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(asc) | File Format | |
|---|---|---|---|
| 10-707 | Residential Habilitation for Dependent Youth (RHDY) Engagement Plan (Developmental Disabilities Administration) | ||
| 27-247 | Residential Habilitation for Dependent Agreement for Youth (Age 18-20) (Developmental Disabilities Administration) | ||
| 15-494 | Residential Habilitation Center (RHC) / Individual Habilitation Plan (IHP) / Individual Plan of Care (IPOC) Meeting Notification (Developmental Disabilities Administration) | ||
| 10-563 | Residential Care Services Notes (Residential Care Services) | ||
| 13-939 | Residential Care Services (Adult Family Home, Assisted Living Facility, Enhanced Services Facility) Community Programs Infection Prevention and Control (ICP) InspectionTool | ||
| 06-125 | Residential Allowance Request / Insufficient Income (Developmental Disabilities Administration) | ||
| 06-125A | Residential Allowance Request - Start Up Costs (Developmental Disabilities Administration) | ||
| 06-125C | Residential Allowance Request - Shelter Expense (Developmental Disabilities Administration) | ||
| 06-125B | Residential Allowance Request - Damages (Developmental Disabilities Administration) | ||
| 10-556 | Resident Record Review (Residential Care Services) | ||
| 10-555 | Resident Observations (Residential Care Services) | ||
| 10-557 | Resident Medication Review (Residential Care Services) | ||
| 10-551 | Resident List (Residential Care Services) | ||
| 15-447 | Resident Choice Regarding Assisted Living Facility (ALF) Room Requirements (Home and Community Services) | ||
| 14-493 | Requirement to Identify a Representative (Developmental Disabilities Administration) | ||
| 11-193 | Request to Provide CRP-IL Services and Background Check: Update Account (Division of Vocational Rehabilitation) | ||
| 11-192 | Request to Provide CRP-IL Services and Background Check: Create Account (Division of Vocational Rehabilitation) | ||
| 10-709 | Request for Residential Habilitation for Dependent Youth Services (Developmental Disabilities Administration) | ||
| 17-041 | Request for Records |
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| 17-194 | Request for Mental Health Service Information | ||
| 18-701 | Request for Income Information for Purposes of Entering or Enforcing a Child Support Order | ||
| 05-013 | Request for Hearing |
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| 13-925 | Request for Formulary Admission or Deletion (Behavioral Health Administration) | ||
| 02-556 | Request for Exception to Policy (ETP) for Use of Restrictive Procedures (Developmental Disabilities Administration) | ||
| 14-151 | Request for DDA Eligibility Determination |
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