Electronic DSHS Forms

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.

Additionally, you may download the free Shana Informed filler to electronically complete Shana forms below. On opening your first Shana form, you will be asked to enter a registration key. Please enter 32064015014070671 (you only need to enter this once).

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.

Choose search option and begin typing the form #
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Number Form Namesort descending File Format
15-247C Child Care Subsidy Program (CCSP) Provider Payment Termination Notice
16-202 5-Day Investigation Report
11-132 90 Day Review (Division of Vocational Rehabilitation)
23-027 90 Day Review Checklist For Social Workers Staffed Residential Facilities, Group Care Facilities and Child Foster Homes
16-181 A Guide to In-Home Relative Child Care
17-226 AAA DSHS / HCS Systems Access Request
14-541 ABAWD Requirement: Medical Report (Able Bodied Adults without Dependents)
19-232 Academic Cost
19-232A Academic Cost Continuation
10-500 Acknowledgement of Child(ren)’s Adoptive File Provided to Adoptive Family (Children's Administration)
11-055 Acknowledgement of My Responsibilities As The Employer of My Individual Providers
14-225 Acknowledgement of Services
14-118A ADATSA Incapacity Decision/Disposition
02-634 Additional Information Needed for ILP TANF
10-389A Additional Room List For Assisted Living Facilities (ALF)
18-176 Address Release Information Letter
18-176A Address Release Information Letter
20-238 Administrative Report of Incidents (Juvenile Rehabilitation)
20-240 Administrative Reports of Incidents (Parole Programs) (Juvenile Rehabilitation)
13-830 Admissions Review Team Checklist for Admission to an ICF/IID or SONF
10-546 Adoption Archive Request for Non-Identifying Information
10-114 Adoption Data Card
15-425 Adoption Redaction Request (Children's Administration)
10-082 Adoption Support Agreement Review
10-547 Adoption Support Limitations Letter
06-160 Adoption Support Monthly Counseling Billing
10-477 Adoption Support Program Application Checklist (Children's Administration)
09-997 Adoption Support Worksheet
14-299 Adult Assessment Referral (Economic Services Administration)
10-580 Adult Day Services Referral
10-231 Adult Family Home (AFH) Placement Checklist (DDA)
10-422 Adult Family Home (AFH) Quality Improvement Initial Visit
10-417 Adult Family Home Caregiver Experience Attestation (CEA) Form A for Applicants for Licensure
15-449 Adult Family Home Disclosure of Charges Required by RCW 70.128.280
10-508 Adult Family Home Disclosure of Services Required by RCW 70.128.280
10-585 Adult Family Home Information Changes
13-645 Adult Family Home Injuries and Accidents Log
10-410 Adult Family Home License Application
10-412 Adult Family Home License Relinquishment Letter
15-458 Adult Family Home Notice of Transfer or Change
02-516 Adult Family Home Resident Personal Belongings Inventory (Residential Care Services)
05-249 Adult Residential Care Services Notice of a Change
09-052 Affidavit of Forged Endorsement
10-232A AFH / ARC Provider Referral Letter
06-169 AFH Change in Licensed Bed Capacity - Decrease (Adult Family Home) (Residential Care Services)
06-168 AFH Change in Licensed Bed Capacity - Increase (Adult Family Home) (Residential Care Services)
15-215 AFH Quality Improvement Visit Assessment
15-472 After-the-Fact Contract Justification
03-374B Agreement on Nondisclosure of Confidential Information - Non-Employee
17-116 AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion
06-176 ALF Change in Licensed Resident Bed Capacity or Use of Rooms
23-034 Alternative Living Financial Report
15-388 Alternative Living Review and Evaluation
10-269 Alternative Living Services Plan and Provider Report (Developmental Disabilities))
01-212 ALTSA Nurse Delegation Referral and Communication Case / Resource Manager's Request
10-467 ALTSA Sentence / Copy Design Folstein MMSE (Home and Community Services)
15-331 Annual Assessment Checklist (Developmental Disability Administration)
13-001 Applicant Medical Report - Confidential
27-110 Applicant Request for a Copy of Background Check Information
27-137 Applicant Request for a Copy of Background Check Results (Children's Administration)
02-592 Application for Approval of Interpreter Continuing Education Activity
14-001 Application for Cash or Food Assistance
10-413 Application For Contract For Currently Licensed Boarding Home
14-505 Application for Deaf-Blind Communicator (DBC)
12-207 Application for Disaster Cash Assistance
12-206 Application for Disaster Food Benefits
14-542 Application for New Program Certification (Children's Administration)
18-078 Application for Nonassistance Support Enforcement Services
10-356 Application for Peer Counselor Training
10-209 Application for Program Certification
