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(asc) | Form Name | File Format | |
|---|---|---|---|
| 06-125 | Residential Allowance Request / Insufficient Income (Developmental Disabilities Administration) | ||
| 06-124 | Cost of Care Adjustment (COCA) (Developmental Disabilities) | ||
| 06-123 | Nursing Assistant Training and Testing Reimbursement | ||
| 05-277 | Companion Home DCYF Weekly Schedule (Developmental Disability Administration) | ||
| 05-272 | Case Manager Instructions Following a Hearing Decision | ||
| 05-262 | Add or Remove a Service for an Existing DVIT Certification (Domestic Violence Intervention Treatment) | ||
| 05-261 | Add, Change, or Remove Direct Service Staff for a Certified DVIT Program (Domestic Violence Intervention Treatment) | ||
| 05-260 | Change of Address for an Existing DVIT Certification (Domestic Violence Intervention Treatment) | ||
| 05-259 | Risk, Needs, and Responsivity for Assessments and Treatment Planning (Domestic Violence Intervention Treatment) | ||
| 05-258 | Level 4 Questionnaire for Supervisors Applying to Facilitate Level 4 Domestic Violence Intervention Treatment | ||
| 05-255 | Medicaid Transformation Project Notice of Action Exception to Rule | ||
| 05-252 | Code of Ethics and Standards of Practice (Division of Vocational Rehabilitation) | ||
| 05-249 | Adult Residential Care Services Notice of a Change | ||
| 05-248 | On-Site Review (Office of Refugee and Immigrant Assistance) | ||
| 05-013 | Request for Hearing |
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| 05-010 | Rule Exception Request | ||
| 04-452A | DSHS Community Services Customer Survey (Community Services Division) |
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| 04-452 | DSHS Community Services Survey (Community Services Division, Economic Services Administration) |
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| 04-449A | Survivors Feedback (Domestic Violence Intervention Treatment) | ||
| 04-449 | Participants Feedback (Domestic Violence Intervention Treatment) | ||
| 03-509 | DSHS Unpaid Intern / Volunteer Application | ||
| 03-506 | Character, Competence, and Suitability Assessment | ||
| 03-490 | Employee / Contractor Awareness IRS Safeguard Training Certification | ||
| 03-391 | Report of Possible Client Assault | ||
| 03-389A | Witness Report of Possible Client Assault (Per RCW 72.01.045, RCW 74.04.790) |
