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
16-270 Adult Family Home Agrees to Postpone Inspection Date Letter (Residential Care Services)
27-252 Adult Family Home Applicant Attestation Concerning Household Members and Background Check Requirements (Residential Care Services)
10-417 Adult Family Home Caregiver Experience Attestation (CEA)
27-235 Adult Family Home Confidential Identifier List (Residential Care Services)
15-449 Adult Family Home Disclosure of Charges Required by RCW 70.128.280
10-508 Adult Family Home Disclosure of Services Required by RCW 70.128.280
10-564 Adult Family Home Floor Plan Key (Residential Care Services)
10-585 Adult Family Home Information Changes
13-645 Adult Family Home Injuries and Accidents Log
10-412 Adult Family Home License Relinquishment Letter