14-543 Application for Renewal Program Certification (Children's Administration)
14-512 Application For Respite Provider Approval
14-264 Application for Telecommunications Equipment
09-998 Application For The Adoption Support Program and/or Reimbursement of Adoption Finalization Costs
11-022 Application for Vocational Rehabilitation Services
14-341 Application to Convert Payment Services Only (PSO) Case to Full Collection Services
14-475 Appointment Letter for Division of Child Support (DCS) Good Cause Determination
16-209 Archived Records Memo for Adoption
14-492 Assessment Meeting Wrap-up
15-274 Assistance Available Schedule (DDA)
13-692A Assisted Living Facility (ALF) Dementia Screening Tool
10-270 Assisted Living Facility Admission Agreement(s) Attestation
10-372 Assisted Living Facility Contract Requirements - Attachment N
10-367 Assisted Living Facility Environmental Observations - Attachment I
10-373 Assisted Living Facility Environmental Observations for Contract Requirements - Attachment O
10-371 Assisted Living Facility Exit Preparation Worksheet - Attachment M
10-486 Assisted Living Facility Food Service Observations - Attachment P
10-487 Assisted Living Facility Medication Pass Worksheet - Attachment Q
10-370 Assisted Living Facility Notes / Worksheet - Attachment L
10-577 Assisted Living Facility Other Contact Information - Attachment R
10-366 Assisted Living Facility Other Contact Interview - Attachment H
16-197 Assisted Living Facility Policies and Procedures Attestation
10-359 Assisted Living Facility Pre Inspection Preparation - Attachment A
10-362 Assisted Living Facility Resident Characteristic Roster and Sample Selection - Attachment D
10-363 Assisted Living Facility Resident Group Meeting - Attachment E
10-365 Assisted Living Facility Resident Interview - Attachment G
10-361 Assisted Living Facility Resident List - Attachment C
10-368 Assisted Living Facility Resident Record Review - Attachment J
10-369 Assisted Living Facility Staff Sample / Record Review - Attachment K
11-066 Assistive Listening Device(s) (ALD) Sign-Out Register (Office of Deaf and Hard of Hearing)
27-113 Attestation of Individual Provider's Living Situation
17-063 Authorization
27-130 Authorization for Alternate EBT Cardholder
09-415 Authorization for Expenditure (Non-Employee)
17-211 Authorization for SSI Facilitation Records (Economic Services Administration)
09-966 Authorization to Release Information to the Court (Children's Administration)
20-201 Authorized Leave Approval (Juvenile Rehabilitation)
14-532 Authorized Representative
18-484 Automatic Payment Authorization and Electronic Funds Transfer Information
15-367 Background Check Administrative Review
15-490 Background Check Administrative Review for Contracts
09-653 Background Check Authorization
02-573 Background check Identification Verification (Office of Deaf and Hard of Hearing)
27-131 Background Check Request Cover Sheet
27-132 Background Check Summary
23-037 Background Clearance Notification
11-034B Basic Food Eligibility Requirements: What You Need to Know
12-006 Basis of Issuance Tables and Maximum Allowable Monthly Gross and Net Income Standards for the Washington Basic Food Program
27-109 BCCU Applicant Affidavit
10-166A Behavioral Rehabilitation Services Referral
10-360 Boarding Home Request for Documentation - Assisted Living Facility Request For Documentation - Attachment B
15-471 CA / RCM Contract Request / Approval
10-515 CA Worker Questionnaire
07-090 Caregiver Monthly Mileage
10-428 Caregiver Support Plan (Children's Administration)
15-313 Caregiver's Report to the Court
15-259A Case Plan
15-481 CCRSS Complaint Investigation
07-105 CCSP Authorization Letter
07-066 CCSP Award/Change Letter
07-106 CCSP Eligibility Letter
07-106C CCSP Eligibility Letter - Special Assistance for Families Experiencing Homelessness
07-106B CCSP Eligibility Letter Waitlist Space Available (Child Care Subsidy Programs)
07-106A CCSP Eligibility Waitlist Letter (Child Care Subsidy Programs)
16-180 CCSP Rights and Responsibilities (Child Care Subsidy Programs)
11-080 Centers for Independent Living (CILs) Title VII, Part B Monthly Report
11-079 Centers for Independent Living (CILs) Title VII, Part B, Contract Annual Report
11-078 Centers for Independent Living (CILs), Title VII, Part B Two-Year Plan (Division of Vocational Rehabilitation)
15-455 Certificate of Exemption
10-016 Certification for License of Foster Home
05-250 Certification Regarding Environmental Tobacco Smoke
15-389 Certified Community Residential Services and Support Application
15-366 Change of Address
14-076 Change of Circumstances
15-323 Checklist For Approval Long Term Care Agreement For Foster Parents or Relative Caregivers
14-522 Chemical Dependency Good Cause Letter
14-528 Chemical Dependency NonCooperation
14-529 Chemical Dependency Requirement
14-526 Chemical Dependency Treatment Verification Request
