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
17-266 Contractor Designated Contact(s) Background Check (Division of Vocational Rehabilitation)
27-044A Contractor Information Update (for existing DSHS contractors)
16-202A Corrective Action Plan (Developmental Disabilities Administration)
10-393B Cost Estimate Worksheet for Bone Anchored "Hearing Aid" Auditory Devices (BAHA) (Division of Vocational Rehabilitation)
10-393A Cost Estimate Worksheet for Cochlear Implants (Division of Vocational Rehabilitation)
10-393 Cost Estimate Worksheet for Hearing Aids and Services
06-124 Cost of Care Adjustment (COCA) (Developmental Disabilities)
15-318 Crisis Diversion Bed Referral and Intake Information (Developmental Disabilities Administration)
16-352 Crisis Prevention, Intervention, and Stabilization (CPIS) Services Initial Plan and Progress Report (Developmental Disabilities Administration)
10-272 Cross-System Crisis Plan (DDA)