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	EA 14	CHIP Rack Card	Delete
1	Edit	NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	Delete
1	Edit	CPS-100A	FACIS Interstate Compact: Placement Request Form	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	MS-100	Recipient Forms: HIPAA Privacy Consent Form	Delete
1	Edit	RE 04	Medicaid Liens Brochure	Delete
1	Edit	EA-270	Medicare Savings Program Application	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	CPS 05	Positive Indian Parenting Brochure	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	EA-301	Economic Assistance Application	Delete
1	Edit	EA 01	Energy Saving Tips	Delete
1	Edit	EA 19	Guide to Assistance Handbook	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	PA-108	Prior Authorization Form: Incontinence Supply All Waivers	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	CPS 22	Foster Care Handbook	Delete
1	Edit	DCS 08	Child Support Parent Handbook	Delete
1	Edit	CPS-522	Request for Payment	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	BH 16	Pregnancy Alcohol Flyer	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	BH 24	Behavioral Health Resources Flyer	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	CPS 22	Foster Care Handbook	Delete
1	Edit	DCS 08	Child Support Parent Handbook	Delete
1	Edit	CPS-522	Request for Payment	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	PA-108	Prior Authorization Form: Incontinence Supply All Waivers	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	ORFI-831	Estate Recovery Notification of Death Form	Delete
1	Edit	BH 10	South Dakota Community Mental Health Center Flyer	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	BH 16	Pregnancy Alcohol Flyer	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	CCS-970	Child Care Services Request For Payment	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	EA 09	SNAP Shoppers Guide	Delete
1	Edit	DCS 08	Child Support Parent Handbook	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	DSS-CCS	Rate Declaration Form	Delete
1	Edit	CPS-522	Request for Payment	Delete
1	Edit	CPS 22	Foster Care Handbook	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	CPS 20	Foster Care Realities	Delete
1	Edit	CPS 22	Foster Care Handbook	Delete
1	Edit	-	To Order Let’s Be Clear Materials	Delete
1	Edit	SE-415	Petition for Modification Form	Delete
1	Edit	OLA-103	Child Care Declaration of Prior Criminal Conviction and Military History	Delete
1	Edit	CPS 07	Independent Living Program Education and Training Voucher Brochure	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	MS 07	Premium Assistance Rack Card	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	MS-146	Sterilization Consent Form	Delete
1	Edit	CPS 20N	Foster Care Realities (Native American Theme)	Delete
1	Edit	EBT 01	EBT Client Handbook	Delete
1	Edit	CCS 06	Child Care Assistance Program Brochure	Delete
1	Edit	MS 08	Constituent Liaison Services Brochure	Delete
1	Edit	MS 01	Medical Assistance Program Recipient Handbook	Delete
1	Edit	DSS 03	Administrative Hearings Brochure	Delete
1	Edit	BH 04	Substance Use Disorder Involuntary Commitment Process	Delete
1	Edit	CPS 09	Adoption Subsidy Program	Delete
1	Edit	MS 15	Well Visit Poster	Delete
1	Edit	BH 14	Substance Use Prevention Services Flyer	Delete
1	Edit	CCS 10	SD Child Development Associate Training Program	Delete
1	Edit	EA 12	Energy Assistance Brochure	Delete
1	Edit	CPS 13	Young Voices Brochure	Delete
1	Edit	EA 10	SNAP for Students	Delete
1	Edit	CPS 01	Child Protection Services Booklet	Delete
1	Edit	CPS-504	Present Danger Plan	Delete
1	Edit	EA 16	Medical Assistance for Children and Families: IHS Specific	Delete
1	Edit	MS 04	Medicaid Non-Emergency Medical Travel Brochure	Delete
1	Edit	BH 26	Working in Behavioral Health	Delete
1	Edit	EA 11	Weatherization Assistance Brochure	Delete
1	Edit	DCS 04	National Medical Support Notice Brochure	Delete
1	Edit	DCS 03	Income & Wage Withholding Brochure	Delete
1	Edit	CPS 23	Safe Havens Poster	Delete
1	Edit	MS 13	Behavioral Health Resources	Delete
1	Edit	EA 18	Long-Term Care Partnership Brochure	Delete
1	Edit	CPS 02	Common Sense Parenting Brochure	Delete
1	Edit	CPS 21	Foster Care Myths & Facts	Delete
1	Edit	DCS 01	Child Support Modification Handbook	Delete
1	Edit	CCS 14	Choosing Child Care Handbook	Delete
1	Edit	MS 01	Medical Assistance Program Recipient Handbook	Delete