23-033 Child Abuse and Neglect Information Request
10-569 Child Abuse and Neglect Medical Consult Referral
10-471 Child and Family Team (CFT) Care Plan (Developmental Disabilities Administration)
14-417 Child Care Subsidy Programs (CCSP) Application
15-247A Child Care Subsidy Programs (CCSP) Denial Notice
15-247D Child Care Subsidy Programs (CCSP) Income Eligibility Phase Out and Termination Plan
15-247 Child Care Subsidy Programs (CCSP) Termination Notice
18-607 Child Care Verification
27-128 Child Fatality Case Review Confidentiality Agreement
14-444 Child Health and Education Tracking Screening Report (Children's Administration)
15-300 Child Information and Placement Referral
27-129 Child Near Fatality Case Review Confidentiality Agreement
23-036 Child Placing Agency Foster Home Licensing Investigation
23-036A Child Placing Agency Foster Home Licensing Investigation Interviews
10-402 Child Placing Agency Referral
15-450 Child Specific Caregiver Notification
10-490 Child Specific Contract Rate Proposal
09-741 Child Support Order Review Request
14-057 Child Support Referral
14-057D Child Support Referral Continuation
15-359 Child's Physical Description
10-061 Child's Registration
10-454 Children's Administration Caregiver Authorization
03-478 Children's Administration Travel Authorization
10-470 Children's Intensive In-Home Behavioral Support (CIIBS) Service Request (Developmental Disabilities Administration)
16-230 Children's Residential Services
16-221 Children's Respite in Licensed Staffed Residential/Foster Home Settings
21-059 Children's Staffed Residential Quality Assurance Assessment
15-387 Children’s Respite Application
21-060 Children’s State Operated Living Alternative (SOLA) Quality Assurance Assessment
13-041 Child’s Medical and Family Background Report
23-035 CHINS/ARY Report to Juvenile Court
20-226 Claim for Damages (Juvenile Rehabilitation)
20-225 Claim for Facility Damages (Juvenile Rehabilitation)
14-238 Client Income Report
15-314 Client Necessary Supplemental Accommodation Representative Requirement Checklist
18-398 Client Overpayment Notice
15-358 Client Referral Information
14-310 Client Status Change Report
02-587 CLIP/CSO Communication
05-252 Code of Ethics and Standards of Practice (Division of Vocational Rehabilitation)
15-365 Community Protection Treatment Worksheet Quarterly Review
11-100 Community Rehabilitation Program (CRP) Generic Update Report
14-501 Community Resource Declaration
09-995 Companion Home Evaluation and Review (Developmental Disabilities Administration)
02-589 Companion Home Outside Employment Notification and Review (Developmental Disabilities Administration)
15-446 Complaint Investigation
15-440 Complaint Investigation (Assisted Living Facility)
10-248 Compliance Agreement
15-467 Compliance Agreement
10-248A Compliance Agreement Continuation
15-463 Compliance Agreement Desk Review Final Report
15-464 Compliance Agreement On-Site Review Final Report
10-480 Comprehensive Family Evaluation (Children's Administration)
10-349 Comprehensive Regional Review Tool
10-520 Comprehensive Review Final Report
10-541 Comprehensive Review: DLR Foster Home File
10-510 Comprehensive Review: BRS / Contracts Program Review
10-512 Comprehensive Review: BRS Contractor Client File
10-521 Comprehensive Review: Compliance Agreement
10-513 Comprehensive Review: DLR Client File
10-511 Comprehensive Review: DLR Program Review
10-522 Comprehensive Review: Immediate Action Plan Compliance Agreement
10-514 Comprehensive Review: Personnel Files
15-362 Concurrent TANF Benefits / Family Reunification Notice of Removal from TANF Home (Children's Administration)
20-229A Conditions of Employment Employer Agreement (JR Community Facility)
20-228 Conditions of School Involvement School Agreement (JR Community Facility)
20-228A Conditions of School Involvement School Agreement (JR Community Facility)
20-229B Conditions of Treatment Provider Agreement (Juvenile Rehabilitation)
10-489 Confidential Health Information Consent Agreement
03-374E Confidential Information, Fraud and Abuse
09-989 Confidentiality Statement - Tribal Employee
14-012 Consent
20-250 Consent for Release to Parent/Guardian/Involved Individual (Juvenile Rehabilitation)
10-411 Consumer Response: Do Not Hang Up Complaint
14-547 Continuing Care Retirement Community (CCRC) Registration Application
14-544 Continuing Education Summary for DVPT (Domestic Violence Perpetrator Treatment) Providers (Children's Administration)
10-497 Continuous Quality Improvement (CQI) Action Plan
27-111 Continuous Quality Improvement Confidentiality Agreement (Children's Administration)
15-466 Contract Risk Assessment / Analysis
11-084 Contracted Employee(s) to Provide IL Services and Service(s) Approved (Division of Vocational Rehabilitation)
10-566 Contracted Health and Safety Visit Referral
10-567 Contracted Health and Safety Visit Report
