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 #
Keyword Search
Number Form Namesort ascending File Format
20-214 Youth Suicide Precaution Tracking (Juvenile Rehabilitation)
10-484 Youth Run Prevention Plan (Children's Administration)
20-191 Youth Personal Property Transmittal (Juvenile Rehabilitation)
20-247 Youth Media Release (Juvenile Rehabilitation)
10-516 Youth Interview
16-172 Your Rights and Responsibilities When You Receive Services Offered by Aging and Long-Term Support Administration
14-521 Your Rights (Home and Community Services)
14-514 Your Responsibility to Pay Towards Costs of Care at the Residential Habilitation Center
14-520 Your DSHS Cash or Food Assistance Benefits
14-113 Your Cash and Food Assistance Rights and Responsibilities
10-276 WTRS Consumer Response (Office of Deaf and Hard of Hearing)
11-115 Workplace Readiness Report
09-809 WorkFirst Word Experience (WEX) Referral
09-810 WorkFirst Word Experience (WEX) Agreement
14-381 WorkFirst Individual Responsibility Plan
01-205 Workfare Activity Report
11-116 Work-Based Learning Report
11-045 Work Experience (WEX) Referral (Food Stamp Employment and Training)
11-046 Work Experience (WEX) Agreement (Food Stamp Employment and Training)
03-389A Witness Report of Possible Client Assault (Per RCW 72.01.045, RCW 74.04.790)
23-041 Washington State Child Abuse and Neglect Founded Findings Request from Another State
09-728 Washington State Addendum to Box 2 of Part B - Plan Administrator Response
14-439 WASHCAP Application
20-227 Wanted Person Notice of Cancellation (Juvenile Rehabilitation)
14-463 Waiver Transportation Record (DDA)
09-508 Waiver of Statute of Limitations
27-121 Waiver of Right to Receive Written Information on Adoption Support Program Limitation
09-054 Waiver of Notice of Further Hearing (Children's Administration)
16-234 Vulnerable Adult Statement of Rights (Intended for use in NH, ALF, AFH, ICF/IID (non RHC) and ESF)
16-234A Vulnerable Adult Statement of Rights (Intended for use in CCRSS and ICF/IID (RHC))
15-184 Volunteer Chore Service Referral
27-057 Voluntary Placement Services Provider Referral Letter (DDA)
10-257 Voluntary Placement Services Foster Care Medical Team (FCMT) Communication
27-063 Voluntary Placement Services For Youth (Age 18-21)
09-004C Voluntary Placement Agreement for Child or Youth with Developmental Disabilities
10-424 Voluntary Participation Statement (Developmental Disability Administration)
11-019 Vocational Information (Division of Vocational Rehabilitation)
11-098 Vocational Assessment Worksheet
15-448 Visit Report: Parent - Child Visit
15-363 Visit Referral
15-209C Visit Plan
14-162 Veteran's Referral
16-213 Verification of Legal Status
15-128 Verification of Indian Status: Foster Care and Adoptive Applicant
18-398A Vendor Overpayment Notice
09-013 Vendor Affidavit of Lost, Stolen, or Destroyed Warrant
10-462 User Application and Agreement (Children's Administration)
11-094 User Agreement (Office of the Deaf and Hard of Hearing)
11-094 Large Print User Agreement (Large Print) (Office of the Deaf and Hard of Hearing)
14-449 Unmet Need Breakdown
10-581 Unlicensed Placement Application Checklist
10-182A Unlicensed File Checklist
15-280 Unlicensed Caregiver Placement Checklist (Children's Administration)
11-058 Trial Work Experience (TWE) Agreement (Division of Vocational Rehabilitation)
10-460 Treehouse Educational Advocacy Referral (Children's Administration)
10-485 Treehouse Education Advocacy Program Case Activity Report (Children's Administration)
14-478 Treatment Verification Request
18-544 Transmittal of Resident Personal Funds
01-210 Transmittal of Client Funds from the Protective Payee
15-417 Transition Plan for Youth Exiting Care
13-433 Transfer/Discharge Health Summary (Juvenile Rehabilitation)
14-293 Title IVE Initial Eligibility Determinations: Income Calculation Worksheet (Children's Administration)
14-319 Title IVE Initial Eligibility Determination for an Adoption Support Application (CA)
14-434 Title IV-E Requirements for Out of State Foster Care Payments (Children's Administration)
18-400A Third Party Claim Checklist (Children's Administration)
13-906 Therapy Assessment Bed Rails or Side Rails (Home and Community Services)
10-017 Termination of Foster Home License
10-437 Temporary Manager and/or Receiver Application Nursing Home and Assisted Living Facility
02-586 Temporary Employment Hours Tracking Log
04-446 Tell Us How We are Doing! (Division of Child Support)
14-427 Teen Parent Living Assessment
02-578 TED Monthly Client Contact Report (Office of Deaf and Hard of Hearing)
10-532 Team Coordinator Survey
15-441 Team Coordinator (Assisted Living Facility)
20-220 Supervisory Case Review (Juvenile Rehabilitation)
