Forms & Publications :: SD Dept. of Social Services

Cabinet Secretary
Matt Althoff

Forms and Publications

The Department of Social Services has free forms and publications that can provide you with information and guidance in a number of important areas.

This page can help you find the information you need in the following ways:

		Some forms are available to fill out and submit online. The remaining online forms can be filled out on your computer, printed and mailed.
		You can download any form or publication on this page by clicking on the download button.
		There’s a simple “Shopping Cart” that allows you to place an order for free forms and publications. These documents will then be mailed to you at no cost.
		Instructions are available (Click on icon to view)

If you would like to order any form or publication in English, please click on Forms Only, Publications Only or All. The shopping cart will automatically default to the English version of the form or publication.

Note: Some documents are PDF files and require Adobe Acrobat to open them. If you don’t have Adobe Acrobat, click here to download the latest version.

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Service Area:

Abuse and Neglect

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
CPS 04	Mandatory Reporting Brochure	n/a	n/a
CPS 11	Central Registry Brochure	n/a	n/a
CPS-504	Present Danger Plan	n/a		n/a
CPS-593	Permission to Screen for Reports of Abuse and Neglect	n/a			n/a	n/a
CPS-594	Declaration of Prior Criminal Conviction and Military History	n/a		n/a	n/a	n/a

Administrative Hearings

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
DSS 03	Administrative Hearings Brochure		n/a	n/a

Adoption and Foster Care

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
CPS 09	Adoption Subsidy Program	n/a	n/a	n/a
CPS 19	Foster Care Brochure	n/a	n/a	n/a
CPS 19N	Foster Care Brochure (Native American Theme)	n/a	n/a	n/a
CPS 20	Foster Care Realities	n/a	n/a	n/a
CPS 20N	Foster Care Realities (Native American Theme)	n/a	n/a	n/a
CPS 21	Foster Care Myths & Facts	n/a	n/a	n/a
CPS 21N	Foster Care Myths & Facts (Native American Theme)	n/a	n/a	n/a
CPS 22	Foster Care Handbook	n/a		n/a	n/a	n/a
CPS-523	Request for Reimbursement of Adoption Home Study Form	n/a		n/a	n/a	n/a

Behavioral Health

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
-	To Order Notes to Self Materials		n/a	n/a	n/a	n/a
-	To Order Suicide Prevention Materials		n/a	n/a	n/a	n/a
-	To Order Let’s Be Clear Materials		n/a	n/a
BH 04	Substance Use Disorder Involuntary Commitment Process	n/a	n/a	n/a
BH 05	Intensive Methamphetamine Treatment Services	n/a	n/a	n/a
BH 11	Supported Housing Flyer	n/a	n/a	n/a
BH 13	Juvenile Justice Reinvestment Initiative Flyer	n/a	n/a	n/a
BH 14	Substance Use Prevention Services Flyer	n/a	n/a	n/a
BH 15	Criminal Justice Initiative Flyer	n/a		n/a	n/a	n/a
BH 16	Pregnancy Alcohol Flyer	n/a	n/a	n/a
BH 24	Behavioral Health Resources Flyer	n/a	n/a	n/a
BH 26	Working in Behavioral Health	n/a	n/a	n/a