27-043 Contractor Intake
10-393 Cost Estimate Worksheet for Hearing Aids and Services
06-124 Cost of Care Adjustment Request (Developmental Disabilities)
27-095 Court Report (Children's Administration)
10-459 Courtesy Supervision Referral
15-268 CPT Case Presentation Summary
15-266 CPT Staffing Recommendations
10-272 Cross-System Crisis Plan (DDA)
27-143 CSD ABD Medical Evidence Review Contractor Self-Assessment Monitoring Tool
27-144 CSD Disability Eligibility Review Contractor Self-Assessment Monitoring Tool
14-479 DASA Target Data Element - Gain Short Screening Setup
10-584 Data Summary Report and Recommendations (Developmental Disabilities Administration)
27-100A DBHR Authorization to Release Information and Photographs (Division of Behavioral Health and Recovery)
04-420 DBHR Target Agency Staff
04-437 DBHR Target Agency Support Activities (Non-Treatment)
04-423 DBHR Target Change of Circumstances
04-419 DBHR Target Client Support Activities (Non-Treatment)
04-416 DBHR Target Data Elements Assessment/Admission Setup
04-416A DBHR Target Data Elements Discharge
04-444 DBHR Target Data Elements Waiting List - First Contact
04-417 DBHR Target Detox Short Form
04-438 DBHR Target Group Support Activities
04-436 DBHR Target Group Treatment Activities
04-418 DBHR Target Treatment Activities
05-210 DCFS Administrative Approval Request (Children's Administration)
13-738 DDA / CA Request to Cost Share
15-356 DDA Community Protection Program Chaperone Agreement
15-318 DDA Crisis Diversion Bed Referral and Intake Information
10-331 DDA Mortality Review Provider Report
13-911 DDA Nursing Service Referral (Developmental Disabilities Administration)
10-583 DDA PASRR Cover Sheet
13-903 DDA Request for Additional Units Nurse Delegation (Developmental Disability Administration)
16-194 DDA Specialty Training Sign-Up Sheet
11-134 Deaf - Blind Referral Criteria Checklist for Level 4 Community Rehabilitation Program (CRP) Services (Division of Vocational Rehabilitation)
09-765 Declaration of Adoption Facilitator - Indian Child
17-234 Declaration of Commercial Purposes
14-446 Declaration of Financial Status Declaration of Financial Status for Adoption Support Application (Children's Administration)
09-693 Declaration of Lawful Custody
18-433 Declaration of Support Payments (Division of Child Support)
27-056 Dependent / Ward of the Court Verification
18-682 Detail Sheet – Uninsured Health Care Expenses
18-700 Direct Deposit Authorization
14-432 Direct Deposit Enrollment
14-332 Disability Assessment
14-530 Disability Review
15-412 Disability Verification for Youth Over Age 18
09-837 Disclosure of Confidential HIV/AIDS Information
10-351 Disclosure of Services Required by RCW 18.20.300
12-195 Disqualification Consent Agreement
06-162 Division of Vocational Rehabilitation (DVR) Referral to Office of Financial Recovery Referral
16-211 DLR Agency Letter of Reference (Division of Licensed Resources)
15-435 Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration
13-734 Documentation of First Use of Medicaid Benefits (DDA)
10-353 Documentation Request for Medical or Disability Condition
06-172 Domestic Violence Prevention Account
15-252 DRW Access Request Checklist
17-215 DSHS / CA Checklist: Subcontractors Approval Request (Children's Administration
15-470 DSHS / CA Regional Staff Contract Request / Approval
17-227 DSHS / HCA Systems Access Request
27-051 DSHS / Union Contract Decision Process
14-517 DSHS Letter Requesting Non Work SSN
03-387 DSHS Notice of Privacy Practices for Client Medical Information
03-387A DSHS Notice of Privacy Practices for Client Medical Information without Acknowledgement
09-746A DSHS Sex / Kidnapping Offender Preregistration
11-070 DVR Attendance Log and Billing Invoice (Division of Vocational Rehabilitation)
11-071 DVR Employer Expense Worksheet (Division of Vocational Rehabilitation)
11-069 DVR Internship Agreement (Division of Vocational Rehabilitation)
11-068 DVR Internship Application (Division of Vocational Rehabilitation)
11-072 DVR Internship Evaluation (Division of Vocational Rehabilitation)
10-335 Dyskinesia Identification System: DISCUS Rating (DDA)
10-479 Early Intervention Program (EIP) 90 Day Review (Children's Administration)
10-475 Early Intervention Program (EIP) Exit Summary (Children's Administration)
10-083 Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Assessment
14-531 Education and Training Voucher (ETV) Program and Passport to College Promise Scholarship Application
15-377 Education and Training Voucher (ETV) Program Dual Credit Application
15-370 Education and Training Voucher (ETV) Program Payment Request
14-245 Education List Checklist (Juvenile Rehabilitation)
10-499 Education Plan (Children's Administration)
15-368 Educational and Training Voucher (ETV) Program Participation Agreement
15-369 Educational and Training Voucher (ETV) Program Renewal Application
