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
17-296 Certification Evaluation Checklist for Alternative Living Providers (Developmental Disabilities Administration)
17-295 Certification Evaluation Checklist for Companion Homes Providers (Home and Community Living Administration)
10-666 Certification Evaluation Checklist for Overnight Planned Respite Services Providers (Home and Community Living Administration)
15-605 Certification Evaluation Checklist Intensive Habilitation Services for Children Providers (Home and Community Living Administration (HCLA)
10-645 Certification Evaluation Client Interview (Developmental Disabilities Administration)
10-646 Certification Evaluation Legal Representative Interview (Developmental Disabilities Administration)
10-647 Certification Evaluation Staff Interview (Developmental Disabilities Administration)
10-720 Certified Children’s Residential Services Initial Application (Developmental Disabilities Administration)
15-389 Certified Community Residential Services and Support (CCRSS) Initial Application
10-698 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Administrator Record Review and Interview (Residential Care Services)