Forms & Publications :: SD Dept. of Social Services

Cabinet Secretary
Laurie R. Gill

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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-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA-265	Request for Long-Term Care or Home Community Based Services Waiver Assistance	Delete
1	Edit	EA 19	Guide to Assistance Handbook	Delete
1	Edit	DSS 08	Notice of Privacy Brochure	Delete
1	Edit	MS 15	Well Visit Poster	Delete
1	Edit	EBT 01	EBT Client Handbook	Delete
1	Edit	EA-214	TANF 6 Month Report Form	Delete
1	Edit	BH 16	Pregnancy Alcohol Flyer	Delete
1	Edit	CCS	Electronic Payment Exemptions	Delete
1	Edit	BHSPB02	Bethe1SD - Flyer	Delete
1	Edit	BHSPRKIT	REACH FOR LIFE Toolkit	Delete
1	Edit	DSS 03	Administrative Hearings Brochure	Delete
1	Edit	BH 10	South Dakota Community Mental Health Center Flyer	Delete
1	Edit	CPS 10	Independent Living Program Brochure	Delete
1	Edit	MS 05	Well Visit Rack Card	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	BHAO15	AVOID OPIOID – Opioid Medications and Your Pets	Delete
1	Edit	DCS 03	Income & Wage Withholding Brochure	Delete
1	Edit	EA 01	Energy Saving Tips	Delete
1	Edit	EA-240D	Application for Medical Assistance for Workers with Disabilities	Delete
1	Edit	CPS 11	Central Registry Brochure	Delete
1	Edit	EA 15	Emergency Services for SD Flyer	Delete
1	Edit	MS 09	Money Follows the Person Brochure	Delete
1	Edit	CCS	Payment Authorization Form	Delete
1	Edit	BHSPB03	Bethe1SD - Referral Card	Delete
1	Edit	BHAO16	AVOID OPIOD - Naloxone Postcard	Delete
1	Edit	BH 12	Substance Use Disorder Services Flyer	Delete
1	Edit	EA 14	CHIP Rack Card	Delete
1	Edit	CCS-950	Child Care Assistance Application	Delete
1	Edit	DCS 04	National Medical Support Notice Brochure	Delete
1	Edit	CPS 23	Safe Havens Poster	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	CPS 14	Young Voices Handbook	Delete
1	Edit	CC-975	TANF Child Care Benefits Application	Delete
1	Edit	EA-240	Application for Resource Assessment, Long Term Care or Related Medical Assistance	Delete
1	Edit	CPS 03	Safe Havens Brochure	Delete
1	Edit	CPS 13	Young Voices Brochure	Delete
1	Edit	MS 18	Constituent Liaison Services Poster	Delete
1	Edit	DCS 06	Voluntary Paternity Establishment Handbook and Form	Delete
1	Edit	EA-301MA	Children and Family Medical Assistance Supplemental Application	Delete
1	Edit	CPS 02	Common Sense Parenting Brochure	Delete
1	Edit	CCS 06	Child Care Assistance Program Brochure	Delete
1	Edit	EA 04	TANF Brochure	Delete
1	Edit	BHSPB06	Bethe1SD - Pen	Delete
1	Edit	CPS 01	Child Protection Services Booklet	Delete
1	Edit	BH 13	Juvenile Justice Reinvestment Initiative Flyer	Delete
1	Edit	EA 23	CHIP Poster	Delete
1	Edit	EA 16	Medical Assistance for Children and Families: IHS Specific	Delete
1	Edit	EA-324	Wage Verification	Delete
1	Edit	BHAO23	AVOID OPIOID - Note Pads	Delete
1	Edit	BH 04	Substance Use Disorder Involuntary Commitment Process	Delete
1	Edit	BHAO02	AVOID OPIOID - ASAM National Practice Guideline Spiral Book	Delete
1	Edit	BHSPB07	Bethe1SD - Wristband	Delete
1	Edit	EA-249	Disabled Children's Program Application	Delete
1	Edit	DSS 09	DSS Handbook	Delete
1	Edit	BH 14	Substance Use Prevention Services Flyer	Delete
1	Edit	BHAO04	AVOID OPIOID - Booklet	Delete
1	Edit	EA 09	SNAP Shoppers Guide	Delete
1	Edit	BHAO24	AVOID OPIOID - Pens	Delete
1	Edit	SE-405	Application for Income Withholding Only Service	Delete
1	Edit	OLA 03	Office of Licensing and Accreditation Brochure	Delete
1	Edit	EA-347	Application for Social Security Number	Delete
1	Edit	BHSPB08	Bethe1SD - Bag	Delete
1	Edit	BH 05	Intensive Methamphetamine Treatment Services	Delete
1	Edit	BH 15	Criminal Justice Initiative Flyer	Delete
1	Edit	BHAO05	AVOID OPIOID - Referral Card	Delete