15-432 Educational Liaison's Report to the Court
16-229 Educational Resources for Youth in Foster Care Through DSHS in Washington State or a Tribal Child Welfare Agency
14-078 Eligibility Review
14-416 Eligibility Review for Long Term Services and Supports
14-459 Eligible Conditions Specific to Age and Type of Evidence (Developmental Disabilities Administration)
16-204 Emergency Evacuation Plan (Children's Administration)
10-406 Employed Foster Parent Child Care Plan
03-490 Employee / Contractor Awareness IRS Safeguard Training Certification
03-076 Employee Personal Property Damage/Loss Claim
18-483 Employer Payment Identification Instructions
27-081 Employment and Day Program Services Providers: Mandatory Reporting of Abandonment, Abuse, Neglect, Exploitation, or Financial Exploitation of a Child or Vulnerable Adult (Developmental Disability Administration)
14-252 Employment Verification
11-121 Enhanced Case Management Referral Consideration (Developmental Disabilities Administration)
06-174 Enhanced Rate Proposal
10-535 Enhanced Services Facility Application
15-372 Enumeration Referral
14-462 Epilepsy Verification Request (Developmental Disabilities Administration)
03-374D ESA Non-Dislcosure of Confidential Information Agreement - Non Employee
14-454 Estate Recovery: Repaying the State for Medical and Long Term Services and Supports
15-447 Exception to Rule (ETR) to Exempt Room Requirements (Home and Community Services)
10-182B Expedited File Checklist
06-165 Extended Foster Care Denial Letter (Children's Administration)
10-488 Extended Foster Care Program Consent
10-432 Extended Foster Care Program Participant Agreement
15-431 Extended Foster Care Services Voluntary Placement Agreement
02-528 Fair Hearing Withdrawal
20-273 Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program
04-220 Family Ancestry Chart (Children's Administration)
10-498 Family Assessment Response (FAR) Closing Letter (Children's Administration)
10-498A Family Assessment Response (FAR) Closing Letter (Translated Survey Enclosed)
10-496 Family Assessment Response: Referral for Community Resources (Children's Administration)
10-545 Family Feedback Questionnaire
10-043 Family Home Study
10-354 Family Home Study Application (Children's Administration)
27-106 Family Participation Agreement (Children's Administration)
10-502 Family Plan for Change
10-464 FamLink Access Application and Agreement (Children's Administration)
10-463 FamLink Data Access Request / Change (Children's Administration)
10-474 FAR Family Assessment (Children's Administration)
13-713 Fast Track Service Agreement
05-180 Federal Grant Application (Washington State Partnership Council on Juvenile Justice)
05-180F Federal Grant Application - B (Washington State Partnership Council on Juvenile Justice)
05-254 Federal Subminimum Wage Certificate Holder
14-443 Financial / Social Services Communication
07-104 Financial Communication to Social Services
18-503 Financial Information Sheet
18-555 Financial Information Sheet
18-504 Financial Information Sheet Instructions
14-068 Financial Statement (Division of Vocational Rehabilitation)
14-452 Financial Worksheet (Children's Administration)
14-084 Financial/Social Services Communications
27-059 Finger Print Appointment
27-089 Fingerprint-Based Background Check Notice
27-082 Five Day Notice to Move (Children's Administration)
15-445 Follow-up / Monitoring Inspection
15-439 Follow-up / Monitoring Inspection (Assisted Living Facility)
17-011 Forms and Publications Request
10-436 Foster Care License Renewal Notice
10-261 Foster Care Rate Assessment
10-183 Foster Home Inspection Checklist (Children's Administration)
10-416 Foster Home Monitoring Visit
10-405 Foster Home Re-Assessment
10-518 Foster Parent Interview
18-400 Foster Parent Reimbursement Claim and Checklist (Children's Administration)
10-418 Fostering Well-Being Care Coordination Referral
15-383 Functional Behavioral Assessment (FA)
06-170 Funding and Expenditure Data
06-171 Funding and Expenditure Data (Tribal)
14-485 GAIN-SS (Mental Health)
10-442 Goal Setting and Action Planning Worksheet
16-237 GovDelivery Communication Request
15-494 Guardian / Family Response to Individual Habilitation Plan (IHP) Notification (Developmental Disabilities Administration)
15-324 Guardianship Approval Checklist
16-182 Guidelines for Completing the ICAP/SIB-R Adaptive Behavior Scale (Children's Administration)
15-304 HCBS Waiver Enrollment Database Update (Developmental Disabilities Administration)
10-468 HCS / AAA / DDA Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults
27-122 HCS / AAA / DDA Individual Provider Contractor Intake
10-481 Health Action Plan (HAP)
11-101 Highline Community College, PETS Phase 1.0 School-Based Job Clubs Report
11-102 Highline Community College, PETS Phase 2.0 Summer Career Readiness Academy (SCRA) Report
