List Forms & Brochures by Number

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Form Number [Sorted] Title [Sort] Categories [Sort] [?] File Format [?]
Booklet 1

Child Support Guidelines 2006

CSE

PDF

Form 1

I-9 (Employment Eligibility Verification)

HRM

PDF++

Poster 1

And Justice for All (SNAP)

SNAP

PDF

Form 1

CHIP Notice C021 Food Stamps - Phone Recertification Appointment Notice (English)

SNAP

PDF++

Form 1

CHIP Notice F006 Appointment Letter - Initial Application (English)

SNAP

PDF++

1

Links to Child Care Licensing Forms and Laws

CC

PDF

Form 1 SPA

CHIP Notice C021 Food Stamps - Phone Recertification Appointment Notice (Spanish)

SNAP

PDF++

Form 1 SPA

CHIP Notice F006 Appointment Letter - Initial Application (Spanish)

SNAP

PDF++

Form 1 SPA

Spanish Days of the Week

SNAP

PDF

Form 1 SPA

Spanish Months of the Year

SNAP

PDF

Form 1025

Jobs Upfront Mean More Pay

FA

PDF++

Form 1025 SPA

Programa de Trabajo JUMMP

FA

PDF

Form 1164

Purchase of Service Reimbursement Request

FIN

PDF++

Flyer 1202

ePAY Debit Card (includes Spanish version)

FI

PDF

Form 1204

SCCAP Application Cover Letter

SNAP

PDF

Form 1205

Declaration and Consent to Participate in the SCCAP

SNAP

PDF

Form 1205 SPA

Declaración y Autorización para Participar en el Proyecto de Solicitud Combinada de Carolina del Sur (SCCAP)

SNAP

PDF

Form 1206

SCCAP Rights and Responsibilities

SNAP

PDF

Form 1206 SPA

PROYECTO DE SOLICITUD COMBINADA DE CAROLINA DEL SUR (SCCAP) DERECHOS Y RESPONSABILIDADES

SNAP

PDF

Form 1211 SPA

Solicitud de Información para Manutencion de Menores

FS

PDF

Form 1214

Notification Regarding Psychotropic Medication

HS

PDF

Form 1216

Voluntary Child Support/Contributions Form

FAM

PDF++

Form 1232

Father Involvement and Marriage Questionnaire

FA

PDF++

Form 1234 SPA

Formulario de Referencia/Comunicación del Cliente

FNP/FI

PDF

Form 1245

Request for Wage Information

FI

PDF++

Form 1245 PORT

Request for Wage Information - Portuguese Brazilian

FI

Word

Form 1245 SPA

Solicitud Para Información de Salario

FI

PDF+

Form 1247

Medical Release/Physician's Statement

FI

PDF++

Form 1247 A

Medical Release/Physician's Statement – Required In-Home

FA

PDF++

Form 1247 B

Family Independence Self Evaluation Activities of Daily Living

FA

PDF++

Form 1247 C

Family Independence Program Certification of Necessary Treatment

FA

PDF++

Brochure 1250

When Opportunity Knocks...

FI

PDF

Brochure 1273

South Carolina Combined Application Project

SNAP

PDF

Form 1299

SCCAP Excess Expense Letter

SNAP

PDF

Form 1300

Record of School Attendance and Performance Report

FA

PDF++

Form 1301

Certification of Homework Hours

FA

PDF++

Form 1302

Supervised Homework Hours

FA

PDF++

Form 1303

Authorization for Verification of Attendence for Vocational Education

FA

PDF

Brochure 1308

Project HOPE (Adult)

FAM

PDF

Brochure 1311

Employer Services, Benefits and Incentives

FAM

PDF

Form 1319

Supervised Job Search Log – Job Search Verification

FA

PDF++

Form 1326

Notification of Eligibility Determination for Refugee Resettlement Program

FA

PDF++

Brochure 1327

Refugee Resettlement Program

RR

PDF

Brochure 1436

Sexual Harassment Policy

HRM

PDF

Form 1474

Employee Exit Survey

HRM

PDF++

Form 1503

Assurance of Compliance with the Department of Health and Human Services Regulation Under Title VI, Section 601 of the Civil Rights Act of 1964, as Amended

PD

PDF++

Form 1508

Memorandum of Agreement on Criminal Records Checks for Child Caring Institutions, Group Homes and Child Placing Agencies

PD

PDF++

Form 1509

Assurance of Compliance with the Multiethnic Placement Act of 1994 (MEPA)

