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
11-130 Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Eligibility Determination (Home and Community Services)
10-328 Residential Site Approval Request
15-360 Residential Services Vacancy Profile (Developmental Disabilities Administration)
10-403 Residential Services Providers and County and Count-Contracted Providers (Developmental Disabilities Administration (DDA): Mandatory Reporting of Abuse, Neglect, Exploitation, or Abandonment of a Child or Vulnerable Adult
15-564 Residential Quarterly Report for Children's Residential Services (Developmental Disabilities Administration)
02-632 Residential Provider's Report of Weapon Ownership in Residential Setting
27-248 Residential Habilitation for Dependent Youth Acknowledgement (Developmental Disabilities Administration)
10-707 Residential Habilitation for Dependent Youth (RHDY) Engagement Plan (Developmental Disabilities Administration)
27-247 Residential Habilitation for Dependent Agreement for Youth (Age 18-20) (Developmental Disabilities Administration)
10-563 Residential Care Services Notes (Residential Care Services)