1	Edit	EA 02	SNAP Brochure	Delete
1	Edit	MS 02	Provider Selection Rack Card	Delete
1	Edit	CPS-522	Request for Payment	Delete
1	Edit	CPS-504	Present Danger Plan	Delete
1	Edit	EA-320	Self-Employment Ledger	Delete
1	Edit	EA-310	Form for Reporting Changes	Delete
1	Edit	EA-305	Boarding School-Institution Documentation	Delete
1	Edit	BHAO06	AVOID OPIOID - Project Briefs	Delete
1	Edit	BHSPL02	LGBTQ – Always Help Unisex Poster	Delete
1	Edit	EA 10	SNAP for Students	Delete
1	Edit	MS 01	Medical Assistance Program Recipient Handbook	Delete
1	Edit	EA-301	SNAP Application	Delete
1	Edit	EA-298	Weatherization Application	Delete
1	Edit	EA 11	Weatherization Assistance Brochure	Delete
1	Edit	EA 18	Long-Term Care Partnership Brochure	Delete
1	Edit	BHSPL01	LGBTQ – Always Hope Boy Poster	Delete
1	Edit	SE-415	Petition for Modification Form	Delete
1	Edit	EA-270	Medicare Savings Program Application	Delete
1	Edit	BHAO07	AVOID OPIOID - Trifold Pocket Card	Delete
1	Edit	RE 04	Medicaid Liens Brochure	Delete
1	Edit	MS-103	Provider Change Form	Delete
1	Edit	SE-492	Notice of Shared Medical Expenses	Delete
1	Edit	CPS 07	Independent Living Program Education and Training Voucher Brochure	Delete
1	Edit	EA 12	Energy Assistance Brochure	Delete
1	Edit	SE-408	Application and Agreement for Full Services	Delete
1	Edit	MS 06	Health Home Brochure	Delete
1	Edit	MS 04	Medicaid Non-Emergency Medical Travel Brochure	Delete
1	Edit	MS 01	Medical Assistance Program Recipient Handbook	Delete
1	Edit	MS-102	Provider Selection Form	Delete
1	Edit	BHSPM01	MILITARY – Light Blue Poster	Delete
1	Edit	SE-431A	Child Support Payment Authorization Form	Delete
1	Edit	DSS 06	Discrimination Complaint Brochure	Delete
1	Edit	EA 22	SNAP Notice of Rights Poster	Delete
1	Edit	MS 03	Well-Child Care Brochure	Delete
1	Edit	BHMC05	METH – Small Magnet	Delete
1	Edit	OS-954	Client Authorized Debit for Repayment of Overissuance	Delete
1	Edit	DSS-CCS	Rate Declaration Form	Delete
1	Edit	BHSPM02	MILITARY – Green Poster	Delete
1	Edit	EA-231	Child Support Enforcement Referral	Delete
1	Edit	RE 03	Estate Recovery Program Brochure	Delete
1	Edit	EA 08	Medicaid Spousal Care Handbook	Delete
1	Edit	CCS-970	Child Care Services Request For Payment	Delete
1	Edit	CCS	Pathways to Professional Development - Career Lattice Application Form	Delete
1	Edit	EA-297	Energy Assistance Application	Delete
1	Edit	BHAO10	AVOID OPIOID - Mat Brochure	Delete
1	Edit	CCS	Pathways to Professional Development - Renewal Application	Delete
1	Edit	EAFSSA	Children and Family Medical Assistance Application	Delete
1	Edit	EA 05	Medicare Savings Program Brochure	Delete
1	Edit	MS 08	Constituent Liaison Services Brochure	Delete
1	Edit	CPS 19	Foster Care Brochure	Delete
1	Edit	CCS 14	Choosing Child Care Handbook	Delete
1	Edit	SE-406	Application for Location Only Services	Delete
1	Edit	BHSP03	SUICIDE PREVENTION - Suicide Facts	Delete
1	Edit	DCS 08	Child Support Parent Handbook	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	CPS 20	Foster Care Realities	Delete
1	Edit	EA-307G	SNAP Group Home Exit Form	Delete
1	Edit	BH 01	Substance Use Disorder Services Brochure	Delete
1	Edit	CCS 09	SD Child Safety Seat Brochure	Delete
1	Edit	MS 12	Well Child Poster	Delete
1	Edit	EA-214	SNAP 6 Month Report Form	Delete
1	Edit	BHSP01	SUICIDE PREVENTION – Business Card	Delete
1	Edit	CPS 04	Mandatory Reporting Brochure	Delete
1	Edit	DCS 01	Child Support Modification Handbook	Delete
1	Edit	EA-208	Authorization to Furnish / Release Information	Delete
1	Edit	EA-301	Economic Assistance Application	Delete
1	Edit	CPS 21	Foster Care Myths & Facts	Delete
1	Edit	BHSPB01	Bethe1SD - Brochure	Delete
1	Edit	DSS-W9	W-9 Form	Delete
1	Edit	BH 02	Mental Health Services Brochure	Delete
1	Edit	CCS 10	SD Child Development Associate Training Program	Delete