Washington State Department of Social and Health Services Home page

ODHH Forms

Download various forms to obtain various services available to you. Our forms are available in alternative formats upon request.

Table of ODHH forms
Form Number Title Format
02-573 Background Check Identification Verification Word, PDF
02-578 TED Monthly Client Contact Report Word, PDF
02-585 Deaf-Blind Contact Report Word
03-468 Are You Satisfied Word
10-276 Washington Telecommunications Relay Service complaint form Word, PDF
10-411 "Don't Hang Up" complaint form Word, PDF
10-441 Individuals: Subscription and Directory Word, PDF, LP PDF
10-443 Organizations: Subscription and Directory Word, PDF
11-064 New Client Information Word
11-064lp New Client Information - Large Print Word
11-065 Service Delivery Plan Word
11-065lp Service Delivery Plan - Large Print Word
11-066 Assistive Listening Systems Request Word, PDF
11-074 Statement of Rights and Responsibilities Word
11-075 Conditions of Acceptance Word
11-076 CAPTEL Order Word
11-083 Communication Facilitator Service Word
11-085 Cost Difference Agreement Word
11-086 Returned Equipment Tracking Word
11-087 Trainer Monthly Billing Report Word
11-089 Trainers Worksheet for Other Expenses Word
14-264 Telecommunication Equipment Distribution Application Word, PDF
14-440 Non-Profit Organization Application for Reconditioned Equipment Word, PDF
17-123a Request for Sign Language Interpreter Word, PDF
17-155 Sign Language Interpreter Registration Form Word, PDF
17-155a Language Interpreter Registration Renewal Word, PDF