South Dakota Department of Human Services Forms
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Form DHS-DD-750 "Discharge/Termination Summary" - South Dakota
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Form DHS-DD-716 "Home/Community-Based Services Eligibility Determination Form" - South Dakota
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8 votes
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Form DHS-DD-101 "Request for Extraordinary Needs Funding (Enf)" - South Dakota
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21 votes
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99 KB
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Form DHS-DD-770 "Request for Admission to Sddc" - South Dakota
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Form DHS-DD-102 "Extraordinary Needs Funding (Enf) Follow up" - South Dakota
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Form DHS-500 "Representative's Quarterly Report" - South Dakota
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21 votes
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29 KB
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Form DHS-RS-358 "Service Provider Application" - South Dakota
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Form DHS-CI-2011 "Cochlear Implant Application Form" - South Dakota
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25 votes
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74 KB
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Form DHS-CI-2011 "Certification of Hearing Impairment for Cochlear Implant Program" - South Dakota
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24 votes
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96 KB
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SD Form 0516 (DHS-VR-302) "Application for Rehabilitation Services" - South Dakota
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14 votes
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60 KB
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Form BOP-PA-NP "Non-permanent Payroll Form" - South Dakota
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"South Dakota Hearing Aid Assistance Program Application Form" - South Dakota
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"Organizational Application for Funding - Board of Vocational Rehabilitation (Bvr)" - South Dakota
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153 KB
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"Application for Contractual Agreement as Guardian/Conservator Representative on Behalf of the Department of Human Services" - South Dakota
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"Request for Payment for Respite Care Services" - South Dakota
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"South Dakota DHS Establishment Program Application" - South Dakota
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"Conservator's Monthly Accounting" - South Dakota
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"Application for Statewide Family Support" - South Dakota
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"Application for Respite Care Program" - South Dakota
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"Audiologist's Medical Information Form" - South Dakota
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7 votes
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"Employee's Authorization Agreement for Direct Deposit" - South Dakota
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Instructions for "Application for Respite Care Program" - South Dakota
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![Form DHS-DD-750 "Discharge/Termination Summary" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179423/form-dhs-dd-750-discharge-termination-summary-south-dakota.png "Form DHS-DD-750 "Discharge/Termination Summary" - South Dakota")
![Form DHS-DD-716 "Home/Community-Based Services Eligibility Determination Form" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179416/form-dhs-dd-716-home-community-based-services-eligibility-determination-form-south-dakota.png "Form DHS-DD-716 "Home/Community-Based Services Eligibility Determination Form" - South Dakota")
![Form DHS-DD-101 "Request for Extraordinary Needs Funding (Enf)" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179424/form-dhs-dd-101-request-for-extraordinary-needs-funding-enf-south-dakota.png "Form DHS-DD-101 "Request for Extraordinary Needs Funding (Enf)" - South Dakota")
![Form DHS-DD-770 "Request for Admission to Sddc" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179407/form-dhs-dd-770-request-for-admission-to-sddc-south-dakota.png "Form DHS-DD-770 "Request for Admission to Sddc" - South Dakota")
![Form DHS-DD-102 "Extraordinary Needs Funding (Enf) Follow up" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179425/form-dhs-dd-102-extraordinary-needs-funding-enf-follow-up-south-dakota.png "Form DHS-DD-102 "Extraordinary Needs Funding (Enf) Follow up" - South Dakota")
![Form DHS-500 "Representative's Quarterly Report" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179414/form-dhs-500-representative-s-quarterly-report-south-dakota.png "Form DHS-500 "Representative's Quarterly Report" - South Dakota")
![Form DHS-RS-358 "Service Provider Application" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179457/form-dhs-rs-358-service-provider-application-south-dakota.png "Form DHS-RS-358 "Service Provider Application" - South Dakota")
![Form DHS-CI-2011 "Cochlear Implant Application Form" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179447/form-dhs-ci-2011-cochlear-implant-application-form-south-dakota.png "Form DHS-CI-2011 "Cochlear Implant Application Form" - South Dakota")
![Form DHS-CI-2011 "Certification of Hearing Impairment for Cochlear Implant Program" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179446/form-dhs-ci-2011-certification-of-hearing-impairment-for-cochlear-implant-program-south-dakota.png "Form DHS-CI-2011 "Certification of Hearing Impairment for Cochlear Implant Program" - South Dakota")
![SD Form 0516 (DHS-VR-302) "Application for Rehabilitation Services" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179435/sd-form-0516-dhs-vr-302-application-for-rehabilitation-services-south-dakota.png "SD Form 0516 (DHS-VR-302) "Application for Rehabilitation Services" - South Dakota")
![Form BOP-PA-NP "Non-permanent Payroll Form" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179464/form-bop-pa-np-non-permanent-payroll-form-south-dakota.png "Form BOP-PA-NP "Non-permanent Payroll Form" - South Dakota")
!["South Dakota Hearing Aid Assistance Program Application Form" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179443/south-dakota-hearing-aid-assistance-program-application-form-south-dakota.png ""South Dakota Hearing Aid Assistance Program Application Form" - South Dakota")
!["Organizational Application for Funding - Board of Vocational Rehabilitation (Bvr)" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179459/organizational-application-for-funding-board-of-vocational-rehabilitation-bvr-south-dakota.png ""Organizational Application for Funding - Board of Vocational Rehabilitation (Bvr)" - South Dakota")
!["Application for Contractual Agreement as Guardian/Conservator Representative on Behalf of the Department of Human Services" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179411/application-for-contractual-agreement-as-guardian-conservator-representative-on-behalf-of-the-department-of-human-services-south-dakota.png ""Application for Contractual Agreement as Guardian/Conservator Representative on Behalf of the Department of Human Services" - South Dakota")
!["Request for Payment for Respite Care Services" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179430/request-for-payment-for-respite-care-services-south-dakota.png ""Request for Payment for Respite Care Services" - South Dakota")
!["South Dakota DHS Establishment Program Application" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179408/south-dakota-dhs-establishment-program-application-south-dakota.png ""South Dakota DHS Establishment Program Application" - South Dakota")
!["Conservator's Monthly Accounting" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179410/conservator-s-monthly-accounting-south-dakota.png ""Conservator's Monthly Accounting" - South Dakota")
!["Application for Statewide Family Support" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179428/application-for-statewide-family-support-south-dakota.png ""Application for Statewide Family Support" - South Dakota")
!["Application for Respite Care Program" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179431/application-for-respite-care-program-south-dakota.png ""Application for Respite Care Program" - South Dakota")
!["Audiologist's Medical Information Form" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179445/audiologist-s-medical-information-form-south-dakota.png ""Audiologist's Medical Information Form" - South Dakota")
!["Employee's Authorization Agreement for Direct Deposit" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179438/employee-s-authorization-agreement-for-direct-deposit-south-dakota.png ""Employee's Authorization Agreement for Direct Deposit" - South Dakota")
![Instructions for "Application for Respite Care Program" - South Dakota](https://data.templateroller.com/pdf_docs_html/2179/21794/2179460/instructions-for-application-for-respite-care-program-south-dakota.png "Instructions for "Application for Respite Care Program" - South Dakota")