PD

PDF++

Form 1510

Physical Examination Blank for Foster Parent

CFAS

PDF++

Form 1513

Original Licensing/Relicensing/Changes for Foster Home Licensing

CFAS

PDF++

Form 1521

Application for License

PD

PDF++

Form 1522

Application for Renewal of License

PD

PDF++

Form 1524

Notice of Change in Child-Placing Agency's Foster Family Home License

CFAS

PDF++

Form 1527

Application for a Child-Placing Agency's Foster Family Home License

CFAS

PDF

Form 1531

Foster Parent Agreement with DSS Regarding Placement of a Child

HS

PDF++

Form 1536

Original Licensing/Relicensing/Changes for Residential Facility and Child Placing Agency Licensing

PD

PDF++

Form 1538

DSS Transportation Log

CFAS

PDF++

Form 1548

Responsible Father Registry Notice of Change

ADOPT

PDF++

Form 1549

Responsible Father Registry Registration

ADOPT

PDF++

Form 1571

Reference Letter for Foster/Adoptive Applicant

HS

PDF++

Form 1572

Application to Foster Care/Adoption

ADOPT

PDF

Form 1572 SPA

Solicitud para CrianzaTemporal/Adopción

HS

PDF

Form 1573 SPA

Información Financiera

ADOPT

PDF

Form 1574

Medical Report Form for Prospective Foster/Adoptive Parent

HS

PDF

Form 1575 A

Biological Family History Information

ADOPT

PDF

Form 1575 A SPA

Información E Historial De Familia Biológica

ADOPT

PDF

Form 1606

Application for Participation for Child Care Homes

CACFP

PDF++

Form 1613 1

CACFP Internal Controls

CACFP

PDF

Form 1613 2

CACFP Fiscal Resources and Financial History

CACFP

PDF

Form 1613 3

CACFP Sponsor Training Plan

CACFP

PDF

Form 1613 4

CACFP Monitoring Schedule

CACFP

PDF

Form 1613 5

Monitor Responsibility

CACFP

PDF

Form 1620

Change Report Form for Simplified Reporters

FAM

PDF

Form 1620 SPA

Formulario Para Reportar Cambios Simples

FA

PDF

Brochure 1622

What You Need to Know! Food Stamp Eligibility for Residents

FNP

PDF

Form 1625

Sponsor Application for Participation

SFSP

PDF++

Form 1633

Application for Participation for Child Care and Adult Day Care Centers in the Child and Adult Care Food Program (CACFP)

