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
10-688 DDA Specialty Adult Family Home (AFH) Pilot Monthly Client Goal and Progress Report (Developmental Disabilities Administration)
10-687 DDA Specialty Adult Family Home (AFH) Pilot: Strengths, Abilities, Interests, Learn (SAIL) (Developmental Disabilities Administration)
15-597 DDA Youth Transitional Care Facility Admission Checklist (Developmental Disabilities Administration)
15-215 DDCS AFH Quality Improvement Visit Assessment (Development Disabilities Community Living / Adult Family Home)
15-607 DDCS Overnight Respite Services Provider Application (Developmental Disabilities Community Services)
10-583 DDCS PASRR Cover Sheet (Developmental Disabilities Community Services Preadmission Screening and Resident Review)
27-219 Death Notification Checklist for Medical Providers (Developmental Disabilities Administration)
27-218 Death Notification Checklist for Residential Habilitation Center (RHC) Staff (Developmental Disabilities Administration)
09-693 Declaration of Lawful Custody
18-433 Declaration of Support Payments (Division of Child Support)