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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditEA-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditBRODSS08Notice of Privacy BrochureDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditCCSElectronic Payment ExemptionsDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditBRODSS03Administrative Hearings BrochureDelete
1EditFLYRBH01South Dakota Community Mental Health Center FlyerDelete
1Edit- South Dakota Medicaid Handicapping Labio-Langual Deviations Form (HLD Index)Delete
1EditMS-146Sterilization Consent FormDelete
1EditBROEA01Energy Saving TipsDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditCCSPayment Authorization FormDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditEA-320Self-Employment LedgerDelete
1EditCPS-506Foster/Adoptive Parent Health ReportDelete
1EditPAPrior Authorization Forms: Applied Behavior Analysis TherapyDelete
1EditEA-260Statement of EarningsDelete
1EditBROCPS03Safe Havens BrochureDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBROCPS13Young Voices BrochureDelete
1EditBROCCS06Child Care Assistance Program BrochureDelete
1EditCPSProvider Mileage RequestDelete
1EditCCS-964Child Care Declaration of Prior Criminal Conviction and Military HistoryDelete
1EditHDBKCPS01Child Protection Services BookletDelete
1EditFLYRBH04Juvenile Justice Reinvestment Initiative FlyerDelete
1EditBROEA16Medical Assistance for Children and Families: IHS SpecificDelete
1EditBROBH04Substance Use Disorder Involuntary Commitment ProcessDelete
1EditEA-249Disabled Children's Program ApplicationDelete
1EditCPS-500Newborn Medical Report for Voluntary Termination of Parental RightsDelete
1EditHDBKDSS09DSS HandbookDelete
1EditFLYRBH05Substance Use Prevention Services FlyerDelete
1EditCPS-508Reference Form - Adoption / Foster / Kinship CareDelete
1EditCPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)Delete
1EditFLYRBH06Criminal Justice Initiative FlyerDelete
1EditCPSIndependent Living Program Education and Training Voucher Delete
1EditCCSOrientation Training Verification FormDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditBROMS02Provider Selection Rack CardDelete
1EditCPS-522Request for PaymentDelete
1EditCPS-593Permission to Screen for Reports of Abuse or NeglectDelete
1EditPAPrior Authorization Forms: BRCADelete
1EditEA-320Self-Employment LedgerDelete
1EditBROHSC01Mental Health Wellness and Recovery Phone Apps BrochureDelete
1EditEA-301SNAP ApplicationDelete
1EditEA-298Weatherization ApplicationDelete
1EditBROEA11Weatherization Assistance BrochureDelete
1EditPAPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditSE-415Petition for Modification FormDelete
1EditPAPrior Authorization Form: Incontinence Supply Family Support 360 WaiverDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditBROCPS07Independent Living Program Education and Training Voucher BrochureDelete
1EditBROEA12Energy Assistance BrochureDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditPAPrior Authorization Form: Incontinence Supply Supply HOPE WaiverDelete
1EditFLYREA02Long-Term Care Partnership Fact SheetDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditMS-102Provider Selection FormDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditBROMS03Well-Child Care BrochureDelete
1Edit Recipient Forms: HIPAA Privacy Consent FormDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditPAPrior Authorization Forms: Genetic Testing Delete
1EditPAPrior Authorization Form: Incontinence Supply ADLS Support 360 WaiverDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditBRORE03Estate Recovery Program BrochureDelete
1EditCCS-970Child Care Services Request For PaymentDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditCCSPathways to Professional Development - Renewal ApplicationDelete
1EditFSSAChildren and Family Medical Assistance ApplicationDelete
