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 | |
|---|---|---|---|
| 17-296 | Certification Evaluation Checklist for Alternative Living Providers (Developmental Disabilities Administration) | ||
| 15-608 | Certification Evaluation Checklist Enhanced Respite Services for Children (Home and Community Living Administration) | ||
| 15-606 | Certification Evaluation Checklist Children’s Residential Habilitation Providers | ||
| 27-245 | Central Contracts and Legal Services (CCLS) Vendor Agreement Review | ||
| 27-231 | Central Contracts and Legal Services (CCLS) Source Contract Justification | ||
| 27-230 | Central Contracts and Legal Services (CCLS) Emergency Contract Justification | ||
| 27-232 | Central Contracts and Legal Services (CCLS) Department of Enterprise Services (DES) Late Filing Justification | ||
| 15-515 | CCSS Family Agreement (Community Crisis Stabilization Services) (Developmental Disabilities Administration) | ||
| 13-942 | CCRSS Infection Prevention and Control (IPC) Complaint Investigation Tool (Residential Care Services) | ||
| 10-700 | CCRSS Follow-Up Visit (Certified Community Residential Services and Supports, Residential Care Services.) | ||
| 27-229 | CCLS Sole Source Amendment Justification | ||
| 27-234 | CCLS Small Business Self-Certification Statement | ||
| 27-228 | CCLS Additional Delegated Authority Request | ||
| 02-760 | Case Mix Index Detail (CMID) Report Authorization (Home and Community Living Administration (HCLA)) | ||
| 05-272 | Case Manager Instructions Following a Hearing Decision | ||
| 02-766 | Care Agreement for Beneficiaries and their Caregivers (WA Cares) |
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| 13-952 | Bowel Protocol (Developmental Disabilities Administration) | ||
| 17-300 | BHA Personal Information Release (Behavioral Health Administration) | ||
| 13-712 | Behavioral Health Wraparound Support (BHWS) Request (Home and Community Services Administration) | ||
| 27-109 | BCCU Applicant Affidavit | ||
| 07-103 | Basic Food Employment and Training (BFET) Participant Reimbursement |
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| 11-034B | Basic Food Eligibility Requirements: What You Need to Know |
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| 12-008 | Basic Food Affidavit Replacement for Household Disaster |
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| 17-263 | Background Check Review: Character, Competence, and Suitability for Contractor Employees / Volunteers (Division of Vocational Rehabilitation) | ||
| 09-653 | Background Check Authorization |
