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
13-939 Residential Care Services (Adult Family Home, Assisted Living Facility, Enhanced Services Facility) Community Programs Infection Prevention and Control (ICP) InspectionTool
06-125 Residential Allowance Request / Insufficient Income (Developmental Disabilities Administration)
06-125A Residential Allowance Request - Start Up Costs (Developmental Disabilities Administration)
06-125C Residential Allowance Request - Shelter Expense (Developmental Disabilities Administration)
06-125B Residential Allowance Request - Damages (Developmental Disabilities Administration)
10-556 Resident Record Review (Residential Care Services)
10-555 Resident Observations (Residential Care Services)
10-557 Resident Medication Review (Residential Care Services)
10-551 Resident List (Residential Care Services)
15-447 Resident Choice Regarding Assisted Living Facility (ALF) Room Requirements (Home and Community Services)