11-103 Highline Community College, PETS Phase 3.0 Summer Internship Report
11-104 Highline Community College, PETS Student Summary Report
10-182 Home Study File Checklist (Children's Administration)
15-375 Home Study Referral for Contracted Services
10-458 Home Study Referral Notice (Children's Administration)
10-453 Household Safety Inspection for Unlicensed Placements and Adoption Home Study Updates
27-147 Housing Modification Property Release Agreement
18-334 How You Must Help with Child Support Collection for Temporary Assistance for Needy Families (TANF) and Medical Assistance Programs
20-289 ICJ (Interstate Compact for Juveniles) Transition Checklist (Juvenile Rehabilitation)
15-468 Immediate Action Plan Compliance Agreement (Contracts)
10-337 Important Information for SSP Recipients and Their Payees (DDA)
14-417A In-Home/Relative Pending Letter (Child Care Subsidy Program)
07-075 In-Home/Relative Provider
23-032 In-State Child Abuse and Neglect Founded Findings Request
14-525 Incapacity Review for Medical Care Services
10-519 Incident Report Review
15-433 Incomplete Application
04-220A Indian Heritage Questionnaire (Developmental Disabilities Administration)
09-539A Indian Heritage Questionnaire and Notice to an Indian Tribe, Nation or Band of Youth Committed to JR
09-761 Indian Identity Request
15-380 Individual and Family Services Assessment Worksheet
15-495 Individual Habilitation Plan (IHP) (Developmental Disabilities Administration)
15-496 Individual Habilitation Plan (IHP) Revision (Developmental Disabilities Administration)
06-175 Individual Provider (IP) Travel Time Request
16-198 Individual Provider Notification
07-097 Individual Provider Planned Action Notice Training / Certification (Home and Community Services)
19-231A Individual Site Billing Details
06-166 Individual Training Plan (Division of Licensed Resources, Children's Administration
10-234 Individual with Challenging Support Issues (DDA)
10-258 Individual with Community Protection Issues (DDA)
11-118 Individualized Plan for Employment (IPE) Worksheet (Division of Vocational Rehabilitation)
16-195 Information About Your Role as the Identified Necessary Supplemental Accommodation (NSA) Representative
10-348 Information Checklist (DDA)
10-400 Information Request Letter
11-119 Informational Interview Worksheet (Division of Vocational Rehabilitation)
10-329 Informed Consent for ICAP
18-235 Initial payment (Interim Assistance Reimbursement Authorization)
09-536 Inquiry to Bureau of Indian Affairs (BIA)
09-539 Inquiry to Indian Tribe
15-438 Inspection (Assisted Living Facility)
10-570 Intake and Referral
16-218 Intake Cover Letter to Tribes
20-256 Integrated Treatment Plan (Juvenile Rehabilitation)
10-395 Intensive Family Preservation Service (IFPS)/Family Preservation Service (FPS) Exit Summary
11-088 Interagency Agreement - DVR, DSB, and PIHE Student Accommodation Cost Share Worksheet
14-503 Interim Assistance Reimbursement Agreement Cover
27-104 Interstate Compact On Placement of Children (ICPC) Closure Letter
10-537 Interstate Compact On Placement of Children (ICPC) Parent Home Study Information
15-092 Interstate Compact On Placement of Children (ICPC) Placement Request
16-217 Interstate Compact On Placement of Children (ICPC) Quarterly Supervision Report
15-093 Interstate Compact on the Placement of Children Report on Child's Placement Date or Change of Placement - 100B
18-464 Introduction to New Hire Reporting
14-473 Inventory for Client and Agency Planning (ICAP) Letter
13-628 Involuntary Treatment Act Patient Claim Information
14-540 Irrevocable Burial Fund Provision for SSI Related Healthcare
11-133 Jobs and Training Inventory (Division of Vocational Rehabilitation)
20-188 JR (Juvenile Rehabilitation) Authorized Leave Order
20-271 JRA Integrated Treatment Assessment (Rehabilitation Administration) 
09-808 JRA Notice and Finding of Financial Responsibility
19-227 Juvenile Accountability Incentive Block Grant (JAIBG) Financial Report (JRA)
19-228 Juvenile Accountability Incentive Block Grant (JAIBG) Progress Report
05-180C Juvenile Detention Alternatives Initiative Grant Application (Washington State Partnership Council on Juvenile Justice)
20-234 Juvenile Rehabilitation Youth Complaint
20-230 Juvenile Volunteer Project Supervisor Agreement (JR Community Facility)
20-215 Law Enforcement Records Request (Juvenile Rehabilitation)
15-245 LEP Client Service Record (Limited English Proficient)
14-413A Level 2 Interrupted Evaluation
15-478 Level 2 PASRR Follow-Up or Significant Change in Condition Psychiatric Evaluation Summary
14-338 Level 2 PASRR Initial Psychiatric Evaluation Summary
14-413 Level 2 PASRR Invalidation
15-479 Level 2 PASRR Supplemental Substance Use Disorder Questionnaire
14-300 Level One Pre-Admission Screening and Resident Review (PASRR)
10-419 Licensing and Safety Supervision Plan For Site Specific Conditions