CACFP

PDF++

Form 1633 2

Ethnic Racial Form

CACFP

PDF

Form 1633 3

Center Training Plan

CACFP

PDF

Form 1641

Monthly Claim for Reimbursement

SFSP

PDF++

Form 1641 1

Multi-County Listing Claim for Reimbursement

FS

PDF

Form 1645

Application for Free and Reduced-Price Meals in Adult Care Food Programs

FNP

PDF

Form 1650

Child and Adult Care Food Program Child Enrollment Form

CACFP

PDF++

Form 1667

Applicant/Recipient Information Questionnaire

FI

PDF

Form 1667 SPA

Cuestionario de Información del Solicitante/Beneficiario

FI

PDF

Form 1668

Authorization for Special Investigation

FS

PDF

Form 1669

Request for Information

FNP/FI

PDF

Form 1669 KIR

Request to Applicant for Information

FA

PDF

Form 1669 SPA

Petición de Información al Solicitante

FS

PDF

Form 1669 SWA

Request to Applicant for Information

FA

PDF

Form 1670

Child Care Payment Verification Form

FS

PDF++

Form 1766 SPA

Declaración

FS

PDF

Form 1903

Case Review and Change Report for IV-E Foster Care

FA

PDF++

Form 1905

Referral for Field Operations and IV-E Eligibility Determination

FA

PDF+

Form 1908

Application for IV-E Eligibility

FA

PDF+

Form 2012

Landlord/Owner Statement

FI

PDF++

Form 2012 SPA

Declaración del Propietario/Dueño

FI

PDF

Booklet 2111

Intern Handbook

SD&T

PDF

Brochure 2112

The Internship Program

SD&T

PDF

Brochure 2401

The Adoption Reunion Register

ADOPT

PDF

Brochure 2401 SPA

El Registro de Reunión para las Personas Adoptadas

ADOPT

PDF

Brochure 2402

Problem Pregnancy Here's Help

ADOPT

PDF

Brochure 2402 SPA

Un Embarazo Problemático Aquí Tiene Ayuda

ADOPT

PDF

Brochure 2408

Administrative Disqualification Hearings

IPR

PDF

Brochure 2408 SPA

Audiencias de Descalificación Administrativa

IPR

PDF

Brochure 2410

Fair Hearings

IPR

PDF

Brochure 2410 SPA

La Audiencia Imparcial

IPR

PDF

Brochure 2412

The Adoption Option

ADOPT

PDF

Brochure 2412 SPA

La Opción de la Adopción

ADOPT

PDF

Brochure 2416

Know Your Rights

AS

PDF

Brochure 2416 SPA

Conozca sus Derechos

IPR/CR

PDF

Form 2418

Fair Hearing Information

FA

PDF

Form 2418 ARAB

Fair Hearing Information

FA

PDF

Form 2418 BUR

Fair Hearing Information

FA

PDF

Form 2418 KIR

Fair Hearing Information

FA

PDF

Form 2418 RUS

Fair Hearing Information

FA

PDF

Form 2418 SPA

Información Sobre una Audiencia Imparcial

FA

PDF

Form 2418 SWA

Fair Hearing Information

FA

PDF

Form 2418 TIG

Fair Hearing Information

FA

PDF

Form 2418 VIET

Fair Hearing Information

CPS

PDF

Brochure 2419

Adoption Guidelines and Steps to Adoption

ADOPT

PDF

Brochure 2419 SPA

Guía para la Adopción y Pasos de la Adopción

ADOPT

PDF

Brochure 2422

Questions and Answers About SNAP Benefits

SNAP

PDF

Brochure 2422 SPA

Preguntas y Respuestas Sobre Cupones de Alimentos

SNAP

PDF

Poster 2427

Toll-Free From Anywhere in South Carolina

FNP

PDF

Poster 2427 SPA

Llamadas Gratuitas de Cualquier Lugar en Carolina del Sur

FNP

PDF

Brochure 2444

SNAP 2 WORK Program

SNAP

PDF

Brochure 2444 SPA

Programa de Asistencia Nutricional Complementaria (SNAP por sus siglas en inglés) Programa de Entrenamiento y Trabajo

SNAP

PDF

Poster 2452

SNAP: Your Rights

SNAP

PDF

Poster 2452 SPA

SNAP: Sus Derechos

SNAP

PDF

Form 2454

Roomer/Boarder Payment Verification Form

FAM

PDF

Form 2454 SPA

Formulario de Confirmación de Pagos por Concepto de Alojamiento Con/Sin Comida

FAM

PDF

Brochure 2475

Important Information About Nonrecurring Costs for Parents Who Have Adopted a Child With Special Needs

ADOPT

PDF

Brochure 2475 SPA

Información Importante Sobre el Reembolso de Gastos No Recurrentes para Padres que Están Adoptando a un Niño con Necesidades Especiales

ADOPT

PDF

Brochure 2483

Keep Your Home and Children Safe From Fire

FI

PDF

Brochure 2493

Daniel's Law

PA

PDF

Brochure 2493 SPA

La Ley de Daniel

PA

PDF

Brochure 2495

Faith-Based Initiative

CRD

PDF

Flyer 2496

The Safe Haven for Abandoned Babies Act

HS

PDF

Poster 2497

The Safe Haven for Abandoned Babies Act

HS

PDF

Form 2533

MEPA Educational Materials

ADOPT

PDF

Form 2534

Licensed Professional's Statement

ADOPT

PDF

Form 2535

Notice

ADOPT

PDF

Form 2540

Shaken Baby Video

ADOPT

PDF

Form 2601

Civil Rights Discrimination Complaint Form

IPR/CR

PDF

Form 2601 SPA

Formulario de Quejas por Discriminación de los Derechos Civiles

IPR/CR

PDF

Form 2627 A

Repayment Agreement and Acknowledgment of Debt

FAM

PDF++

Form 2627 A SPA

Acuerdo de Pagos y Reconocimiento de Deuda

FAM

PDF

Form 2633

Request for Fair Hearing

IPR

PDF

Form 2633 SPA

Solicitud de Audiencia Imparcial

IPR

PDF

Form 2647

State and Federal Fingerprint Review Transmittal Form

INV

PDF++

Form 2647 1

State and Federal Fingerprint Review Transmittal Form (Resubmit Only)

INV

PDF++

Poster 2660

You Need to Know/Usted Necesita Saber

IPR/CR

PDF

Poster 2661

Interpretation Service Available

IPR/CR

PDF

Poster 2661 SPA

Servicios de Interpretación Disponibles

IPR/CR

PDF

Form 2665

Certification for $8 Reduced Criminal Record Search Fee

INV

PDF++

Form 2667

Spanish-English Interpreting Invoice

IPR/CR

PDF++

Form 2700 1

Custodial Parents Application for Child Support Services

CSE

PDF

Form 2700 1 SPA

Solicitud Para el Padre/La Madre en Custodia de Servicios Para la Manutención Para Menores

CSE

PDF

Booklet 2712

For Your Child's Sake...Establish Legal Fatherhood

CSE

PDF

Booklet 2712 SPA

¡Por el bien de su hijo...iestablezca la paternidad legal!

