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
10-721 Children’s Residential Habilitation Services Certification Evaluation (Home and Community Living Administration)
21-060 Children’s State Operated Living Alternative (SOLA) Quality Assurance Assessment
12-209 Client Fraud Report
14-238 Client Income Report (Developmental Disabilities Community Services)
15-314 Client Necessary Supplemental Accommodation Representative Requirement Checklist
18-398 Client Overpayment Notice
15-358 Client Referral Summary (Developmental Disabilities Administration)
18-720 Client Responsibility Notice (Home and Community Services)
05-252 Code of Ethics and Standards of Practice (Division of Vocational Rehabilitation)
14-431A Community Crisis Stabilization Services (CCSS) Medical / Dental Services Authorization (Developmental Disabilities Administration)