10-578 Licensing Application Checklist (Division of Licensed Resources)
15-411 Licensing Waiver/Administrative Approval
10-503 Limitation Extension Evaluation
10-506 Limitation Extension Request Checklist
10-504 Limitation Extension Request for Clients Under Age 21
10-505 Limitation Extension Task Explanation
09-653D List of Additional Crimes or Pending Charges
19-074 Loan Agreement for Tools, Equipment, Initial Stock and Supplies, and Devices (Division of Vocational Rehabilitation)
27-126 Local Indian Child Welfare Advisory Committee Confidentiality Agreement
15-322 Long Term Care Agreement For Foster Parents or Relative Caregivers
10-438 Long-Term Care Partnership (LTCP) Asset Designation
10-294 Mandatory Report to Law Enforcement
27-076 Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult
09-979 Marital History
27-094 Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration)
16-232 Medicaid Provider Profile Request
05-255 Medicaid Transformation Project Demonstration Notice of Action Exception to Rule
15-492 Medicaid Transformation Project Demonstration Service Notice
14-431 Medical / Dental Services Authorization
14-527 Medical Care Services Case Plan
14-144A Medical Disability Decision
06-173 Medical Evidence Reimbursement
10-565 Medical Exemption for Influenza Vaccination
10-455 Medical Log (Children's Administration)
13-690 Medical Services Authorization (Juvenile Rehabilitation)
15-398 Medically Intensive Children's Program (MICP) Application
16-200 Memo to Provider for Behavior Support, Counseling, and Consultation Services
10-456 Mental Health Treatment Options
17-231 Mental Incapacity Evaluation (MIE) Contractor Travel Plan
14-467 Mid-Certification Review
15-451 Missed and No Show Report: Parent - Child Visit
15-308 Missing Child Staffing
10-334 Monitoring of Side Effects Scale (MOSES) (DDA)
15-465 Monitoring Report for Compliance Action Notice
15-461 Monitoring Review Report – Desk Review
15-462 Monitoring Review Report – On-Site Visit
11-067 Monthly Budget Worksheet (Division of Vocational Rehabilitation)
14-495 Naturalization Letter
10-382 Naturalization Services Pre-Screening
16-199 New Case/Resource Manager Technology Training Checklist
18-463 New Hire Reporting Methods and Instructions
15-422 No Paid Services Group
17-230 Non-Emergency Medical Transportation (NEMT) for PASRR Program Request
14-440 Non-Profit Organization Application for Reconditioned Telecommunications Equipment (Office of the Deaf and Hard of Hearing)
18-399A Non-SSPS Client / Provider Overpayment AFRS Coding Computation
16-072 NonAssistance Support Enforcement Information (Division of Child Support)
14-057B Noncustodial Parent Child Support Enforcement Application
16-107 Noncustodial Parent's Rights and Responsibilities
27-156 Notice and Consent of Communication via Text
14-515 Notice and Finding of Responsibility
15-031 Notice of Action - Adult Residential Services
05-246 Notice of Action Exception to Rule (Excluding AFH)
05-256 Notice of Action Exception to Rule for AFH Daily Rates
15-342 Notice of Exception to Rule Decision
09-877 Notice of Hearing Re: Out-of-Home Placement (Child with a Developmental Disability)
14-460 Notice of Insufficient Information (Developmental Disabilities Administration)
14-535 Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration)
09-746 Notice of Sex/Kidnapping Offender Registration Requirements
10-237 Notice of Transfer or Discharge
15-402 Notice to Foreign Consulate of Child Protection Proceedings
14-402 Notice to Parents (WorkFirst)
20-236 Notification and Legal Requirements (Juvenile Rehabilitation)
14-401 Notification of Address Disclosure Request - Part 1
14-401A Notification of Address Disclosure Request - Part 2
15-473 Notification of Age 18 Eligibility Expiration
15-474 Notification of Age 20 Eligibility Expiration
10-377 Notification of Age Four (4) Eligibility Expiration-
10-378 Notification of Age Ten (10) Eligibility Expiration
10-582 Notification of Age Twenty (20) Eligibility Review (Developmental Disabilities Administration)
15-290 Notification of Annual Assessment Review
10-301 Notification of Eligibility Review (Developmental Disabilities Administration)
09-747 Notification of Release (Juvenile Rehabilitation Administration)
09-747A Notification of Sex Offender Release (Juvenile Rehabilitation)
14-491 NSA Representative Checklist For AAG Authorization
16-193 Nurse Aide Registry Inquiry (ADSA)
10-448 Nurse Delegation Contract Monitoring Chart Audit
13-678 Page 1 Nurse Delegation: Consent for Delegation Process
13-678 Page 2 Nurse Delegation: Instructions for Nursing Task
13-678B Nurse Delegation: Assumption of Delegation
13-681 Nurse Delegation: Change in Medical Orders
10-217 Nurse Delegation: Nursing Assistant Credentials and Training
14-484 Nurse Delegation: Nursing Visit
13-678A Nurse Delegation: PRN Medication
