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
12-195 Disqualification Consent Agreement
16-276 Diversion Navigator Interview (Office of Forensic Mental Health Services (OFMHS))
11-149 Division of Vocational Rehabilitation (DVR) Customer Job Seeker Accommodation Worksheet
06-162 Division of Vocational Rehabilitation (DVR) Referral to Office of Financial Recovery Referral
15-435 Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration
10-353 Documentation Request for Medical Condition and Residual Functional Capacity
06-172 Domestic Violence Prevention Account
17-305 DPI Authorization for Release of Information (Division of Program Integrity)
06-192 DPI Dividend and Interest Request (Division of Program Integrity)
06-194 DPI Statement of Earnings (Division of Program Integrity)