CSE

PDF

Form 2719 1

Change of Custodial Parent's Application for Child Support

CSE

PDF

Form 2719 1 SPA

Cambio de la Solicitud del Padre/la Madre con Custodia para Manutención para Menores

CSE

PDF

Form 2719 2

Change of Custodial Parent's Application for Child Support

CSE

PDF

Form 2719 2 SPA

Cambio de la Solicitud del Padre/la Madre con Custodia para Manutención para Menores

CSE

PDF

Form 2719 3

Change of Custodial Parent's Application for Child Support

CSE

PDF

Form 2719 3 SPA

Cambio de la Solicitud del Padre/la Madre con Custodia para Manutención para Menores

CSE

PDF

Form 2719 4

Change of Custodial Parent's Application for Child Support

CSE

PDF

Form 2719 4 SPA

Cambio de la Solicitud del Padre/la Madre con Custodia para Manutención para Menores

CSE

PDF

Form 2719 5

Change of Custodial Parent's Application for Child Support

CSE

PDF

Form 2719 5 SPA

Cambio de la Solicitud del Padre/la Madre con Custodia para Manutención para Menores

CSE

PDF

Brochure 2797

South Carolina Parenting Opportunity Program

CSE

PDF

Brochure 2797 SPA

Programa de Oportunidades para Padres de Carolina del Sur

CSE

PDF

Form 2810

Physician's Report

CSE

PDF

Form 2900

General Record and Statement of Child's Health for Admission to Child Care Facility

DC

PDF++

Form 2900 SPA

Expediente General y Declarción Ingreso a una Guardería Infantil

DC

PDF

Form 2901

Child Care Regulatory Services Medical Statement

DC

PDF

Form 2902

Application to Operate a Child Care Facility

CC

PDF++

Form 2905

DHEC-Fire Inspection Request: Child Care Facility

DC

PDF++

Form 2908

Child Care Reference Release Statement

DC

PDF++

Form 2909

Family Child Care Home Consumer Parent Statement

DC

PDF++

Form 2922

Original or Renewal Registration of Family Child Care Home (FCCH)

DC

PDF++

Form 2924

Central Registry Release of Information and Compliance Statement

DC

PDF++

Form 2925

Director/Staff Evidence of Non-Conviction and Statement of Compliance

DC

PDF++

Form 2927

Household Member List

CC

PDF++

Form 2930

Authorization for Intervention, Therapy and Extracurricular Activities

CC

PDF++

Form 2944

Original or Continuing Registration Study for a Facility Operated by A...

DC

PDF++

Form 2945

Current Faith-Based Facility List of Children

CC

PDF++

Booklet 2955

S.C. Child Care Licensing Law

DC

PDF

Booklet 2960

Regulations for Family Child Care Homes

CC

PDF

Form 2963

Child Care Facility Current List of Children

DC

PDF++

Brochure 2966

A Guide to Key Regulations

DC

PDF

Brochure 2969

Emergency Procedures for Child Care Providers

DC

PDF

Form 2970

Supervisory Visit Form for Licensed Centers

DC

PDF++

Form 2971

Supervisory Visit Form for Licensed Group Child Care Homes

DC

PDF++

Form 2972

Supervisory Visit Form for Registered Church Child Care Centers

DC

PDF++

Booklet 2974

Child Care Emergency Plan Template

DC

PDF++

Booklet 2974 SPA

Modelo de un Plan de Emergencia para Programas de Cuidado Infantil

DC

PDF

Brochure 3001

Foster or Adopt a Child

FPCWS

PDF

Brochure 3001 SPA

Nuestros Niños, Nuestro Futuro

HS

PDF

Form 3004

ABC Child Care Program CPS/FC Child Care Referral Form

ABC

PDF++

Form 3006

Suspected Child Abuse and Neglect Referral for Health Professional...

