Laurie Gill
Cabinet Secretary

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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/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
1EditDSS-CPSSafe Havens PosterDelete
1EditEA-320Self-Employment LedgerDelete
1EditBH-12aYouth SUD Initial Outcome ToolDelete
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
1EditEA-260Statement of EarningsDelete
1EditBH-09Indigent Medication ApplicationDelete
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
1EditBRO/CPS2Common Sense Parenting BrochureDelete
1EditPosterCHIP PosterDelete
1EditBRO/CCS6Child Care Assistance Program BrochureDelete
1EditCPSProvider Mileage RequestDelete
1EditBRO/EA4TANF Work Program BrochureDelete
1EditCCS-964Child Care Declaration of Prior Criminal Conviction and Military HistoryDelete
1EditBH-12cYouth SUD Discharge Outcome ToolDelete
1EditBRO/CPS1Child Protection Services BookletDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditPosterCHIP PosterDelete
1EditBRO/EA16Medical Assistance for Children and Families: IHS SpecificDelete
1EditEA-324Wage VerificationDelete
1EditBRO/RE1Stop Benefit Fraud BrochureDelete
1EditBRO/BH4Substance Use Disorder Involuntary Commitment ProcessDelete
1EditBH-11Behavioral Health Treatment Outcomes Program ManualDelete
1EditCPS-500Newborn Medical Report for Voluntary Termination of Parental RightsDelete
1EditBRO/DSS9DSS HandbookDelete
1EditCPS-508Reference Form - Adoption / Foster / Kinship CareDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditBH-12fYouth MH Discharge Outcome ToolDelete
1EditCPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)Delete
1EditOS-964Non-Emergency Medical Travel HIPAA AuthorizationDelete
1EditBRO/CCS3Registration & Licensure of Child Care EnvironmentsDelete
1EditEA-347Application for Social Security NumberDelete
1EditBRO/EA2SNAP BrochureDelete
1EditCPSIndependent Living Program Education and Training Voucher Delete
1EditCCSOrientation Training Verification FormDelete
1EditBH-13aFamily SUD Initial Outcome ToolDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditCPS-522Request for PaymentDelete
1EditCPS-593Permission to Screen for Reports of Abuse or NeglectDelete
1EditPAPrior Authorization Forms: BRCADelete
1EditCPS-504Present Danger PlanDelete
1EditEA-320Self-Employment LedgerDelete
1EditEA-305Boarding School-Institution DocumentationDelete
1EditRec and FraudStop Benefit Fraud InsertDelete
1EditBRO/EA10SNAP for StudentsDelete
1EditBRO/EA12Energy Assistance BrochureDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditEA-301SNAP ApplicationDelete
1EditBH-13bFamily SUD Update Outcome ToolDelete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditEA-298Weatherization ApplicationDelete
1EditBRO/EA18Long-Term Care Partnership BrochureDelete
1EditPAPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditSE-415Petition for Modification FormDelete
1EditPAPrior Authorization Form: Incontinence Supply Family Support 360 WaiverDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditBRO/DSS4Direct Deposit BrochureDelete
1EditBRO/RE4Medicaid Liens BrochureDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditBH-13cFamily SUD Discharge Outcome ToolDelete
1EditBRO/CPS7Independent Living Program Education and Training Voucher BrochureDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1EditBRO/CPS15Family Group Conferencing – My Family Meeting Delete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditPAPrior Authorization Form: Incontinence Supply Supply HOPE WaiverDelete
1EditBRO/MS4Medicaid Non-Emergency Medical Travel BrochureDelete
1EditCPS-565Foster Parent Training & Self-InstructionDelete
1EditPOS/EA02Long-Term Care Partnership Fact SheetDelete
1EditEA-269Child Care Expense Billing InformationDelete
1EditBRO/MS1Medical Assistance Program Recipient HandbookDelete
1EditMS-102Provider Selection FormDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditBRO/DSS6Filing a Discrimination Complaint Brochure and FormDelete
1EditBH-13dFamily MH Initial Outcome ToolDelete
1EditBRO/MS3Well-Child Care BrochureDelete
1Edit Recipient Forms: HIPAA Privacy Consent FormDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditPAPrior Authorization Forms: Genetic Testing Delete
1EditPAPrior Authorization Form: Incontinence Supply ADLS Support 360 WaiverDelete