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
16-218 Intake Cover Letter to Tribes
10-570 Intake and Referral
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)
10-400 Information Request Letter
13-915 Information for Respite Care Service Providers: Addendum to TCARE Assessment (Aging and Long-Term Support Administration)
16-195 Information About Your Role as the Identified Necessary Supplemental Accommodation (NSA) Representative
11-118 Individualized Plan for Employment (IPE) Worksheet (Division of Vocational Rehabilitation)
10-258 Individual With Possible Community Protection Issues (Developmental Disabilities Administration)
10-234A Individual with Complex Behaviors (Aging and Long-Term Support Administration)
10-234 Individual with Challenging Support Issues (DDA)
16-262 Individual Integrated Settings Checklist for Residential Providers (Optional) (Developmental Disabilities Administration)
16-280 Individual Integrated Settings Checklist for Residential Providers
15-380 Individual and Family Services Assessment Worksheet (Developmental Disabilities Administration)
11-165 Independent Living (IL) Services and Qualifications (Division of Vocational Rehabilitation)
16-282 Independent Informal Dispute Resolution (IIDR) Request (Residential Care Services)
20-330 Incident Report to DDA (Developmental Disabilities Administration)
14-525 Incapacity Review for Medical Care Services
27-147A In-Home Environmental Adaptations General Utility and Repair Property Release Agreement (Aging and Long-Term Support Administration)
10-337 Important Information for SSP Recipients and Their Payees (DDA)