South Dakota Department of Social Services Forms

170
total templates

Documents

170

Form DSS06 "Discrimination Complaint Form" - South Dakota

Rate (4.7 / 5) 10 votes
Size: 279 KB
2 pages

Form BRO/DCS6S "Voluntary Acknowledgment of Paternity" - South Dakota (English/Spanish)

Rate (4.3 / 5) 6 votes
Size: 1 MB
7 pages

Form BH-04 "102b Hardship Considerations" - South Dakota, 2020

Rate (4.4 / 5) 23 votes
Size: 75 KB
2 pages

Form BH-02 "Financial Eligibility" - South Dakota, 2020

Rate (4.3 / 5) 10 votes
Size: 175 KB
2 pages

Form BH-05 "Refusal of Hardship Consideration" - South Dakota, 2020

Rate (4.8 / 5) 27 votes
Size: 66 KB
1 page

Form BH-03 "102a Hardship Consideration" - South Dakota, 2020

Rate (4.6 / 5) 18 votes
Size: 64 KB
1 page

Form BH-08 "Mental Health - Impact Application" - South Dakota

Rate (4.7 / 5) 18 votes
Size: 143 KB
2 pages

Form MS-116 "Medicaid Credit Balance Report" - South Dakota

Rate (4.8 / 5) 19 votes
Size: 140 KB
2 pages

Form OLA-109 "Serious Incident Report Form" - South Dakota

Rate (4.7 / 5) 14 votes
Size: 120 KB
1 page

Form OLA-113 "Emergency Preparedness and Response Plan Family Child Care Home Template" - South Dakota

Rate (4.3 / 5) 10 votes
Size: 1 MB
4 pages

Form OLA-112 "Procedures for Identifying Child Abuse and Neglect Acknowledgement of Responsibility to Report" - South Dakota

Rate (4.4 / 5) 11 votes
Size: 1 MB
2 pages

Form DSS-CC-950 "Child Care Assistance Application" - South Dakota

Rate (4.6 / 5) 69 votes
Size: 223 KB
9 pages

Formulario CCS-950 "Solicitud De Asistencia Para Cuidado Infantil" - South Dakota (Spanish)

Rate (4.7 / 5) 24 votes
Size: 397 KB
8 pages

Form DSS-CC-975 "Child Care Assistance Application for TANF Approved Activities and Employment" - South Dakota

Rate (4.4 / 5) 45 votes
Size: 131 KB
2 pages

Form OLA101 "Orientation Training Verification Form" - South Dakota

Rate (4.5 / 5) 15 votes
Size: 89 KB
2 pages

Form DSS-NEMT-950 "Non-emergency Medical Travel (Nemt) Reimbursement Form" - South Dakota

Rate (4.3 / 5) 6 votes
Size: 101 KB
2 pages

Form DSS-NEMT-964 "Medicaid Non-emergency Medical Travel Authorization for the Use or Disclosure of Protected Health Information" - South Dakota

Rate (4.5 / 5) 6 votes
Size: 104 KB
2 pages

Form DSS-NEMT-952 "Non-emergency Medical Travel (Nemt) Payment Authorization Form" - South Dakota (English/Spanish)

Rate (4.4 / 5) 7 votes
Size: 246 KB
3 pages

Form CPS-100 "Education and Training Voucher (Etv) Application" - South Dakota

Rate (4.3 / 5) 6 votes
Size: 230 KB
4 pages

Form OLA-100 "Background Screening Information Authorization" - South Dakota

Rate (4.4 / 5) 22 votes
Size: 148 KB
1 page

Form CPS-593 "South Dakota Permission to Screen for Reports of Abuse or Neglect" - South Dakota

Rate (4.6 / 5) 5 votes
Size: 152 KB
2 pages

Form OLA103 "Child Care Declaration of Prior Criminal Conviction and Military History" - South Dakota

Rate (4.6 / 5) 22 votes
Size: 103 KB
1 page

Form DSS-SE-405 "Application for Income Withholding Only Services" - South Dakota

Rate (4.5 / 5) 93 votes
Size: 179 KB
4 pages

Form DSS-EA-265 "Request for Long-Term Care or Home Community Based Services Waiver Assistance" - South Dakota

Rate (4.7 / 5) 22 votes
Size: 170 KB
3 pages

Form DSS-EA-243 "Application for Chronic Renal Disease Program" - South Dakota

Rate (4.4 / 5) 11 votes
Size: 283 KB
5 pages

Formulario DSS-EA-208 "Autorizacion Para Proporcionar/Divulgar Informacion" - South Dakota (Spanish)

Rate (4.4 / 5) 30 votes
Size: 195 KB
1 page

Form DSS-EA-240 "Application for Resource Assessment, Long Term Care or Related Medical Assistance" - South Dakota

Rate (4.5 / 5) 48 votes
Size: 1 MB
22 pages

Form DSS-EA-208 "Authorization to Furnish/Release Information" - South Dakota

Rate (4.3 / 5) 20 votes
Size: 157 KB
1 page

Form DSS-EA-270 "South Dakota Application for Medicare Savings Program" - South Dakota

Rate (4.7 / 5) 41 votes
Size: 1 MB
8 pages

Form DSS-EA-269 "Child Care Expense Billing Verification" - South Dakota

Rate (4.6 / 5) 13 votes
Size: 172 KB
1 page

Form CPS-502 "Agency Request for Screening for Substantiated Reports of Child Abuse or Neglect" - South Dakota

Rate (4.4 / 5) 5 votes
Size: 88 KB
1 page

Form CPS-501 "Individual Request for Screening for Substantiated Reports of Child Abuse or Neglect" - South Dakota

Rate (4.8 / 5) 22 votes
Size: 91 KB
1 page

Form DSS-EA-249 "Disabled Children's Program Application" - South Dakota

Rate (4.4 / 5) 28 votes
Size: 1 MB
20 pages

Form BH-11A "Substance Use Disorder Outcome Tool - Initial" - South Dakota

Rate (4.5 / 5) 13 votes
Size: 230 KB
3 pages

Form BH-11B "Adult Substance Use Disorder Update Outcome Tool" - South Dakota

Rate (4.5 / 5) 21 votes
Size: 242 KB
3 pages

Form BH-11C "Adult Substance Use Disorder Discharge Outcome Tool" - South Dakota

Rate (4.4 / 5) 27 votes
Size: 263 KB
4 pages

Form BH-12E "Youth Mh Update Outcome Tool" - South Dakota

Rate (4.3 / 5) 35 votes
Size: 236 KB
3 pages

Form BH-12F "Youth Mh Discharge Outcome Tool" - South Dakota

Rate (4.7 / 5) 16 votes
Size: 236 KB
3 pages

Form BH-13E "Family Mh Update Outcome Tool" - South Dakota

Rate (4.5 / 5) 16 votes
Size: 232 KB
3 pages

Form BH-13F "Family Mh Discharge Outcome Tool" - South Dakota

Rate (4.3 / 5) 14 votes
Size: 232 KB
3 pages
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