Child Care Services

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
CCS 06	Child Care Assistance Program Brochure	n/a	n/a
CCS 09	SD Child Safety Seat Brochure	n/a	n/a
CCS 10	SD Child Development Associate Training Program	n/a	n/a	n/a
CCS 14	Choosing Child Care Handbook	n/a	n/a
OLA 03	Office of Licensing and Accreditation Brochure	n/a	n/a	n/a
OLA-102	Application for Admission to Child Care	n/a		n/a	n/a	n/a
OLA-104	Daily Attendance Form	n/a		n/a	n/a	n/a
OLA-105	Child Care Provider Training Record	n/a		n/a	n/a	n/a
OLA-106	Immunization Affidavit	n/a		n/a	n/a	n/a
OLA-107	Medication Administration Form	n/a		n/a	n/a	n/a
OLA-108	Parent Agreement	n/a		n/a	n/a	n/a
OLA-109	Serious Incident Report Form	n/a		n/a	n/a	n/a
OLA-110	Child Care Provider Form	n/a		n/a	n/a	n/a
OLA-111	Emergency Preparedness Drill Log	n/a		n/a	n/a	n/a
OLA-112	Procedures for Identifying CA/N	n/a		n/a	n/a	n/a
OLA-113	Sample Emergency Preparedness Plan	n/a		n/a	n/a	n/a
OLA-114	Licensed School Age Care Programs Located in a School - Floor Plan Review	n/a		n/a	n/a	n/a
OLA-116	Floor Plan Review Process and Program Proposal	n/a		n/a	n/a	n/a
OLA-118	Written Care Plan for a Child with Allergies	n/a		n/a	n/a	n/a

Child Protection Services

Doc #	Document Name	Instructions	Online Version	Spanish Version
CPS 01	Child Protection Services Booklet	n/a	n/a
CPS 03	Safe Havens Brochure	n/a	n/a	n/a
CPS 07	Independent Living Program Education and Training Voucher Brochure	n/a	n/a
CPS 10	Independent Living Program Brochure	n/a	n/a
CPS 13	Young Voices Brochure	n/a	n/a	n/a
CPS 14	Young Voices Handbook	n/a	n/a	n/a
CPS 23	Safe Havens Poster	n/a	n/a	n/a

Child Support

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
DCS 01	Child Support Modification Handbook	n/a	n/a	n/a
DCS 02	A Guide for Teenage Parents Brochure	n/a		n/a	n/a	n/a
DCS 03	Income & Wage Withholding Brochure	n/a	n/a	n/a
DCS 04	National Medical Support Notice Brochure	n/a	n/a	n/a
DCS 05	Payment Options Brochure	n/a	n/a	n/a
DCS 06	Voluntary Paternity Establishment Handbook and Form	n/a	n/a
DCS 08	Child Support Parent Handbook	n/a	n/a	n/a

General

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
-	South Dakota Weatherization Field Guide	n/a		n/a	n/a	n/a
EA 11	Weatherization Assistance Brochure	n/a	n/a
EA 12	Energy Assistance Brochure	n/a	n/a

General Social Service Documents

Doc #	Document Name	Instructions	Online Version	Spanish Version
DSS 06	Discrimination Complaint Brochure	n/a	n/a	n/a
DSS 07	Discrimination Complaint Poster	n/a	n/a	n/a
DSS 08	Notice of Privacy Brochure	n/a	n/a
DSS 09	DSS Handbook	n/a	n/a	n/a
EA 15	Emergency Services for SD Flyer	n/a	n/a	n/a
EA 18	Long-Term Care Partnership Brochure	n/a	n/a	n/a
EA 19	Guide to Assistance Handbook	n/a	n/a

Medical Eligibility

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
EA 05	Medicare Savings Program Brochure	n/a	n/a
EA 08	Medicaid Spousal Care Handbook	n/a	n/a	n/a
EA 14	CHIP Rack Card	n/a	n/a
EA 16	Medical Assistance for Children and Families: IHS Specific	n/a	n/a	n/a
EA 23	CHIP Poster	n/a	n/a	n/a
EA-211	Authorization to Release Information	n/a			n/a	n/a
EA-340	Psychiatric Residential Treatment Facility Referral Form	n/a		n/a	n/a	n/a
MS 01	Medical Assistance Program Recipient Handbook	n/a	n/a

