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.

Choose search option and begin typing the form #
Keyword Search
Number Form Name(desc) File Format
10-707 Residential Habilitation for Dependent Youth (RHDY) Engagement Plan (Developmental Disabilities Administration)
27-248 Residential Habilitation for Dependent Youth Acknowledgement (Developmental Disabilities Administration)
02-632 Residential Provider's Report of Weapon Ownership in Residential Setting
15-564 Residential Quarterly Report for Children's Residential Services (Developmental Disabilities Administration)
10-403 Residential Services Providers and County and Count-Contracted Providers (Developmental Disabilities Administration (DDA): Mandatory Reporting of Abuse, Neglect, Exploitation, or Abandonment of a Child or Vulnerable Adult
15-360 Residential Services Vacancy Profile (Developmental Disabilities Administration)
10-328 Residential Site Approval Request
11-130 Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Eligibility Determination (Home and Community Services)
15-596 Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Referral (Home and Community Services)
06-177 Residential Training Roster / Reimbursement (Developmental Disabilities Administration)
10-635 Residential Transition Exchange of Information (Developmental Disabilities Administration)
15-381 Respite Assessment Worksheet
15-600 Respite, Stabilization, and Residential Health Center (RHC) Support Referral (Developmental Disabilities Administration)
13-899 Review of Medical Evidence
10-348 Risk Assessment and Community Protection Program Information Checklist
05-259 Risk, Needs, and Responsivity for Assessments and Treatment Planning (Domestic Violence Intervention Treatment)
10-389 Room List For Assisted Living Facilities (ALF)
05-010 Rule Exception Request
18-551 School Statement
14-534 SDCP Eligibility Checklist (Home and Community Services)
13-954 Seizure Protocol (Developmental Disabilities Administration)
07-098 Self Employment Monthly Sales and Expense Worksheet
14-155 Senior Citizens Service Application
11-112A Service Delivery Outcome Plan (SDOP) Job Shadow (Division of Vocational Rehabilitation)
11-182 Service Delivery Outcome Plan (SDOP): Customized Employment - Discovery (Division of Vocational Rehabilitation)