CFAS

PDF++

Form 3008

Child Factors Checklist

ADOPT

PDF

Brochure 3034

Child Protective Services: A Guide for Parents

CPS

PDF++

Brochure 3034 SPA

Servicios de Protección a Menores: Una Guía para los Padres

CPS

PDF++

Card 3039

Helpline Phone Card

FPCWS

PDF

Brochure 3053

Child Protective Services: A Guide for Caregivers in Out of Home Settings

CPS

PDF

Brochure 3066

Caring for Children... Caring for Families... Caring for the Future

CPS

PDF

Brochure 3066 SPA  

CPS

PDF

Form 3072

Consent to Release Information

HS

PDF

Form 3072 SPA

Permiso para Divulgar Información

HS

PDF+

Form 3082

Abandoned Infants Form for Safe Havens

CPS

PDF++

Form 3087

Safety Plan

CPS

PDF

Form 3249

Verification of Application for Social Security Number

FAM

PDF

Form 3249 SPA

Verificación de Solicitud de Número de Seguro Social

FAM

PDF

Form 3302

Preoperational Site Visit

SFSP

PDF

Form 3303

Change Form

SFSP

PDF

Form 3306

SFSP Site Information Application

SFSP

PDF++

Form 3307

Daily Record for Week of:

SFSP

PDF

Brochure 3310

Child and Adult Care Food Program in Emergency Shelters

CACFP

PDF

Form 3314

Claim for Reimbursement – At-Risk Afterschool Snack Program

CACFP

PDF++

Form 3314 A

Claim for Reimbursement/Afterschool Snack Program

FA

PDF++

Form 3320

Claim for Reimbursement

CACFP

PDF++

Form 3321

Claim for Reimbursement

FNP/CACFP

PDF++

Brochure 3328

Questions and Answers About Being a Day Care Home Sponsor

CACFP

PDF

Form 3329

Pre-Approval Training Checklist for Child-Care Home Providers

FNP

PDF

Poster 3332

Senior Farmers' Market Nutrition Program

SFMNP

PDF

Brochure 3333

Food Stamps Can Help!

SNAP

PDF

Brochure 3333 A

Food Stamps Can Help! (Local Office)

SNAP

PDF

Brochure 3333 A SPA

¡Las Estampillas Alimenticias le Pueden Ayudar!

SNAP

PDF

Card 3334

Attention Seniors: Healthy Helpings

SNAP

PDF

Brochure 3335

Emergency Shelters Food Program

CACFP

PDF

Brochure 3336

Summer Food Service Program

SFSP

PDF

Brochure 3337

Afterschool Snack Program

CACFP

PDF

Brochure 3338

The Child & Adult Care Food Program in Day Care Homes

CACFP

PDF

Brochure 3339

The Child & Adult Care Food Program in Adult Care Centers

CACFP

PDF

Brochure 3340

The Child & Adult Care Food Program in Child Care Centers

CACFP

PDF

Flyer 3343

Come See What's For Lunch This Summer!

SFSP

PDF

Flyer 3343 SPA

Venga a ver lo que hay para almorzar este verano

SFSP

PDF

Brochure 3344

Senior Farmers' Market Nutrition Program

SFMNP

PDF

Flyer 3345

Senior Farmers' Market Nutrition Program

SFMNP

PDF

Form 3350

Consolidated Weekly Meal Count Record

SFSP

PDF

Brochure 3351

The Commodities Program

TEFAP

PDF

Brochure 3352

SCCAP Are you on Supplemental Security Income?

SNAP

PDF

Form 3353

Attendance Record

CACFP

PDF++

Form 3354

Infant Statement

CACFP

PDF+

Form 3354 SPA

Declaración Sobre Infante

FA

PDF+

Form 3356

Afterschool Snack Program Site Information Form

CACFP

PDF++

Form 3357

At-Risk Afterschool Care Program/Outside School Hours Program Application for Participation

CACFP

PDF++

Form 3357 ADDEN

At-Risk Afterschool Care Program/Outside School Hours Care Program Application for Participation – Sponsor Addendum

CACFP

PDF++

Form 3358

Emergency Shelter Food Program (ESP) Facility Information Form

FA

PDF++

Form 3359

Emergency Shelters Program (ESP) Application For Participation

FA

PDF++

Form 3360

Senior Farmers' Market Nutrition Program Application

SFMNP

PDF

Form 3362

SNAP Employment and Training Program - ABAWD Referral Form

SNAP

PDF++

Form 3362 SPA

Programa de Empleo y Capacitación de SNAP - Formulario de Derivación al Programa ABAWD

SNAP

PDF++

Form 3363

SNAP Employment and Training Program - Noncompliance Notice

SNAP

PDF++

Form 3364

SNAP Employment and Training Program - Personal Responsibility Agreement (PRA)

SNAP

PDF

Form 3365

SNAP 2 WORK Program - Job Search Activity Log

SNAP

PDF

Form 3401

Claims for Reimbursement

CACFP

PDF

Form 3401 A

Claim for Reimbursement Addendum

FA

PDF++

Brochure 3459

Food Watch During Disasters

SNAP

PDF

Brochure 3460

Truth or Consequences

SNAP

PDF

Poster 3463

Do you have a complaint against the Supplemental Nutrition Assistance Program (SNAP)?