03-133A Supervisor's Review of Safety Incident / Near Miss Report
11-117 Student Summary Report
14-438 Stop Work
02-611 Statement of Understanding: Mid-Certification Review
18-097 Statement of Resources and Expenses
10-450 Statement of Qualifications and Verification of Issues Discussed (Children's Administration)
14-050 Statement of Health, Education, and Employment
14-222 SUMMARY Statement of Collateral Information Summary
14-222 Statement of Collateral Information
10-491 Statement of Children’s Administration (CA) Worker
14-436 Statement of Adult Acting in Loco Parentis (As a Parent)
14-223 Statement from School
14-224 Statement from Landlord/Manager
05-180B State Grant Application (Washington State Partnership Council on Juvenile Justice)
10-326 Staffed Residential Rate Proposal (Developmental Disabilities Administration)
15-424 Staffed Residential Cost of Care Adjustment Request
10-210 Staff Statement of Qualifications
15-437 Staff Orientation Checklist
10-517 Staff Interview
15-379 Staff Add-on Request for Client Specific Need (DDA)
18-627 SSP Client Overpayment Notice (State Supplementary Program)
14-489 SSIF Introduction Letter
10-396 SSI Letter (DDA)
14-502 SSI Hearing Denial
17-123 Spoken Language Interpreter Service Appointment Record
14-465 Sources For Eligibility Information (DDA)
14-281 Source of Funds Application for Child in Placement
16-191 SOLA Vehicle Trip Log (Developmental Disabilities Administration)
16-220 SOLA Incident Report (DDA)
15-243 Social Services Case Reading Guide
14-084 Social Service Referral
18-399 Social Service Incorrect Payment Computation
15-376 Skin Observation Protocols
16-203 SIS Rating Key
17-155 Sign Language Interpreter Registration
15-452 Sibling Visit Report
14-474 Shared Planning Meeting
10-423 Shared Planning for Youth Aged 18-21 Receiving Voluntary Placement Services
10-244 Shared Parenting Plan (Developmental Disabilities)
20-222 Sexual Aggression Vulnerability Youth Assessment (Juvenile Rehabilitation)
10-531 Session 3 Participatory Survey
10-530 Session 2 Participatory Survey
10-529 Session 1 Participatory Survey
10-104B Service Verification/Attendance Record For Alternative Living Providers (Developmental Disabilities Administration)
10-492 Service Referral (Children's Administration)
11-097 Service Delivery Outcome Report (Independent Living Services - IL)
11-030 Service Delivery Outcome Report (Community Rehabilitation Program - CRP)
11-125 Service Delivery Outcome Plan: WBL - Experience C
11-124 Service Delivery Outcome Plan: WBL - Experience B
11-123 Service Delivery Outcome Plan: WBL - Experience A
11-142 Service Delivery Outcome Plan: Pre-ETS IL Skills Training
20-198 Sentencing Worksheet (Juvenile Rehabilitation)
14-155 Senior Citizens Service Application
07-042B Self-Employment Income Report
07-098 Self Employment Monthly Sales and Expense Worksheet
15-430A Seasonal Child Care (SCC) Denial Notice
15-430 Seasonal Child Care (SCC) Client Termination Notice
14-534 SDCP Eligibility Checklist (Home and Community Services)
20-235 SchoolNotification (Juvenile Rehabilitation)
18-551 School Statement
27-093 School Notification (Children's Administration)
10-427 School District Communication
20-216 School Behavior Records Request (Juvenile Rehabilitation)
15-259 Safety Plan
03-133 Safety Incident / Near Miss Report
15-258 Safety Assessment
05-010 Rule Exception Request
05-251 Rule Change Comments (Residential Care Services)
10-389 Room List For Assisted Living Facilities (ALF)
20-199 Room and Isolation Confinement Record (Juvenile Rehabilitation)
10-574 Roads to Community Living (RCL) Person Centered Transition Planning
10-527 Risk Assessment Survey
27-127 Rights of Child and Youth in Foster Care
14-539 Revocable Burial Fund Provision for SSI Related Healthcare
13-899 Review of Medical Evidence
15-309 Returning Child De-Briefing
10-425 Respite Provider Reference Questionnaire
14-510 Respite Provider Policy Agreement
16-225 Respite Provider Checklist
14-513 Respite Care Provider Cover Letter
10-426 Respite Care Applicant Approval Letter
15-381 Respite Assessment Worksheet
10-572 Respite Application for Overnight Planned Respite (OPRS), Emergent and/or Planned Short-Term Stay Services at an RHC
06-177 Residential Training Roster / Reimbursement (Developmental Disabilities Administration)
10-327 Residential Staff Schedule Reporting
10-328 Residential Site Approval Request
10-403 Residential Services Provider: Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult
15-360 Residential Services Capacity Profile
02-632 Residential Provider's Report of Weapon Ownership in Residential Setting
17-242 Residential Habilitation Center (RHC) Informed Consent (Developmental Disabilities Administration)
06-125 Residential Allowance Request (Developmental Disabilities)
14-493 Requirement to Identify a Representative (Developmental Disabilities Administration)
20-260 Request for Warrant Check on JR Youth (Juvenile Rehabilitation)
17-123A Request for Sign Language Interpreter
17-041 Request for Records
17-194 Request for Mental Health Service Information
10-330 Request For Legal Advice
07-076 Request for Information (Child Care Subsidy Programs)
18-701 Request for Income Information for Purposes of Entering or Enforcing a Child Support Order
15-420 Request For ICF / IID or SONF Admission
05-013 Request for Hearing
20-219 Request for Exception to Standards (Juvenile Rehabilitation)
02-556 Request for Exception to Policy (ETP) for Use of Restrictive Procedures (Developmental Disabilities Administration)
15-282A Request for Enrollment in Developmental Disabilities Administration (DDA) Home and Community Based Services (HCBS) Waiver or Request to Change from One DDA HCBS Waiver to Another
14-151 Request for DDA Eligibility Determination
09-520 Request for Conference Board
18-681 Request for Collection of Uninsured Health Care Expenses
10-277 Request for Children's Residential Services
17-041A Request for Children's Administration Records
10-238 Request for an Administrative Hearing (Residential Care Services)
15-436 Request for Adult Family Home Application Fee Waiver
10-241 Report to Protective Services (Juvenile Rehabilitation)
03-391 Report of Possible Client Assault (Per RCW 72.01.045, RCW 74.04.790)
03-077 Release of All Claims
10-444 Relative Caregiver / Suitable Other Placement Fact Sheet and Home Study Checklist
15-419 Refusal of Services Statement
10-501 Referral to DSHS for Basic Food Employment and Training (BFET)
11-114 Referral Contact Sheet
10-539 Reference Questionnaire for Parent Home Study
15-286 Reference Questionnaire
16-179 Reference Cover Letter (Children's Administration)
10-589 Recreation Assessment
09-097 Record of Official Actions (Juvenile Rehabilitation Administration)
15-444 Re-Inspection
15-456 RCS Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults
13-585A Range of Joint Motion Evaluation Chart
10-472 Quality Review Tool: Functional Assessment / Positive Behavior Support Plan (Developmental Disabilities Administration)
10-255 Public Health Nurse (PHN) Summary and Recommendations
06-159 Psychologist and Sex Offender Treatment Provider Invoice
13-865 Psychological/Psychiatric Evaluation
13-851C Psychoactive Medication Treatment Plan Annual Continuation of Medication
13-851A Psychoactive Medication Treatment Plan
13-851 Psychiatric Referral Summary
15-433A Provisional Expedited Incomplete Application (Children's Administration)
10-182B Provisional Expedited File Checklist
10-232 Provider Referral Letter For Supported Living/Group Home Providers
15-384 Provider Progress Report of Behavior Management and Consultation and Staff/Family Training and Consultation Services (DDA)
27-124 Provider Owned Housing Memorandum of Understanding Residential Provider Attestation
27-123 Provider Owned Housing Memorandum of Understanding Renter Attestation
15-363B Provider Notification of Visit / Transport Schedule Initial Intake Screening Report
14-435 Provider Employment Eligibility Verification (Children's Administration)
15-385 Provider Consent For Use of Restrictive Procedures Requiring an ETP
01-110C Protective Payee Report Continuation
01-110 Protective Payee Report
01-110A Protective Payee Periodic Social Services Report
14-426 Protective Payee Payment Plan, Case Assignment, and Closure Notice
14-453 Protective Payee Decision
14-349 Protective Payee Assessment
15-428 Protective Action(s) Plan (Children's Administration)
10-540 Project SafeCare Monthly Summary
19-231C Program Billing Details Continuation
19-231B Program Billing Details
15-344 Private Duty Nursing Logs and Skilled Nursing Tasks Log
27-115 Privacy Complaint
17-208 PRISM Registration
13-783 Pressure Injury Assessment and Documentation (Home and Community Services)
10-214 Preauthorization for Services (Children's Administration)
10-268 Pre-Placement Agreement (Developmental Disabilities Administration)
11-113 Pre-ETS (Pre-Employment Transition Services) Social Skills (Division of Vocational Rehabilitation)
11-106 Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation)
11-107 Pre-ETS (Pre-Employment Transition Services) Peer Mentoring (Division of Vocational Rehabilitation)
11-112 Pre-ETS (Pre-Employment Transition Services) Job Shadow (Division of Vocational Rehabilitation)
11-111 Pre-ETS (Pre-Employment Transition Services) Job Exploration (Division of Vocational Rehabilitation)
11-110 Pre-ETS (Pre-Employment Transition Services) Informational Interview (Division of Vocational Rehabilitation)
15-469 Pre-Contract Action Request (P-CAR)
17-229 Pre-Admission Screening and Resident Review (PASRR) Records Request
14-538 Pre-Admission Screening and Resident Review (PASRR) Addendum
27-107 Post Placement Report (Children's Administration)
15-382 Positive Behavior Support Plan (PBSP)
20-253 Polygraph Notification (Juvenile Rehabilitation)
10-290 Policy Agreement (Children's Administration)
10-573 Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination
15-491 Plan of Safe Care
16-202A Plan of Correction (5-Day Investigation)
15-281 Placement Agreement (Children's Administration)
10-590 Physical Therapy Evaluation
13-021 Physical Evaluation
16-235 Photo Release
11-105 PETS CCTS Quarterly Report
09-892 Petition for Review of Continued Out-of-Home Care (Child with Disabilities) (Developmental Disabilities Administration)
09-280B Petition for Modification - Administrative Order
09-762A Petition for Court Validation of Voluntary Consent to Foster Care Placement of An Indian Child (Indian Child with Disabilities) (Developmental Disabilities Administration)
20-190 Personal Property Inventory (Juvenile Rehabilitation)
17-180 Personal Information Release (Economic Services Administration)
15-276 Personal Information (Children's Administration)
16-205 Personal Emergency Plan Information
13-712 Personal Care Related to Diagnosed Psychiatric Condition
15-291 Person Centered Service Planning and Annual Assessment Meeting
15-295 Person Centered Service Plan Meeting Survey
27-096 Permission to Share Documents for Reimbursement of Medical Expenses
16-231 Permanency Planning Matrix
09-876 Permanency Planning Findings and Order (Child With a Developmental Disability)
10-246 Permanency Plan
09-893 Periodic Review of Individual Service Plan (DDA)
10-509 Pediatric Symptoms Checklist (PSC-17)
27-053 Paternity Information
15-480 PASRR Notice of Determination
15-493 PASRR Client Referral
07-081 Participation Reimbursement
07-103A Participant Reimbursement with Interpreter Declaration
07-103 Participant Reimbursement
09-706 Parole Revocation Petition (Juvenile Rehabilitation Administration)
20-223 Parent/Guardian Notification (Juvenile Rehabilitation)
15-260 Parent Information Sheet For Shared Planning Meetings and Staffings
15-454 Parent - Child Visit (PCV) Incident Report
10-571 Overnight Planned Respite Services Individualized Agreement
11-093 Outreach Attendance (Office of the Deaf and Hard of Hearing)
15-460 Out of State Child Abuse and Neglect Check
10-507 Orientation Sign-In Sheet
10-443 Organizations: Subscription and Directory (Office of the Deaf and Hard of Hearing)
09-714 Order Revoking Parole (Juvenile Rehabilitation Administration)
09-341 Order of Parole Conditions (Juvenile Rehabilitation Administration)
09-705 Order of Continued Detention or Release (Juvenile Rehabilitation)
09-713 Order Denying Parole Revocation Petition (Juvenile Rehabilitation)
09-878 Order Approving Continued Out-of-Home Care (Child With a Developmental Disability)
15-434 On-Going Mental Health (OMH) Screening Report
17-238 ODHH Approved Sign Language Interpreter Complaints
10-528 Observational Surveys
13-776 Nursing Services Referral (Home and Community Services)
13-780 Nursing Services Basic Skin Assessment (Home and Community Services)
13-784 Nursing Services Assessment
04-442 Nursing Home Credit Balance Report
10-339 Nursing Care Consultant (NCC) Assessment (DDA)
06-123 Nursing Assistant Training and Testing Reimbursement
13-680 Nurse Delegation: Rescinding Delegation
13-893 Nurse Delegation: Request For Additional Units
13-678A Nurse Delegation: PRN Medication
14-484 Nurse Delegation: Nursing Visit
10-217 Nurse Delegation: Nursing Assistant Credentials and Training
13-681 Nurse Delegation: Change in Medical Orders
13-678B Nurse Delegation: Assumption of Delegation
13-678 Page 2 Nurse Delegation: Instructions for Nursing Task
13-678 Page 1 Nurse Delegation: Consent for Delegation Process
10-448 Nurse Delegation Contract Monitoring Chart Audit
16-193 Nurse Aide Registry Inquiry (ADSA)
14-491 NSA Representative Checklist forDDA Review
09-747A Notification of Sex Offender Release (Juvenile Rehabilitation)
09-747 Notification of Release (Juvenile Rehabilitation Administration)
10-301 Notification of Eligibility Review (Developmental Disabilities Administration)
15-290 Notification of Annual Assessment Review
10-582 Notification of Age Twenty (20) Eligibility Review (Developmental Disabilities Administration)
10-378 Notification of Age Ten (10) Eligibility Expiration
10-377 Notification of Age Four (4) Eligibility Expiration-
15-474 Notification of Age 20 Eligibility Expiration
15-473 Notification of Age 18 Eligibility Expiration
14-401A Notification of Address Disclosure Request - Part 2
14-401 Notification of Address Disclosure Request - Part 1
20-236 Notification and Legal Requirements (Juvenile Rehabilitation)
27-161 Notice to Persons Creating a Mental Health Advance Directive
14-402 Notice to Parents (WorkFirst)
15-402 Notice to Foreign Consulate of Child Protection Proceedings
10-237 Notice of Transfer or Discharge
09-746 Notice of Sex/Kidnapping Offender Registration Requirements
14-535 Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration)
14-460 Notice of Insufficient Information (Developmental Disabilities Administration)
09-877 Notice of Hearing Re: Out-of-Home Placement (Child with a Developmental Disability)
15-342 Notice of Exception to Rule Decision
05-256 Notice of Action Exception to Rule for AFH Daily Rates
05-246 Notice of Action Exception to Rule (Excluding AFH)
15-031 Notice of Action - Adult Residential Services
14-515 Notice and Finding of Responsibility
27-156 Notice and Consent of Communication via Text
16-107 Noncustodial Parent's Rights and Responsibilities
14-057B Noncustodial Parent Child Support Enforcement Application
16-072 NonAssistance Support Enforcement Information (Division of Child Support)
18-399A Non-SSPS Client / Provider Overpayment AFRS Coding Computation
14-440 Non-Profit Organization Application for Reconditioned Telecommunications Equipment (Office of the Deaf and Hard of Hearing)
17-230 Non-Emergency Medical Transportation (NEMT) for PASRR Program Request
15-422 No Paid Services Group
18-463 New Hire Reporting Methods and Instructions
16-199 New Case/Resource Manager Technology Training Checklist
10-382 Naturalization Services Pre-Screening
14-495 Naturalization Letter
11-067 Monthly Budget Worksheet (Division of Vocational Rehabilitation)
15-462 Monitoring Review Report – On-Site Visit
15-461 Monitoring Review Report – Desk Review
15-465 Monitoring Report for Compliance Action Notice
10-334 Monitoring of Side Effects Scale (MOSES) (DDA)
15-308 Missing Child Staffing
15-451 Missed and No Show Report: Parent - Child Visit
14-467 Mid-Certification Review
17-231 Mental Incapacity Evaluation (MIE) Contractor Travel Plan
10-456 Mental Health Treatment Options
16-200 Memo to Provider for Behavior Support, Counseling, and Consultation Services
15-398 Medically Intensive Children's Program (MICP) Application
13-690 Medical Services Authorization (Juvenile Rehabilitation)
10-455 Medical Log (Children's Administration)
10-565 Medical Exemption for Influenza Vaccination
06-173 Medical Evidence Reimbursement
14-144A Medical Disability Decision
14-527 Medical Care Services Case Plan
14-431 Medical / Dental Services Authorization
15-492 Medicaid Transformation Project Demonstration Service Notice
05-255 Medicaid Transformation Project Demonstration Notice of Action Exception to Rule
16-232 Medicaid Provider Profile Request
27-094 Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration)
09-979 Marital History
27-076 Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult
10-294 Mandatory Report to Law Enforcement
10-438 Long-Term Care Partnership (LTCP) Asset Designation
15-322 Long Term Care Agreement For Foster Parents or Relative Caregivers
27-126 Local Indian Child Welfare Advisory Committee Confidentiality Agreement
19-074 Loan Agreement for Tools, Equipment, Initial Stock and Supplies, and Devices (Division of Vocational Rehabilitation)
09-653D List of Additional Crimes or Pending Charges
10-505 Limitation Extension Task Explanation
10-504 Limitation Extension Request for Clients Under Age 21
10-506 Limitation Extension Request Checklist
10-503 Limitation Extension Evaluation
15-411 Licensing Waiver/Administrative Approval
10-578 Licensing Application Checklist (Division of Licensed Resources)
10-419 Licensing and Safety Supervision Plan For Site Specific Conditions
14-300 Level One Pre-Admission Screening and Resident Review (PASRR)
15-479 Level 2 PASRR Supplemental Substance Use Disorder Questionnaire
14-413 Level 2 PASRR Invalidation
14-338 Level 2 PASRR Initial Psychiatric Evaluation Summary
15-478 Level 2 PASRR Follow-Up or Significant Change in Condition Psychiatric Evaluation Summary
14-413A Level 2 Interrupted Evaluation
15-245 LEP Client Service Record (Limited English Proficient)
20-215 Law Enforcement Records Request (Juvenile Rehabilitation)
20-230 Juvenile Volunteer Project Supervisor Agreement (JR Community Facility)
20-234 Juvenile Rehabilitation Youth Complaint
05-180C Juvenile Detention Alternatives Initiative Grant Application (Washington State Partnership Council on Juvenile Justice)
19-228 Juvenile Accountability Incentive Block Grant (JAIBG) Progress Report
19-227 Juvenile Accountability Incentive Block Grant (JAIBG) Financial Report (JRA)
09-808 JRA Notice and Finding of Financial Responsibility
20-271 JRA Integrated Treatment Assessment (Rehabilitation Administration) 
20-188 JR (Juvenile Rehabilitation) Authorized Leave Order
11-133 Jobs and Training Inventory (Division of Vocational Rehabilitation)
14-540 Irrevocable Burial Fund Provision for SSI Related Healthcare
13-628 Involuntary Treatment Act Patient Claim Information
14-473 Inventory for Client and Agency Planning (ICAP) Letter
18-464 Introduction to New Hire Reporting
14-105 Interview Appointment for Applicant (Community Services Division)
15-093 Interstate Compact on the Placement of Children Report on Child's Placement Date or Change of Placement - 100B
16-217 Interstate Compact On Placement of Children (ICPC) Quarterly Supervision Report
15-092 Interstate Compact On Placement of Children (ICPC) Placement Request
10-537 Interstate Compact On Placement of Children (ICPC) Parent Home Study Information
27-104 Interstate Compact On Placement of Children (ICPC) Closure Letter
14-503 Interim Assistance Reimbursement Agreement Cover
11-088 Interagency Agreement - DVR, DSB, and PIHE Student Accommodation Cost Share Worksheet
10-395 Intensive Family Preservation Service (IFPS)/Family Preservation Service (FPS) Exit Summary
20-256 Integrated Treatment Plan (Juvenile Rehabilitation)
16-218 Intake Cover Letter to Tribes
10-570 Intake and Referral
15-438 Inspection (Assisted Living Facility)
09-539 Inquiry to Indian Tribe
18-235 Initial payment (Interim Assistance Reimbursement Authorization)
10-329 Informed Consent for ICAP
11-119 Informational Interview Worksheet (Division of Vocational Rehabilitation)
10-400 Information Request Letter
10-348 Information Checklist (DDA)
16-195 Information About Your Role as the Identified Necessary Supplemental Accommodation (NSA) Representative
11-118 Individualized Plan for Employment (IPE) Worksheet (Division of Vocational Rehabilitation)
10-258 Individual with Community Protection Issues (DDA)
10-234 Individual with Challenging Support Issues (DDA)
06-166 Individual Training Plan (Division of Licensed Resources, Children's Administration
19-231A Individual Site Billing Details
07-097 Individual Provider Planned Action Notice Training / Certification (Home and Community Services)
16-198 Individual Provider Notification
06-175 Individual Provider (IP) Travel Time Request
15-496 Individual Habilitation Plan (IHP) Revision (Developmental Disabilities Administration)
15-495 Individual Habilitation Plan (IHP) (Developmental Disabilities Administration)
15-380 Individual and Family Services Assessment Worksheet
09-761 Indian Identity Request
09-539A Indian Heritage Questionnaire and Notice to an Indian Tribe, Nation or Band of Youth Committed to JR
04-220A Indian Heritage Questionnaire (Developmental Disabilities Administration)
15-433 Incomplete Application
10-519 Incident Report Review
14-525 Incapacity Review for Medical Care Services
23-032 In-State Child Abuse and Neglect Founded Findings Request
07-075 In-Home/Relative Provider
14-417A In-Home/Relative Pending Letter (Child Care Subsidy Program)
10-337 Important Information for SSP Recipients and Their Payees (DDA)
15-468 Immediate Action Plan Compliance Agreement (Contracts)
20-289 ICJ (Interstate Compact for Juveniles) Transition Checklist (Juvenile Rehabilitation)
18-334 How You Must Help with Child Support Collection for Temporary Assistance for Needy Families (TANF) and Medical Assistance Programs
27-147 Housing Modification Property Release Agreement
10-453 Household Safety Inspection for Unlicensed Placements and Adoption Home Study Updates
10-458 Home Study Referral Notice (Children's Administration)
15-375 Home Study Referral for Contracted Services
10-182 Home Study File Checklist (Children's Administration)
11-104 Highline Community College, PETS Student Summary Report
11-103 Highline Community College, PETS Phase 3.0 Summer Internship Report
11-102 Highline Community College, PETS Phase 2.0 Summer Career Readiness Academy (SCRA) Report
11-101 Highline Community College, PETS Phase 1.0 School-Based Job Clubs Report
10-481 Health Action Plan (HAP)
27-122 HCS / AAA / DDA Individual Provider Contractor Intake
10-468 HCS / AAA / DDA Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults
15-304 HCBS Waiver Enrollment Database Update (Developmental Disabilities Administration)
16-182 Guidelines for Completing the ICAP/SIB-R Adaptive Behavior Scale (Children's Administration)
15-324 Guardianship Approval Checklist
15-494 Guardian / Family Response to Individual Habilitation Plan (IHP) Notification (Developmental Disabilities Administration)
10-442 Goal Setting and Action Planning Worksheet
14-485 GAIN-SS (Mental Health)
06-171 Funding and Expenditure Data (Tribal)
06-170 Funding and Expenditure Data
15-383 Functional Behavioral Assessment (FA)
10-418 Fostering Well-Being Care Coordination Referral
18-400 Foster Parent Reimbursement Claim and Checklist (Children's Administration)
10-518 Foster Parent Interview
10-405 Foster Home Re-Assessment
10-416 Foster Home Monitoring Visit
10-183 Foster Home Inspection Checklist (Children's Administration)
10-261 Foster Care Rate Assessment
10-436 Foster Care License Renewal Notice
17-011 Forms and Publications Request
15-439 Follow-up / Monitoring Inspection (Assisted Living Facility)
15-445 Follow-up / Monitoring Inspection
27-082 Five Day Notice to Move (Children's Administration)
27-089 Fingerprint-Based Background Check Notice
27-059 Finger Print Appointment
14-452 Financial Worksheet (Children's Administration)
14-068 Financial Statement (Division of Vocational Rehabilitation)
18-504 Financial Information Sheet Instructions
18-503 Financial Information Sheet
18-555 Financial Information Sheet
07-104 Financial Communication to Social Services
14-443 Financial / Social Services Communication
05-254 Federal Subminimum Wage Certificate Holder
05-180F Federal Grant Application - B (Washington State Partnership Council on Juvenile Justice)
05-180 Federal Grant Application (Washington State Partnership Council on Juvenile Justice)
13-713 Fast Track Service Agreement
10-474 FAR Family Assessment (Children's Administration)
10-463 FamLink Data Access Request / Change (Children's Administration)
10-464 FamLink Access Application and Agreement (Children's Administration)
10-502 Family Plan for Change
27-106 Family Participation Agreement (Children's Administration)
10-354 Family Home Study Application (Children's Administration)
10-043 Family Home Study
10-545 Family Feedback Questionnaire
10-496 Family Assessment Response: Referral for Community Resources (Children's Administration)
10-498A Family Assessment Response (FAR) Closing Letter (Translated Survey Enclosed)
10-498 Family Assessment Response (FAR) Closing Letter (Children's Administration)
04-220 Family Ancestry Chart (Children's Administration)
20-273 Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program
02-528 Fair Hearing Withdrawal
15-431 Extended Foster Care Services Voluntary Placement Agreement
10-432 Extended Foster Care Program Participant Agreement
10-488 Extended Foster Care Program Consent
06-165 Extended Foster Care Denial Letter (Children's Administration)
15-447 Exception to Rule (ETR) to Exempt Room Requirements (Home and Community Services)
14-454 Estate Recovery: Repaying the State for Medical and Long Term Services and Supports
03-374D ESA Non-Dislcosure of Confidential Information Agreement - Non Employee
14-462 Epilepsy Verification Request (Developmental Disabilities Administration)
15-372 Enumeration Referral
10-535 Enhanced Services Facility Application
06-174 Enhanced Rate Proposal
11-121 Enhanced Case Management Referral Consideration (Developmental Disabilities Administration)
14-252 Employment Verification
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)
18-483 Employer Payment Identification Instructions
03-076 Employee Personal Property Damage/Loss Claim
03-490 Employee / Contractor Awareness IRS Safeguard Training Certification
10-406 Employed Foster Parent Child Care Plan
16-204 Emergency Evacuation Plan (Children's Administration)
14-459 Eligible Conditions Specific to Age and Type of Evidence (Developmental Disabilities Administration)
14-416 Eligibility Review for Long Term Services and Supports
14-078 Eligibility Review
16-229 Educational Resources for Youth in Foster Care Through DSHS in Washington State or a Tribal Child Welfare Agency
15-432 Educational Liaison's Report to the Court
15-369 Educational and Training Voucher (ETV) Program Renewal Application
15-368 Educational and Training Voucher (ETV) Program Participation Agreement
10-499 Education Plan (Children's Administration)
14-245 Education List Checklist (Juvenile Rehabilitation)
15-370 Education and Training Voucher (ETV) Program Payment Request
15-377 Education and Training Voucher (ETV) Program Dual Credit Application
14-531 Education and Training Voucher (ETV) Program and Passport to College Promise Scholarship Application
10-083 Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Assessment
10-475 Early Intervention Program (EIP) Exit Summary (Children's Administration)
10-479 Early Intervention Program (EIP) 90 Day Review (Children's Administration)
10-335 Dyskinesia Identification System: DISCUS Rating (DDA)
11-072 DVR Internship Evaluation (Division of Vocational Rehabilitation)
11-068 DVR Internship Application (Division of Vocational Rehabilitation)
11-069 DVR Internship Agreement (Division of Vocational Rehabilitation)
11-071 DVR Employer Expense Worksheet (Division of Vocational Rehabilitation)
11-070 DVR Attendance Log and Billing Invoice (Division of Vocational Rehabilitation)
09-746A DSHS Sex / Kidnapping Offender Preregistration
03-387A DSHS Notice of Privacy Practices for Client Medical Information without Acknowledgement
03-387 DSHS Notice of Privacy Practices for Client Medical Information
14-517 DSHS Letter Requesting Non Work SSN
27-051 DSHS / Union Contract Decision Process
17-227 DSHS / HCA Systems Access Request
15-470 DSHS / CA Regional Staff Contract Request / Approval
17-215 DSHS / CA Checklist: Subcontractors Approval Request (Children's Administration
15-252 DRW Access Request Checklist
06-172 Domestic Violence Prevention Account
10-353 Documentation Request for Medical or Disability Condition
13-734 Documentation of First Use of Medicaid Benefits (DDA)
15-435 Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration
16-211 DLR Agency Letter of Reference (Division of Licensed Resources)
06-162 Division of Vocational Rehabilitation (DVR) Referral to Office of Financial Recovery Referral
12-195 Disqualification Consent Agreement
10-351 Disclosure of Services Required by RCW 18.20.300
09-837 Disclosure of Confidential HIV/AIDS Information
15-412 Disability Verification for Youth Over Age 18
14-530 Disability Review
14-332 Disability Assessment
14-432 Direct Deposit Enrollment
18-700 Direct Deposit Authorization
18-682 Detail Sheet – Uninsured Health Care Expenses
27-056 Dependent / Ward of the Court Verification
18-433 Declaration of Support Payments (Division of Child Support)
09-693 Declaration of Lawful Custody
14-446 Declaration of Financial Status Declaration of Financial Status for Adoption Support Application (Children's Administration)
17-234 Declaration of Commercial Purposes
09-765 Declaration of Adoption Facilitator - Indian Child
11-134 Deaf - Blind Referral Criteria Checklist for Level 4 Community Rehabilitation Program (CRP) Services (Division of Vocational Rehabilitation)
16-194 DDA Specialty Training Sign-Up Sheet
13-903 DDA Request for Additional Units Nurse Delegation (Developmental Disability Administration)
10-583 DDA PASRR Cover Sheet
13-911 DDA Nursing Service Referral (Developmental Disabilities Administration)
10-331 DDA Mortality Review Provider Report
16-237 DDA GovDelivery Communication Request (Developmental Disabilities Administration)
15-318 DDA Crisis Diversion Bed Referral and Intake Information
15-356 DDA Community Protection Program Chaperone Agreement
13-738 DDA / CA Request to Cost Share
05-210 DCFS Administrative Approval Request (Children's Administration)
04-418 DBHR Target Treatment Activities
04-436 DBHR Target Group Treatment Activities
04-438 DBHR Target Group Support Activities
04-417 DBHR Target Detox Short Form
04-444 DBHR Target Data Elements Waiting List - First Contact
04-416A DBHR Target Data Elements Discharge
04-416 DBHR Target Data Elements Assessment/Admission Setup
04-419 DBHR Target Client Support Activities (Non-Treatment)
04-423 DBHR Target Change of Circumstances
04-437 DBHR Target Agency Support Activities (Non-Treatment)
04-420 DBHR Target Agency Staff
27-100A DBHR Authorization to Release Information and Photographs (Division of Behavioral Health and Recovery)
10-584 Data Summary Report and Recommendations (Developmental Disabilities Administration)
14-479 DASA Target Data Element - Gain Short Screening Setup
27-144 CSD Disability Eligibility Review Contractor Self-Assessment Monitoring Tool
27-143 CSD ABD Medical Evidence Review Contractor Self-Assessment Monitoring Tool
10-272 Cross-System Crisis Plan (DDA)
15-266 CPT Staffing Recommendations
15-268 CPT Case Presentation Summary
10-459 Courtesy Supervision Referral
27-095 Court Report (Children's Administration)
06-124 Cost of Care Adjustment Request (Developmental Disabilities)
10-393 Cost Estimate Worksheet for Hearing Aids and Services
27-043 Contractor Intake
10-567 Contracted Health and Safety Visit Report
10-566 Contracted Health and Safety Visit Referral
11-084 Contracted Employee(s) to Provide IL Services and Service(s) Approved (Division of Vocational Rehabilitation)
15-466 Contract Risk Assessment / Analysis
27-111 Continuous Quality Improvement Confidentiality Agreement (Children's Administration)
10-497 Continuous Quality Improvement (CQI) Action Plan
14-544 Continuing Education Summary for DVPT (Domestic Violence Perpetrator Treatment) Providers (Children's Administration)
14-547 Continuing Care Retirement Community (CCRC) Registration Application
10-411 Consumer Response: Do Not Hang Up Complaint
20-250 Consent for Release to Parent/Guardian/Involved Individual (Juvenile Rehabilitation)
14-012 Consent
09-989 Confidentiality Statement - Tribal Employee
03-374E Confidential Information, Fraud and Abuse