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	CCS-970	Child Care Services Request For Payment	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	CCS-970	Child Care Services Request For Payment	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	CCS-970	Child Care Services Request For Payment	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	Delete
1	Edit	DSS 08	Notice of Privacy Brochure	Delete
1	Edit	MS 18	Constituent Liaison Services Poster	Delete
1	Edit	OLA-103	Child Care Declaration of Prior Criminal Conviction and Military History	Delete
1	Edit	EA-307G	SNAP Group Home Exit Form	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	EA-270	Medicare Savings Program Application	Delete
1	Edit	CPS 05	Positive Indian Parenting Brochure	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	CPS-100	Independent Living Program Education and Training Voucher	Delete
1	Edit	MS 26	BabyReady Poster	Delete
1	Edit	DSS 08	Notice of Privacy Brochure	Delete
1	Edit	EA-301	Economic Assistance Application	Delete
1	Edit	SE-415	Petition for Modification Form	Delete
1	Edit	OLA 03	Office of Licensing and Accreditation Brochure	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA-240	Application for Resource Assessment, Long Term Care or Related Medical Assistance	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	DCS 06	Voluntary Paternity Establishment Handbook and Form	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	RE 04	Medicaid Liens Brochure	Delete
1	Edit	CPS	Provider Mileage Request	Delete
1	Edit	-	To Order Let’s Be Clear Materials	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	MS-100	Recipient Forms: HIPAA Privacy Consent Form	Delete
1	Edit	OLA-103	Child Care Declaration of Prior Criminal Conviction and Military History	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	CPS 05	Positive Indian Parenting Brochure	Delete
1	Edit	EA-270	Medicare Savings Program Application	Delete
1	Edit	MS 07	Premium Assistance Rack Card	Delete
1	Edit	EA-301	Economic Assistance Application	Delete
1	Edit	PA-103	Prior Authorization Forms: Synagis	Delete
1	Edit	MS 26	BabyReady Poster	Delete
1	Edit	DCS 08	Child Support Parent Handbook	Delete
1	Edit	CPS-100	Independent Living Program Education and Training Voucher	Delete
1	Edit	CPS	Potential Placement Statement	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	EA-307G	SNAP Group Home Exit Form	Delete
1	Edit	OLA 03	Office of Licensing and Accreditation Brochure	Delete