13-893 Nurse Delegation: Request For Additional Units
13-680 Nurse Delegation: Rescinding Delegation
06-123 Nursing Assistant Training and Testing Reimbursement
10-339 Nursing Care Consultant (NCC) Assessment (DDA)
04-442 Nursing Home Credit Balance Report
13-784 Nursing Services Assessment
13-780 Nursing Services Basic Skin Assessment (Home and Community Services)
13-776 Nursing Services Referral
10-528 Observational Surveys
17-238 ODHH Approved Sign Language Interpreter Complaints
15-434 On-Going Mental Health (OMH) Screening Report
09-878 Order Approving Continued Out-of-Home Care (Child With a Developmental Disability)
09-713 Order Denying Parole Revocation Petition (Juvenile Rehabilitation)
09-705 Order of Continued Detention or Release (Juvenile Rehabilitation)
09-341 Order of Parole Conditions (Juvenile Rehabilitation Administration)
09-714 Order Revoking Parole (Juvenile Rehabilitation Administration)
10-443 Organizations: Subscription and Directory (Office of the Deaf and Hard of Hearing)
10-507 Orientation Sign-In Sheet
15-460 Out of State Child Abuse and Neglect Check
11-093 Outreach Attendance (Office of the Deaf and Hard of Hearing)
10-571 Overnight Planned Respite Services Individualized Agreement
15-454 Parent - Child Visit (PCV) Incident Report
15-260 Parent Information Sheet For Shared Planning Meetings and Staffings
20-223 Parent/Guardian Notification (Juvenile Rehabilitation)
09-706 Parole Revocation Petition (Juvenile Rehabilitation Administration)
07-103 Participant Reimbursement
07-103A Participant Reimbursement with Interpreter Declaration
07-081 Participation Reimbursement
15-493 PASRR Client Referral
15-480 PASRR Notice of Determination
27-053 Paternity Information
02-635 Patient to Patient Assault Incident Review Report
10-509 Pediatric Symptoms Checklist (PSC-17)
09-893 Periodic Review of Individual Service Plan (DDA)
10-246 Permanency Plan
09-876 Permanency Planning Findings and Order (Child With a Developmental Disability)
16-231 Permanency Planning Matrix
27-096 Permission to Share Documents for Reimbursement of Medical Expenses
15-295 Person Centered Service Plan Meeting Survey
15-291 Person Centered Service Planning and Annual Assessment Meeting
13-712 Personal Care Related to Diagnosed Psychiatric Condition
16-205 Personal Emergency Plan Information
15-276 Personal Information (Children's Administration)
17-180 Personal Information Release (Economic Services Administration)
20-190 Personal Property Inventory (Juvenile Rehabilitation)
09-762A Petition for Court Validation of Voluntary Consent to Foster Care Placement of An Indian Child (Indian Child with Disabilities) (Developmental Disabilities Administration)
09-280B Petition for Modification - Administrative Order
09-892 Petition for Review of Continued Out-of-Home Care (Child with Disabilities) (Developmental Disabilities Administration)
11-105 PETS CCTS Quarterly Report
16-235 Photo Release
13-021 Physical Evaluation
15-281 Placement Agreement (Children's Administration)
16-202A Plan of Correction (5-Day Investigation)
15-491 Plan of Safe Care
10-573 Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination
10-290 Policy Agreement (Children's Administration)
20-253 Polygraph Notification (Juvenile Rehabilitation)
15-382 Positive Behavior Support Plan (PBSP)
27-107 Post Placement Report (Children's Administration)
14-538 Pre-Admission Screening and Resident Review (PASRR) Addendum
17-229 Pre-Admission Screening and Resident Review (PASRR) Records Request
15-469 Pre-Contract Action Request (P-CAR)
11-110 Pre-ETS (Pre-Employment Transition Services) Informational Interview (Division of Vocational Rehabilitation)
11-111 Pre-ETS (Pre-Employment Transition Services) Job Exploration (Division of Vocational Rehabilitation)
11-112 Pre-ETS (Pre-Employment Transition Services) Job Shadow (Division of Vocational Rehabilitation)
11-107 Pre-ETS (Pre-Employment Transition Services) Peer Mentoring (Division of Vocational Rehabilitation)
11-106 Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation)
11-113 Pre-ETS (Pre-Employment Transition Services) Social Skills (Division of Vocational Rehabilitation)
10-268 Pre-Placement Agreement (Developmental Disabilities Administration)
10-214 Preauthorization for Services (Children's Administration)
13-783 Pressure Injury Assessment and Documentation (Home and Community Services)
17-208 PRISM Registration
27-115 Privacy Complaint
15-344 Private Duty Nursing Logs and Skilled Nursing Tasks Log
19-231B Program Billing Details
19-231C Program Billing Details Continuation
10-540 Project SafeCare Monthly Summary
15-428 Protective Action(s) Plan (Children's Administration)
14-349 Protective Payee Assessment
14-453 Protective Payee Decision
14-426 Protective Payee Payment Plan, Case Assignment, and Closure Notice
01-110A Protective Payee Periodic Social Services Report