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
27-272 Area Agency on Aging (AAA) Health-Related Social Needs (HRSN) Direct Service Approval
20-330 Incident Report to Developmental Disabilities Administration (DDA)
16-346 Assisted Living Facilities (ALF) Certified Memory Care Disclosure (Residential Care Services)
10-745 Assisted Living Facilities (ALF) Certified Memory Care Application (Residential Care Services)
16-345 Health Related Social Needs (HRSN) Home Accessibility
20-341 WA Cares Fund Provider Application for Registration
17-265 DSHS Request for Approval to Subcontract Checklist
27-269 Authorization to Release Information (Office of Refugee and Immigrant Assistance)
18-739 Pre-Acquisition Disclosure (Division of Child Support)
16-343 Student Status Confirmation