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.
| Number | Form Name(desc) | File Format | |
|---|---|---|---|
| 19-074 | Transfer / Loan / Recovery Agreement (Division of Vocational Rehabilitation) | ||
| 17-345 | Transitional Care Management Exchange of Information (Developmental Disability Administration) | ||
| 10-574A | Transitional Care Planning and Tracking: Part A. Transition Preparation (Developmental Disabilities Administration) | ||
| 10-574B | Transitional Care Planning and Tracking: Part B. Active Coordinator of Transition (ACT) (Developmental Disabilities Administration) | ||
| 10-574C | Transitional Care Planning Tracking: Part C. Post Move and Stabilization (Developmental Disabilities Administration) | ||
| 01-210 | Transmittal of Client Funds from the Protective Payee | ||
| 18-544 | Transmittal of Resident Personal Funds | ||
| 11-058 | Trial Work Experience (TWE) Agreement (Division of Vocational Rehabilitation) | ||
| 10-628 | Trust Fund Review (Aging and Long-Term Support Administration) | ||
| 14-449 | Unmet Need Breakdown | ||
| 18-398A | Vendor / Provider Overpayment Notice |
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| 09-013 | Vendor Affidavit of Lost, Stolen, or Destroyed Warrant | ||
| 17-299 | Vendor Agreement Information (Behavioral Health Administration) | ||
| 16-213 | Verification of Legal Status | ||
| 13-955 | Vital Signs Tracking (Developmental Disabilities Administration) | ||
| 11-098 | Vocational Assessment Worksheet |
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| 10-424 | Voluntary Participation Statement (Developmental Disability Administration) |
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| 09-004C | Voluntary Placement Agreement for Child or Youth with Developmental Disabilities | ||
| 15-184 | Volunteer Chore Service Referral | ||
| 16-234A | Vulnerable Adult Statement of Rights (Intended for use in CCRSS and ICF/IID (RHC)) | ||
| 16-234 | Vulnerable Adult Statement of Rights (Intended for use in NH, ALF, AFH, ICF/IID (non RHC) and ESF) | ||
| 20-335 | WA Care Fund Rights and Responsibilities | ||
| 20-335 | WA Cares Fund Application for Long-Term Care Benefits and Services | ||
| 12-212 | Waiver of Administrative Disqualification Hearing (Community Services Division) | ||
| 09-508 | Waiver of Statute of Limitations |
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