1EditBROEA05Medicare Savings Program BrochureDelete
1EditCPSDesignated Tribal Agent Request FormDelete
1EditBROBH03Quick Reference GuideDelete
1EditEA-307SNAP Exit FormDelete
1EditCPSICPC Financial and Medical PlanDelete
1EditSE-406Application for Location Only ServicesDelete
1EditMSTransportation Exceptions FormDelete
1EditBRODCS08Child Support Parent HandbookDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditCPSBackground Information for Voluntary Termination of Parental RightsDelete
1EditCPSPotential Placement StatementDelete
1EditPAPrior Authorization Forms: Out-of State Services Delete
1EditEA-214SNAP 6 Month Report FormDelete
1EditBROCPS04Mandatory Reporting of Child Abuse & Neglect BrochureDelete
1EditRec and FraudCasualty Settlement Report FormDelete
1EditEA-301Economic Assistance ApplicationDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 0-4Delete
1Edit- South Dakota Medicaid Pre-Orthodontic Certification FormDelete
1EditBROEA19Guide to Assistance HandbookDelete
1EditHDBKEBT01EBT Client HandbookDelete
1EditBROCPS10Independent Living Program BrochureDelete
1EditEA-320Self-Employment LedgerDelete
1EditBRODCS03Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditEA-240DApplication for Medical Assistance for Workers with DisabilitiesDelete
1EditCPS-566Foster Parent EvaluationDelete
1EditBROCPS11Central Registry of Child Abuse & NeglectDelete
1EditFLYRBH03Substance Use Disorder Services FlyerDelete
1EditBROEA14CHIP Rack CardDelete
1EditBRODCS04National Medical Support Notice Brochure - An Employers GuideDelete
1EditMSMedicaid Non-Emergency Travel (NEMT) Payment Authorization FormDelete
1EditCC-975TANF Child Care Benefits ApplicationDelete
1EditPOSCPS03Safe Havens PosterDelete
1EditOS-950Recipient Forms: Medicaid Non-Emergency Medical Travel FormDelete
1EditHDBKCPS14Young Voices HandbookDelete
1EditCC-975TANF Child Care Benefits ApplicationDelete
1EditEA-240Application for Resource Assessment, Long Term Care or Related Medical AssistanceDelete
1EditDSS-ORFI-831Estate Recovery Notification of Death FormDelete
1EditPOSMS08Constituent Liaison Services PosterDelete
1EditHDBKDCS06Voluntary Paternity Establishment Handbook and FormDelete
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete
1EditMSHospice NotificationDelete
1EditBROCPS02Common Sense Parenting BrochureDelete
1EditBROEA04TANF Work Program BrochureDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditPOSEA03CHIP PosterDelete
1EditEA-324Wage VerificationDelete
1EditCPS-533Adoption Registry FormDelete
1EditEA-345Affidavit for SNAP Work RegistrantsDelete
1EditBROEA09SNAP Shoppers GuideDelete
1EditSE-405Application for Income Withholding Only ServiceDelete
1EditOS-964Non-Emergency Medical Travel HIPAA AuthorizationDelete
1EditBROCCS03Registration & Licensure of Child Care EnvironmentsDelete
1EditEA-347Application for Social Security NumberDelete
1EditBROBH05Intensive Methamphetamine Treatment ServicesDelete
1EditBROEA02SNAP BrochureDelete
1EditCPSDesignated Tribal Agent Request for Change of AddressDelete
1EditCPS-504Present Danger PlanDelete
1EditEA-310Form for Reporting ChangesDelete
1EditEA-305Boarding School-Institution DocumentationDelete
1EditRec and FraudStop Benefit Fraud InsertDelete
1EditBROEA10SNAP for StudentsDelete
1EditHDBKMS01Medical Assistance Program Recipient HandbookDelete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditBROEA18Long-Term Care Partnership BrochureDelete
1EditMSMedicaid Transportation Documentation FormDelete
1EditBRORE04Medicaid Liens BrochureDelete
1EditMS-103Provider Change FormDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditPAPrior Authorization Forms: GeneralDelete
1EditBROMS06Health Home BrochureDelete
1EditBROMS04Medicaid Non-Emergency Medical Travel BrochureDelete
1EditCPS-565Foster Parent Training & Self-InstructionDelete
1EditHDBKMS01Medical Assistance Program Recipient HandbookDelete