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
09-052 Affidavit of Forged Endorsement
06-169 AFH Change in Licensed Bed Capacity - Decrease (Adult Family Home) (Residential Care Services)
06-168 AFH Change in Licensed Bed Capacity - Increase (Adult Family Home) (Residential Care Services)
10-638 AFH Meaningful Day - Monthly Activities and Challenging Behavior Log
14-478 Aged, Blind, or Disabled (ABD) Program Medical Treatment Participation
14-332 Aged, Blind, or Disabled SSI Facilitation Referral
10-728 Agency Alternative Living Provider Supplemental Information (Developmental Disabilities Community Services)
03-374B Agreement on Nondisclosure of Confidential Information - Non-Employee
17-116 AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion
15-388 Alternative Living Certification Evaluation (Home and Community Living Administration)