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
14-224 Statement from Landlord/Manager
10-7223 State-Operated Community Residential Transitions Program (SOCR-T) Quality Assurance Review
10-723 State-Operated Community Residential Transitions (SOCR-T) Program Certification Evaluation
10-625 State Task Checklist (Aging and Long-Term Support Administration)
13-935 State Hospital Triage Consultation and Expedited Admission (TCEA) Request
10-653 State Civil Penalty Reinvestment Program Grant (SCPRP) Community Residential Services and Supports (CCRSS) Grant Application
10-626 Staffing Pattern (Aging and Long-Term Support Administration)
10-326 Staffed Residential Rate Proposal (Developmental Disabilities Administration)
10-326A Staffed Residential Home DCYF Billing
15-424 Staffed Residential Cost of Care Adjustment Request