Medical Services

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
MS 01	Medical Assistance Program Recipient Handbook	n/a	n/a
MS 02	Provider Selection Rack Card	n/a	n/a	n/a
MS 03	Well-Child Care Brochure	n/a	n/a
MS 04	Medicaid Non-Emergency Medical Travel Brochure	n/a	n/a	n/a
MS 05	Well Visit Rack Card	n/a	n/a	n/a
MS 06	Health Home Brochure	n/a	n/a	n/a
MS 07	Premium Assistance Rack Card	n/a	n/a
MS 08	Constituent Liaison Services Brochure	n/a	n/a	n/a
MS 10	Medicaid Pregnancy Handbook	n/a	n/a	n/a
MS 12	Well Child Poster	n/a	n/a	n/a
MS 13	Behavioral Health Resources	n/a	n/a	n/a
MS 15	Well Visit Poster	n/a	n/a	n/a
MS 18	Constituent Liaison Services Poster	n/a	n/a	n/a
MS 25	BabyReady Rackcard	n/a	n/a	n/a
MS 26	BabyReady Poster	n/a	n/a	n/a
MS 28	BabyReady Flyer	n/a		n/a	n/a	n/a
MS-101	Advanced Recipient Notice of Non-Coverage	n/a		n/a	n/a	n/a
MS-112	Primary Care Provider Program Reminders - Emergency Room	n/a		n/a	n/a	n/a
MS-121	Hospice Notification	n/a		n/a	n/a	n/a
MS-129	Medicaid Attestation Form on the Appropriateness of the Qualified Clinical Trials	n/a		n/a	n/a	n/a
MS-130	Preadmission Screening and Resident Review (PASRR) Screening Form	n/a		n/a	n/a	n/a
MS-131	Preadmission Hospital Exemption Form	n/a		n/a	n/a	n/a
MS-132	ID/DD Level II Evaluation Form	n/a		n/a	n/a	n/a
MS-133	BabyReady Program Addendum	n/a		n/a	n/a	n/a
MS-134	BabyReady Program Application	n/a		n/a	n/a	n/a
MS-135	BabyReady Program Barriers to Care Initiatives	n/a		n/a	n/a	n/a
MS-136	BabyReady Program Overview	n/a		n/a	n/a	n/a
MS-137	BabyReady Program Opt-In & Selection Form	n/a		n/a	n/a	n/a
MS-138	Barriers to Care Initiative Annual Reporting Form	n/a		n/a	n/a	n/a
MS-139	BabyReady Exit Form	n/a		n/a	n/a	n/a
NEMT-953	NEMT Primary Care Provider/Health Home Provider Questionnaire	n/a		n/a	n/a	n/a
NEMT-964	Non-Emergency Medical Travel (NEMT) HIPAA Authorization	n/a		n/a	n/a	n/a
NEMT-970	NEMT Reimbursement Form \| Day Trip	n/a		n/a	n/a	n/a
NEMT-971	NEMT Reimbursement Form \| Overnight Trip	n/a		n/a	n/a	n/a
NEMT-972	NEMT Additional Lodging	n/a		n/a	n/a	n/a
NEMT-973	NEMT Appointment Verification Form	n/a		n/a	n/a	n/a
PA-112	Prior Authorization Form: Long Term Acute Care and Out-of-State Rehab	n/a		n/a	n/a	n/a
PA-113	Prior Authorization Form: Medical Nutrition	n/a		n/a	n/a	n/a

Parent Education

Doc #	Document Name	Instructions	Online Version	Spanish Version
CPS 02	Common Sense Parenting Brochure	n/a	n/a
CPS 05	Positive Indian Parenting Brochure	n/a	n/a	n/a
CPS 15	Positive Indian Parenting Flyer	n/a	n/a	n/a

Recoveries and Fraud

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
RE 03	Estate Recovery Program Brochure	n/a	n/a	n/a
RE 04	Medicaid Liens Brochure	n/a	n/a	n/a

South Dakota EBT

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
EBT 01	EBT Client Handbook	n/a	n/a

Temporary Assistance for Needy Families

Doc #	Document Name	Instructions	Online Version	Spanish Version	English Version	Add to Cart
CC-975	TANF Child Care Benefits Application	n/a	n/a	n/a
EA 04	TANF Brochure	n/a	n/a