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.

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.

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Number Form Name(asc) File Format
11-167 Internship: Employer Evaluation
11-168 Internship: Customer Evaluation
15-484 Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities (ICF/IID) Survey and Revisit Skill Building Tool
14-503 Interim Assistance Reimbursement Agreement Cover
10-671 Intensive Habilitation Services for Children Certification Evaluation (Developmental Disabilities Administration)
13-917 Intensive Habilitation Services (IHS) Medical / Dental Services Authorization (Developmental Disabilities Administration)
16-264 Integrated Settings Survey: Waiver Residential Settings (Developmental Disabilities Administration)
16-265 Integrated Settings Survey: Other Settings (Developmental Disabilities Administration)
16-266 Integrated Settings Survey: Employment or Community Inclusion Settings (Developmental Disabilities Administration)
10-719 Integrated Settings Survey Site Contact Interview Adult Family Homes (AFH) / Assisted Living Facilities (ALF) (Developmental Disabilities Community Services (DDCS)
10-718 Integrated Settings Survey Client Interview Adult Family Homes (AFH) / Assisted Living Facilities (ALF) (Developmental Disabilities Community Services (DDCS)
16-263 Integrated Settings Self-Assessment for Residential Providers (Adult) (Developmental Disabilities Administration)
16-350 Integrated Settings Review: Individual Interviews (Developmental Disabilities Administration)
16-267 Integrated Settings Review for Resource Managers (Developmental Disabilities Administration)
27-261 Integrated Settings Provider Attestation (Developmental Disabilities Community Services)
16-351 Integrated Settings Initial Screening Tool All Settings (Developmental Disabilities Administration)
16-218 Intake Cover Letter to Tribes
10-570 Intake and Referral (Home and Community Services)
10-549 Inspection Process and Records Request (Residential Care Services)
10-655 Initial Staff and Family Consultation Plan (Developmental Disabilities Administration)
18-235 Initial payment (Interim Assistance Reimbursement Authorization)
27-188 Initial Opiate Prescription Informed Consent (Behavioral Health Administration)
10-657 Initial Life Skills Plan (Developmental Disabilities Administration)
10-329 Informed Consent for ICAP
11-119 Informational Interview Worksheet (Division of Vocational Rehabilitation)