Lynne A. Valenti
Cabinet Secretary

DSS Mobile Logo Mobile Menu Button

Order Forms and Publications

Ready to Check Out?

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.

All fields are required.

The information being sent to you is free.

If you want to continue looking for more forms and/or publications, click here.

When entering the number of copies - use only numbers, no commas.

CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditEA-249Disabled Children Application / Eligibility ReviewDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditSE-415Petition for Modification FormDelete
1EditEA-269Recipient Forms: Child Care Expense Billing InformationDelete
1EditBRO/VS3Crime Victims Compensation Program BrochureDelete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditBRO/DCS6Voluntary Paternity Establishment Handbook and FormDelete
1EditBRO/EA2SNAP BrochureDelete
1EditBRO/VS3Crime Victims Compensation Program BrochureDelete
1EditEA-301Economic Assistance ApplicationDelete
1EditPAPrior Authorization ManualDelete
1EditCPS-506Foster/Adoptive Parent Health ReportDelete
1EditBRO/CPS16Family Group Conferencing – Family Group Decision Making Delete
1EditMSMedicaid Transportation Documentation FormDelete
1EditBRO/MS3Well-Child Care BrochureDelete
1EditEA-240Application for Resource Assessment, Long Term Care or Related Medical AssistanceDelete
1EditCCSPathways to Professional Development - Career Lattice Application FormDelete
1EditDSS-W9W-9 FormDelete
1EditBRO/CPS18Family Group Conferencing – Provider Guide Delete
1EditVS-694Crime Victims Compensation Primary ApplicationDelete
1EditVS-695Crime Victims Compensation Secondary ApplicationDelete
1EditPAPrior Authorization Forms: Genetic Testing Delete
1EditMSProfessional Services Billing ManualDelete
1EditCPS-522Request for PaymentDelete
1EditCPSProvider Mileage RequestDelete
1EditSE408NCPApplication and Agreement for Services - Non-Custodial Parent Delete
1EditPosterConstituent Liaison Services PosterDelete