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(desc) File Format
02-528 Fair Hearing Withdrawal
20-273 Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program
13-713 Fast Track Service Agreement
14-443 Financial / Social Services Communication
07-104 Financial Communication to Social Services
18-555 Financial Information Sheet
06-186 Financial Solvency Information (Aging and Long-Term Support Administration)
14-068 Financial Statement (Division of Vocational Rehabilitation)
27-059 Fingerprint Appointment
27-089 Fingerprint-Based Background Check Notice
16-253 For Field Staff Use: Sex Offender Notification to Home Care Agency and Consumer Directed Employer (Home and Community Services)
16-255 For Field Use Only: Sex Offender Notification to Facility (Home and Community Services)
13-926 Forensic (6358) Consultation (Behavioral Health Administration)
11-152 Forensic Navigator to Inpatient - Referral Information Form (RIF) (Office of Forensic Mental Health Services)
17-011 Forms and Publications Request
15-383 Functional Behavioral Assessment (FA)
06-171 Funding and Expenditure Data (Tribal)
10-442 Goal Setting and Action Planning Worksheet
11-153 Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services)
10-681 Group Home (GT) / Client Home Sample Packet (Residential Care Services)
10-693 Group Training Home (GTH) Client Sample Packet (Residential Care Services)
10-692 Group Training Home (GTH) Team Coordinator (TC) Packet (Residential Care Services)
16-182 Guidelines for Completing the ICAP / SIB-R Adaptive Behavior Scale (Developmental Disabilities Administration)
15-304 HCBS Waiver Enrollment Database Update (Developmental Disabilities Administration)
10-468 HCS / AAA / ODHH / DDA Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults