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
27-147 Housing Modification Property Release Agreement
27-143 CSD ABD Medical Evidence Review Contractor Self-Assessment Monitoring Tool
27-130 Authorization for Alternate EBT Cardholder
27-124 Provider Owned Housing Memorandum of Understanding Residential Provider Attestation
27-123 Provider Owned Housing Memorandum of Understanding Renter Attestation
27-115 Privacy Complaint
27-110 Applicant Request for a Copy of Background Check Information
27-109 BCCU Applicant Affidavit
27-096 Permission to Share Documents for Reimbursement of Health Care Expenses
27-094 Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration)