Edit | EA-208 | Authorization to Furnish / Release Information | Delete |
1 | Edit | EA-265 | Request for Long-Term Care or Home Community Based Services Waiver Assistance | Delete |
1 | Edit | BRODSS08 | Notice of Privacy Brochure | Delete |
1 | Edit | EA-214 | TANF 6 Month Report Form | Delete |
1 | Edit | CCS | Electronic Payment Exemptions | Delete |
1 | Edit | CPS | Placement Resource Monthly Reporting Form Ages 14 and older | Delete |
1 | Edit | BRODSS03 | Administrative Hearings Brochure | Delete |
1 | Edit | FLYRBH01 | South Dakota Community Mental Health Center Flyer | Delete |
1 | Edit | - | South Dakota Medicaid Handicapping Labio-Langual Deviations Form (HLD Index) | Delete |
1 | Edit | MS-146 | Sterilization Consent Form | Delete |
1 | Edit | BROEA01 | Energy Saving Tips | Delete |
1 | Edit | PA | Prior Authorization Forms: Synagis | Delete |
1 | Edit | CCS | Payment Authorization Form | Delete |
1 | Edit | CPS | Placement Resource Monthly Reporting Form Ages 5-13 | Delete |
1 | Edit | Rec and Fraud | Estate Recovery Program Petition for Limitation | Delete |
1 | Edit | EA-345A | Affidavit for SNAP Work Registrants (Employment & Training) | Delete |
1 | Edit | CCS-950 | Child Care Assistance Application | Delete |
1 | Edit | EA-320 | Self-Employment Ledger | Delete |
1 | Edit | CPS-506 | Foster/Adoptive Parent Health Report | Delete |
1 | Edit | PA | Prior Authorization Forms: Applied Behavior Analysis Therapy | Delete |
1 | Edit | EA-260 | Statement of Earnings | Delete |
1 | Edit | BROCPS03 | Safe Havens Brochure | Delete |
1 | Edit | EA-269 | Child Care Expense Billing Information | Delete |
1 | Edit | BROCPS13 | Young Voices Brochure | Delete |
1 | Edit | BROCCS06 | Child Care Assistance Program Brochure | Delete |
1 | Edit | CPS | Provider Mileage Request | Delete |
1 | Edit | CCS-964 | Child Care Declaration of Prior Criminal Conviction and Military History | Delete |
1 | Edit | HDBKCPS01 | Child Protection Services Booklet | Delete |
1 | Edit | FLYRBH04 | Juvenile Justice Reinvestment Initiative Flyer | Delete |
1 | Edit | BROEA16 | Medical Assistance for Children and Families: IHS Specific | Delete |
1 | Edit | BROBH04 | Substance Use Disorder Involuntary Commitment Process | Delete |
1 | Edit | EA-249 | Disabled Children's Program Application | Delete |
1 | Edit | CPS-500 | Newborn Medical Report for Voluntary Termination of Parental Rights | Delete |
1 | Edit | HDBKDSS09 | DSS Handbook | Delete |
1 | Edit | FLYRBH05 | Substance Use Prevention Services Flyer | Delete |
1 | Edit | CPS-508 | Reference Form - Adoption / Foster / Kinship Care | Delete |
1 | Edit | CPS-549 | Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY) | Delete |
1 | Edit | FLYRBH06 | Criminal Justice Initiative Flyer | Delete |
1 | Edit | CPS | Independent Living Program Education and Training Voucher | Delete |
1 | Edit | CCS | Orientation Training Verification Form | Delete |
1 | Edit | SE408NCP | Application and Agreement for Services - Non-Custodial Parent | Delete |
1 | Edit | BROMS02 | Provider Selection Rack Card | Delete |
1 | Edit | CPS-522 | Request for Payment | Delete |
1 | Edit | CPS-593 | Permission to Screen for Reports of Abuse or Neglect | Delete |
1 | Edit | PA | Prior Authorization Forms: BRCA | Delete |
1 | Edit | EA-320 | Self-Employment Ledger | Delete |
1 | Edit | BROHSC01 | Mental Health Wellness and Recovery Phone Apps Brochure | Delete |
1 | Edit | EA-301 | SNAP Application | Delete |
1 | Edit | EA-298 | Weatherization Application | Delete |
1 | Edit | BROEA11 | Weatherization Assistance Brochure | Delete |
1 | Edit | PA | Prior Authorization Forms: Durable Medical Equipment and Nutrition | Delete |