SNAP

PDF

Poster 3463 SPA

¿Tiene usted una queja contra el Programa de Asistencia Nutricional Complementaria (SNAP por sus siglas en inglés)?

SNAP

PDF

Brochure 3464

Do you have a complaint against the Supplemental Nutrition Assistance Program (SNAP)?

SNAP

PDF

Brochure 3464 SPA

¿Tiene usted una queja en contra del programa de asistencia nutricional complementaria (SNAP, por sus siglas en inglés)?

SNAP

PDF

Brochure 3735

Family Independence Application Information Your Key to Economic Independence

FI

PDF

Form 3773

ABC Child Care Program Level C Provider Rate Form

ABC

PDF

Form 3774

ABC Child Care Program FFN Child Care Enrollment and Agreement

ABC

PDF

Form 3776

ABC Child Care Program FFN Child Care Certification

ABC

PDF

Form 3778

ABC Child Care Program FFN Provider Health and Safety Grant Reimbursement Request

ABC

PDF

Brochure 3780

Child Support and You

FI

PDF

Brochure 3785

FI Program: What it's all about.

FI

PDF

Form 3793

ABC Child Care Program Important Notification to Provider

FI

PDF++

Form 3800

Application for the FI Program, SNAP Program and Refugee Assistance (RA) Program

SNAP

PDF

Form 3800 SPA

Solicitud para el Programa de Independencia Familiar (FI), Programa de Asistencia Nutricional Complimentaria (SNAP), Programa de Asistencia para Refugiados (RA)

SNAP

PDF

Form 3800 UZ

Application for the FI Program, SNAP Program and Refugee Assistance (RA) Program

SNAP

PDF

Form 3800 A

Your Rights and Responsibilities

FA

PDF++

Form 3800 A RUS

Your Rights and Responsibilities

FA

PDF

Form 3800 A SPA

Sus Derechos y Responsibilidades

FI

PDF

Form 3807 A

Mailed Recertification Form

FI

PDF++

Form 3807 A ALB

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A ARA

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A ARM

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A BUR

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A CHI

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A GUR

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A ITA

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A POL

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A POR

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A RUS

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A SPA

Formulario de Recertificación por Correo

FNP/FI

PDF++

Form 3807 A THAI

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A UZ

Mailed Recertification Form

FNP/FI

PDF

Form 3807 A VIET

Mailed Recertification Form

FI

PDF

Form 3816 B SPA

Referencia de Apoyo Infantil Datos del Padre Ausente

CHIP

PDF

Brochure 3903

"Making the Difference; One Child at a Time"

