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
15-582 Enhanced Services Facility (ESF) Exit Preparation Worksheet
15-577 Enhanced Services Facility (ESF) Environmental Observations
10-701 Enhanced Respite Services School Notification (Developmental Disabilities Administration)
10-724 Enhanced Respite Services for Children (ERS) Certification Evaluation (Home and Community Living Administration)
11-121 Enhanced Case Management Referral Consideration (Developmental Disabilities Administration)
14-252 Employment Verification
18-483 Employer Payment Identification Instructions
03-076 Employee Personal Property Damage/Loss Claim
03-490 Employee / Contractor Awareness IRS Safeguard Training Certification
10-640 Emphasis on Hands-On Skills Practice: Planning Attestation (Home and Community Services)
10-697 Emergency Transitional Support Services Certification Evaluation (Developmental Disabilities Administration)
14-459 Eligible Conditions With Age and Type of Evidence (Developmental Disabilities Administration)
14-416 Eligibility Review for Long Term Services and Supports
14-078 Eligibility Review
15-599 Early Engagement of Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services)
11-088 DVR, DSB, and PIHE Student Accommodation Cost Share Worksheet
11-069 DVR Internship Agreement (Division of Vocational Rehabilitation)
11-071 DVR Customer Internship Program Employer Expense Worksheet (Division of Vocational Rehabilitation)
17-264 DVR Background Check Reporting (Division of Vocational Rehabilitation)
11-070 DVR Attendance Log and Billing Invoice (Division of Vocational Rehabilitation)
27-175 DVR Additional Contractor Information (Division of Vocational Rehabilitation)
02-714A DSHS Virtual Classroom Training Application: Addendum to DSHS 02-714 (Home and Community Services)
03-509 DSHS Unpaid Intern / Volunteer Application
27-182 DSHS Request for Positive Identification – Thumbprint
02-744 DSHS Remote Skills Training Application: Virtual Classroom (Home and Community Services)