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	PA-103	Prior Authorization Forms: Synagis	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	DSS 08	Notice of Privacy Brochure	Delete
1	Edit	MS 02	Provider Selection Rack Card	Delete
1	Edit	OLA 03	Office of Licensing and Accreditation Brochure	Delete
1	Edit	MS 07	Premium Assistance Rack Card	Delete
1	Edit	CPS 10	Independent Living Program Brochure	Delete
1	Edit	NEMT-952	Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form	Delete
1	Edit	ENERGY	Vendor Information: Direct Deposit	Delete
1	Edit	BH 16	Pregnancy Alcohol Flyer	Delete
1	Edit	CPS-506	Foster/Adoptive Parent Health Report	Delete
1	Edit	ENERGY	Vendor Information: Direct Deposit	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	CPS-533	Adoption Registry Form	Delete
1	Edit	NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	Delete
1	Edit	CPS	ICPC Financial and Medical Plan	Delete
1	Edit	MS 02	Provider Selection Rack Card	Delete
1	Edit	MS 26	BabyReady Poster	Delete
1	Edit	MS-100	Recipient Forms: HIPAA Privacy Consent Form	Delete
1	Edit	OLA 03	Office of Licensing and Accreditation Brochure	Delete
1	Edit	CPS-100	Independent Living Program Education and Training Voucher	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	OLA 03	Office of Licensing and Accreditation Brochure	Delete
1	Edit	PA-102	Prior Authorization Forms: Applied Behavior Analysis Therapy	Delete
1	Edit	BH 10	South Dakota Community Mental Health Center Flyer	Delete
1	Edit	EA-240	Application for Resource Assessment, Long Term Care or Related Medical Assistance	Delete
1	Edit	CPS 20	Foster Care Realities	Delete
1	Edit	CPS 10	Independent Living Program Brochure	Delete
1	Edit	DSS-CCS	Rate Declaration Form	Delete
1	Edit	CPS-100	Independent Living Program Education and Training Voucher	Delete
1	Edit	CPS-565	Foster Parent Training & Self-Instruction	Delete
1	Edit	-	To Order Let’s Be Clear Materials	Delete
1	Edit	OLA 03	Office of Licensing and Accreditation Brochure	Delete
1	Edit	SE-415	Petition for Modification Form	Delete
1	Edit	EA-240	Application for Resource Assessment, Long Term Care or Related Medical Assistance	Delete