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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
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