MTS

PDF

Brochure 3904

Specialized Foster Home Services

MTS

PDF+

Brochure 3905

Specialized Foster Home Services – Greenwood

MTS

PDF

Brochure 3905 1

Specialized Foster Home Services – Region IV

IFCCS

PDF

Form 4000

Notice of HIPAA Privacy Practices Acknowledgement

AS

Word

Form 4000 SPA

Aceptación de la Notificación de Prácticas Privadas de HIPAA

AS

PDF

Form 4001

Request for Privacy Protection for Protected Health Information

HIPAA

PDF

Form 4002

Request for Confidential Communication of Protected Health Information

HIPAA

PDF

Form 4004

Request for Access to Protected Health Information

HIPAA

PDF

Form 4005

Request for Amendment of Protected Health Information

HIPAA

PDF

Booklet 4017

Notice of HIPAA Privacy Practices

AS

PDF

Booklet 4017 SPA

Notificación de Prácticas Privadas de HIPAA

AS

PDF

Form 12108

Verification of Receipt of Family Independence (FI) Benefits

FI

PDF++

Form 12111

Pocket Resume

FI

PDF

Form 16108

USDA Commodity Food Loss Report

TEFAP

PDF++

Form 16119

Child and Adult Care Food Program Statement of Authority

CACFP

PDF++

Form 16121

Statement of Ownership - For-Profit Institutions

CACFP

PDF

Form 16122

Certification Statement - Non-Profit Institutions

CACFP

PDF

Form 16149

Meal Record for Infants

CACFP

PDF

Form 16150

Individual Infant Meal Record

CACFP

PDF

Flyer 16161

Healthy Helpings – Insert for the "Thrifty Meals" Cookbook

FS

PDF

Form 16163 SPA

Acuerdo Respecto al Reclamo de FI/SNAP

FAM

PDF

Form 16168

Commodity Supplemental Food Program Application

FNP/CSFP

PDF++

Form 16169

Commodity Supplemental Food Program Participant Agreement

FNP/CSFP

PDF

Brochure 16173

Commodity Supplemental Food Program Attention Seniors

FNP/CSFP

PDF

Flyer 16174

Commodity Supplemental Food Program for Women, Infants and Children

FNP/CSFP

PDF

Form 16176

Application for the Food Stamp Program Simplified Application for the Elderly

SNAP

PDF++

Form 16176 SPA

Solicitud Simplificada para Personas de Mayor Edad

SNAP

PDF+

Form 16177

Elderly Simplified Application Project Letter

SNAP

PDF

Form 16177 SPA

Proyecto de Solicitud Simplificada para los Ancianos

SNAP

PDF

Brochure 16178

Elderly Simplified Application Project Brochure

SNAP

PDF

Brochure 16178 SPA

Proyecto de Solicitud Simplificada para los Ancianos

SNAP

PDF

Form 16179

The Emergency Food Assistance Program Commodity Issuance Log

FNP

PDF++

Form 16180

The CSFP Nutrition Education Activity Sheet

FNP/CSFP

PDF++

Form 16181

Change Report Form for the Elderly Simplified Application Project (ESAP)

SNAP

PDF

Form 16182

CSFP Authorized Representative (Proxy) Designation Form

FA

PDF

Form 16183

Expedited Screening Tool

SNAP

PDF

Form 16184

Food Stamp Case Review Sheet

SNAP

PDF++

Poster 16185

The Commodity Supplemental Food Program (CSFP) Income Eligibility Guidelines

FA

PDF

Poster 16186

The Emergency Food Assistance Program (TEFAP) Income Eligibility Guidelines

FA

PDF

Brochure 24117

Fraud Busters

FNP/FI

PDF

Flyer 24118

SCEBT Information (includes Spanish version)

FS/EBT

PDF

Brochure 24126

South Carolina Family Independence Information and Referral Services

FI

PDF

Brochure 24126 SPA

Servicios de Información y Referencia de Independencia Familiar de Carolina de Sur

FI

PDF

Poster 24127

Attention South Carolina EBT Recipients

SNAP

PDF

Form 27103

Non-Custodial Parent's Application for Child Support Services

CSE

PDF

Form 27105

Instructions for Financial Declaration

CSE

PDF

Form 27115

Notice for Parent Locate Service

CSE

PDF

Form 27126

Order/Notice to Withhold Income for Child Support and Notice of an Order to Withhold Income for Child Support

CSE

PDF+

Brochure 27137

You Matter – VIP Program

CSE

PDF

Brochure 27137 SPA

Usted Importa - VIP Program

CSE

PDF

Form 27151

Child Support Obligation: Worksheet A

CSE

PDF

Form 27156

Financial Declaration

CSE

PDF++

Form 27156 SPA

Declaración Financiera

CSE

PDF

Form 27191

Review Packet Instructions

CSE

PDF

Form 27191 SPA

Paquete de Revisión: Instrucciones

CSE

PDF

Form 27192 SPA

Health Insurance Support Review Letter (HIRN)

CSE

PDF++

Form 27193 SPA

Health Insurance Support Review Letter (HSRC)

