Electronic DSHS Forms

The Electronic DSHS Forms page is a centralized repository where the public can find and download official forms for Washington Department of Social and Health Services programs.

You may download some DSHS forms. These are provided only if a DSHS program requests forms to be available electronically for public use. DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files. This means you can open, view, and print each form. To open, view, and print PDF forms, you need to download the free Adobe Acrobat Reader.

We do our best to ensure the links below are accurate; but, if you find a link which does not work, please contact Forms and Records Management.

Number Form Name Form File
09-415 Authorization for Expenditure (Non-Employee)
17-211 Authorization for SSI Facilitation Records (Economic Services Administration)
17-270 Authorization for Use or Disclosure of Psychotherapy Notes
27-269 Authorization to Release Information (Office of Refugee and Immigrant Assistance)
14-532 Authorized Representative
18-484 Automatic Payment Authorization and Electronic Funds Transfer Information
09-653 Background Check Authorization
17-263 Background Check Review: Character, Competence, and Suitability for Contractor Employees / Volunteers (Division of Vocational Rehabilitation)
12-008 Basic Food Affidavit Replacement for Household Disaster
11-034B Basic Food Eligibility Requirements: What You Need to Know to Keep Your Benefits