1 | Edit | SE-415 | Petition for Modification Form | Delete |
1 | Edit | PA | Prior Authorization Form: Incontinence Supply Family Support 360 Waiver | Delete |
1 | Edit | EA-270 | Medical Savings Program Application | Delete |
1 | Edit | BROCPS07 | Independent Living Program Education and Training Voucher Brochure | Delete |
1 | Edit | BROEA12 | Energy Assistance Brochure | Delete |
1 | Edit | SE408CP | Application and Agreement for Services - Custodial Parent and/or Caretaker | Delete |
1 | Edit | FACIS | Interstate Compact: Placement Request Form | Delete |
1 | Edit | PA | Prior Authorization Form: Incontinence Supply Supply HOPE Waiver | Delete |
1 | Edit | FLYREA02 | Long-Term Care Partnership Fact Sheet | Delete |
1 | Edit | EA-269 | Child Care Expense Billing Information | Delete |
1 | Edit | MS-102 | Provider Selection Form | Delete |
1 | Edit | SE-431A | Child Support Payment Authorization Form | Delete |
1 | Edit | BROMS03 | Well-Child Care Brochure | Delete |
1 | Edit | | Recipient Forms: HIPAA Privacy Consent Form | Delete |
1 | Edit | MS | Hysterectomy Acknowledgement of Information | Delete |
1 | Edit | PA | Prior Authorization Forms: Genetic Testing | Delete |
1 | Edit | PA | Prior Authorization Form: Incontinence Supply ADLS Support 360 Waiver | Delete |
1 | Edit | CPS | Background Information for Voluntary Termination of Parental Rights | Delete |
1 | Edit | OS-954 | Client Authorized Debit for Repayment of Overissuance | Delete |
1 | Edit | BRORE03 | Estate Recovery Program Brochure | Delete |
1 | Edit | CCS-970 | Child Care Services Request For Payment | Delete |
1 | Edit | CCS | Pathways to Professional Development - Career Lattice Application Form | Delete |
1 | Edit | CCS | Pathways to Professional Development - Renewal Application | Delete |
1 | Edit | FSSA | Children and Family Medical Assistance Application | Delete |
1 | Edit | BROEA05 | Medicare Savings Program Brochure | Delete |
1 | Edit | CPS | Designated Tribal Agent Request Form | Delete |
1 | Edit | BROBH03 | Quick Reference Guide | Delete |
1 | Edit | EA-307 | SNAP Exit Form | Delete |
1 | Edit | CPS | ICPC Financial and Medical Plan | Delete |
1 | Edit | SE-406 | Application for Location Only Services | Delete |
1 | Edit | MS | Transportation Exceptions Form | Delete |
1 | Edit | BRODCS08 | Child Support Parent Handbook | Delete |
1 | Edit | EA-208 | Authorization to Furnish / Release Information | Delete |
1 | Edit | CPS | Background Information for Voluntary Termination of Parental Rights | Delete |
1 | Edit | CPS | Potential Placement Statement | Delete |
1 | Edit | PA | Prior Authorization Forms: Out-of State Services | Delete |
1 | Edit | EA-214 | SNAP 6 Month Report Form | Delete |
1 | Edit | BROCPS04 | Mandatory Reporting of Child Abuse & Neglect Brochure | Delete |
1 | Edit | Rec and Fraud | Casualty Settlement Report Form | Delete |
1 | Edit | EA-301 | Economic Assistance Application | Delete |
1 | Edit | CPS | Placement Resource Monthly Reporting Form Ages 0-4 | Delete |
1 | Edit | - | South Dakota Medicaid Pre-Orthodontic Certification Form | Delete |
1 | Edit | BROEA19 | Guide to Assistance Handbook | Delete |
1 | Edit | HDBKEBT01 | EBT Client Handbook | Delete |
1 | Edit | BROCPS10 | Independent Living Program Brochure | Delete |
1 | Edit | EA-320 | Self-Employment Ledger | Delete |
1 | Edit | BRODCS03 | Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Income | Delete |
1 | Edit | EA-240D | Application for Medical Assistance for Workers with Disabilities | Delete |
1 | Edit | CPS-566 | Foster Parent Evaluation | Delete |
1 | Edit | BROCPS11 | Central Registry of Child Abuse & Neglect | Delete |