CSE

PDF++

Form 30100

Openness Checklist for Birth Parents

ADOPT

PDF

Form 30102

Medical Statement for Household Members

HS

PDF+

Form 30103

Intake Form

ADOPT

PDF++

Form 30103 SPA

Formulario de Admisión

ADOPT

PDF

Form 30163

SCDSS Children and Youth in Foster Care Bill of Rights

HS

PDF

Form 30165

Criminal Court Data

FPCWS

PDF++

Brochure 30166

Foster Care: What It's All About

FPCWS

PDF

Brochure 30172

Adoption Preservation

ADOPT

PDF

Brochure 30172 SPA

Conservación de la Adopción

ADOPT

PDF

Form 30198

Funding Request for Independent Living Services

HS

PDF++

Brochure 30199

Disaster Preparedness For Foster and Adoptive Parents

FPCWS

PDF

Form 30201

Checklist for Foster/Adoptive Home Study

HS

PDF+

Form 30201 SPA

Lista de Control para el Estudio de Hogares de Adopción/Crianza Temporal

HS

PDF

Form 30202

Medical Statement for Child

HS

PDF+

Form 30206

P.A.T.T.Y. Providing Assistance to Transitioning Youth Program

HS

PDF++

Form 30219

Discipline Agreement

HS

PDF+

Form 30220

Training Evaluation

HS

PDF+

Form 30221

Assessment of Applicant Participation in Foster/Adoptive Training

HS

PDF+

Form 30222

Interest Letter

HS

PDF++

Form 30224

Notice to Foreign Consul of Child Protection Proceedings

CPS

PDF++

Form 30224 SPA

Aviso para el Consulado Extranjero de un Procedimiento de Protección de Menores

HS

PDF+

Booklet 30230

Child Abuse, Child Neglect: What Parents Should Know if They Are Investigated

CPS

PDF

Booklet 30230 SPA

Abuso del Menor, Descuido del Menor: Lo Que Los Padres Deberían Saber Si Están Siendo Investigados

CPS

PDF

Brochure 30232

Domestic Violence

HS

PDF

Brochure 30232 SPA

La Violencia Doméstica

HS

PDF

Brochure 30234

Multiethnic Placement Act

ADOPT

PDF

Brochure 30234 SPA

La Ley de Colocación Multiétnica

ADOPT

PDF

Form 30235

IL Mentoring Outline

HS

PDF

Form 30236

IL Tutoring Request and Progress Report

HS

PDF

Form 30237

IL Invoice for Youth Graduation Award

HS

PDF++

Form 30238

IL Emancipation Budget Analysis Sheet

HS

PDF++

Form 30239

IL Shower Request Form

HS

PDF++

Form 30242

Developmental Milestones Chart

HS

PDF

Form 30245

Education and Health Passport

FC

PDF++

Form 30246

Foster/Adoptive Family Disaster Plan

HS

PDF

Form 30247

Emergency Shelter Placement Authorization

HS

PDF

Form 30248

Responsible Father Registry - Revocation of Claim Paternity

HS

PDF

Form 30249

Foster Care Respite/College Youth Overnight Payment Invoice

HS

PDF

Booklet 30253

Child Abuse, Child Neglect: What Out of Home Caregivers Should Know if They Are Investigated

HS

PDF

Form 30254

NYTD Services Provided by the Youth's Placement Provider

HS

PDF

Booklet 30255

NYTD Categories for Independent Living Services

HS

PDF

Booklet 30258

Independent Living - Guidelines for Services

HS

PDF

Form 30259

Education Encounter Form

FC

PDF++

Form 30260

Medical/Dental Encounter Form

FC

PDF++

Form 30263

Forster Care Documentation - Visitation, Maintaining Connections

 

PDF++

Form 30264

Foster Parent Documentation - Events

 

PDF++

Form 30265

Physician or Current Health Service Provider(s) and Telephone Numbers

 

PDF

Booklet 30267

Independent Living - Guidelines for Services (Youth Version)

HS

PDF

Poster 37100

SNAP Employment and Training Program

SNAP

PDF

Poster 37100 SPA

SNAP Programa de Empleo y Capacitación

SNAP

PDF

Form 37101

ABC Child Care Program Level C Provider Enrollment and Agreement

ABC

PDF

Booklet 37102

ABC Child Care Program Level C Provider Business Procedures

ABC

PDF

Booklet 37103

ABC Child Care Program FFN Provider Business Procedures

ABC

PDF

Booklet 37104

ABC Child Care Program Handbook for Parents

ABC

PDF

Booklet 37105

ABC Child Care Program Level A and B Provider Business Procedures

ABC

PDF

Form 37106 1

ABC Child Care Program Level A Provider Agreement

ABC

PDF

Form 37106 2

ABC Child Care Program Level B Provider Agreement

ABC

PDF

Form 37107

ABC Child Care Program Level A and B Provider Rate Form

ABC

PDF++

Form 37108

ABC Child Care Program Level A and B Provider Enrollment Form

ABC

PDF

Form 37109

ABC Child Care Program Fair Hearing Process Notice

ABC

PDF

Card 37112

FI/SNAP Call Center Cards

FA

PDF

Form 37113

Supplemental Nutrition Assistance Program (SNAP) Contribution Form

SNAP

PDF++

Form 37113 SPA

Formulario de Contribuciones

SNAP

PDF

Form 37117

ABC Child Care Program Guardianship/In Loco Parentis Verification

ABC

PDF

Poster 37118

FI/SNAP Call Center

FAM

PDF

Poster 37118 SPA  

FAM

PDF

Brochure 37119

Families First - Family Group Conferencing

FF

PDF

Card 37123

FI/SNAP Call Center Cards - Greenville

FA

PDF

Card 37125

Family Assistance Interview Center Cards

FAM

PDF

Form 37126

Out of State Provider Enrollment Form and Agreement

ABC

PDF