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
05-261 Add, Change, or Remove Direct Service Staff for a Certified DVIT Program (Domestic Violence Intervention Treatment)
05-262 Add or Remove a Service for an Existing DVIT Certification (Domestic Violence Intervention Treatment)
27-207 Acknowledgement Statement (Meaningful Day) (Home and Community Services)
14-225 Acknowledgement of Services
02-751 Accommodations / Modifications Request
01-205 Able Bodied Adults Without Dependents (ABAWD) Activity Report
14-526 ABD, PWA, and HEN Referral Substance Use Disorder Treatment Verification
14-541 ABAWD Requirement: Medical Report (Able Bodied Adults without Dependents)
17-226 AAA DSHS / HCS Systems Access Request (Aging and Long-Term Support Administration)
11-132 90 Day Review (Division of Vocational Rehabilitation)
16-202 5-Day Investigation Report (Developmental Disabilities Administration (DDA)
15-593 21-Day Competency Check Request (Behavioral Health Administration)
11-110A Service Delivery Outcome Plan (SDOP): Informational Interview (Division of Vocational Rehabilitation)
06-191 DPI College Financial Aid Request (Division of Program Integrity)
11-163 Applicant Certification and Assurances (Division of Vocational Rehabilitation)