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
15-456 RCS Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults
15-449 Adult Family Home Disclosure of Charges Required by RCW 70.128.280
15-447 Resident Choice Regarding Assisted Living Facility (ALF) Room Requirements (Home and Community Services)
15-436 Request for Adult Family Home Application Fee Waiver Change of Ownership (Home and Community Living Administration)
15-435 Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration
15-424 Staffed Residential Cost of Care Adjustment Request
15-422 How to Request Services (Developmental Disabilities Community Services)
15-419 Refusal of Services Statement
15-398 Medically Intensive Children's Program (MICP) Application
15-389 Certified Community Residential Services and Support (CCRSS) Initial Application