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(desc) | File Format | |
|---|---|---|---|
| 17-264 | DVR Background Check Reporting (Division of Vocational Rehabilitation) | ||
| 11-071 | DVR Customer Internship Program Employer Expense Worksheet (Division of Vocational Rehabilitation) | ||
| 11-069 | DVR Partnership Internship Agreement (Division of Vocational Rehabilitation) | ||
| 11-088 | DVR, DSB, and PIHE Student Accommodation Cost Share Worksheet | ||
| 15-599 | Early Engagement of Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services) | ||
| 14-078 | Eligibility Review | ||
| 14-416 | Eligibility Review for Long Term Services and Supports |
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| 14-459 | Eligible Conditions With Age and Type of Evidence (Developmental Disabilities Administration) |
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| 03-490 | Employee / Contractor Awareness IRS Safeguard Training Certification | ||
| 03-076 | Employee Personal Property Damage/Loss Claim | ||
| 18-483 | Employer Payment Identification Instructions | ||
| 14-252 | Employment Verification |
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| 11-121 | Enhanced Case Management Referral Consideration (Developmental Disabilities Administration) | ||
| 27-274 | Enhanced Living Facility (ESF) Exhibit 359 Five Working Days Incident Follow-up Report | ||
| 10-724 | Enhanced Respite Services for Children (ERS) Certification Evaluation (Home and Community Living Administration) | ||
| 10-701 | Enhanced Respite Services School Notification (Developmental Disabilities Administration) | ||
| 15-577 | Enhanced Services Facility (ESF) Environmental Observations | ||
| 15-582 | Enhanced Services Facility (ESF) Exit Preparation Worksheet | ||
| 10-683 | Enhanced Services Facility (ESF) Follow-Up (Residential Care Services) | ||
| 15-583 | Enhanced Services Facility (ESF) Food Service Observations and Interviews | ||
| 15-584 | Enhanced Services Facility (ESF) Medication Pass Worksheet | ||
| 15-602 | Enhanced Services Facility (ESF) Monitoring Visit (Residential Care Services) | ||
| 15-581 | Enhanced Services Facility (ESF) Notes / Worksheets | ||
| 15-576 | Enhanced Services Facility (ESF) Other Contact Interview | ||
| 15-586 | Enhanced Services Facility (ESF) Pre-Inspection Packet |
