Laurie Gill
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-208Authorization to Furnish / Release InformationDelete
1EditEA-265Request for Long-Term Care or Home Community Based Services Waiver AssistanceDelete
1EditBRO/EA19Guide to Assistance HandbookDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditBRO/EBT1EBT Client HandbookDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditCCSElectronic Payment ExemptionsDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditBRO/DSS3Administrative Hearings BrochureDelete
1EditMISC/BH1South Dakota Community Mental Health Center FlyerDelete
1EditBRO/CPS10Independent Living Program BrochureDelete
1EditEA-320Self-Employment LedgerDelete
1EditBH-05Hardship Considerations RefusalDelete
1EditMS-146Sterilization Consent FormDelete
1EditBRO/EA11Weatherization Assistance BrochureDelete
1EditBRO/DCS3Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of IncomeDelete
1EditBRO/EA1Energy Saving TipsDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditEA-240DApplication for Medical Assistance for Workers with DisabilitiesDelete
1EditCPS-566Foster Parent EvaluationDelete
1EditBRO/CPS11Central Registry of Child Abuse & NeglectDelete
1EditCCSPayment Authorization FormDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditMISC/BH3Substance Use Disorder Services FlyerDelete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditBRO/EA14Medical Assistance for Children and FamiliesDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditBH-063rd Party Release of Information (ROI)Delete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditBRO/DCS4National Medical Support Notice Brochure - An Employers GuideDelete
1EditMSMedicaid Non-Emergency Travel (NEMT) Payment Authorization FormDelete
1EditBH-18Substance Use Disorder High Intensity Referral FormDelete
1EditCC-975TANF Child Care Benefits ApplicationDelete
1EditDSS-CPSSafe Havens PosterDelete
1EditEA-320Self-Employment LedgerDelete
1EditBH-12aYouth SUD Initial Outcome ToolDelete
1EditOS-950Recipient Forms: Medicaid Non-Emergency Medical Travel FormDelete
1EditCPS-506Foster/Adoptive Parent Health ReportDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditBRO/DCS2Teenage Parents Guide - How to Establish Paternity and Financial Support for your ChildDelete
1EditPAPrior Authorization Forms: Applied Behavior Analysis TherapyDelete
1EditCC-975TANF Child Care Benefits ApplicationDelete
1EditEA-260Statement of EarningsDelete
1EditBH-09Indigent Medication ApplicationDelete
1EditPosterRecommendations for Exclusion from the Child Care Setting PosterDelete
1EditEA-240Application for Resource Assessment, Long Term Care or Related Medical AssistanceDelete
1EditBRO/CPS3Safe Havens BrochureDelete
1EditBH-12bYouth SUD Update Outcome ToolDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditDSS-ORFI-831Estate Recovery Notification of Death FormDelete
1EditPosterConstituent Liaison Services PosterDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
1EditBRO/DCS6Voluntary Paternity Establishment Handbook and FormDelete
1EditEA-301MAChildren and Family Medical Assistance Supplemental Application Delete