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
27-229 CCLS Sole Source Amendment Justification
27-230 Central Contracts and Legal Services (CCLS) Emergency Contract Justification
27-231 Central Contracts and Legal Services (CCLS) Source Contract Justification
27-232 Central Contracts and Legal Services (CCLS) Department of Enterprise Services (DES) Late Filing Justification
27-234 CCLS Small Business Self-Certification Statement
27-235 Adult Family Home Confidential Identifier List (Residential Care Services)
27-240 Medicaid Provider Disclosure Statement for Nursing Facility
27-245 Central Contracts and Legal Services (CCLS) Vendor Agreement Review
27-247 Residential Habilitation for Dependent Agreement for Youth (Age 18-20) (Developmental Disabilities Administration)
27-248 Residential Habilitation for Dependent Youth Acknowledgement (Developmental Disabilities Administration)