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(asc) | Form Name | File Format | |
|---|---|---|---|
| 27-277 | Property Owner Statement (Home and Community Living Administration) | ||
| 27-276 | Assisted Living Facility (ALF) Exhibit 359 Five Working Days Incident Follow-up Report | ||
| 27-275 | Adult Family Home (AFH) Exhibit 359 Five Working Days Incident Follow-up Report | ||
| 27-274 | Enhanced Living Facility (ESF) Exhibit 359 Five Working Days Incident Follow-up Report | ||
| 27-273 | WA Cares Fund Provider Request for Exception to Rule | ||
| 27-272 | Area Agency on Aging (AAA) Health-Related Social Needs (HRSN) Direct Service Approval | ||
| 27-269 | Authorization to Release Information (Office of Refugee and Immigrant Assistance) |
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| 27-261 | Integrated Settings Provider Attestation (Developmental Disabilities Community Services) | ||
| 27-260 | Environmental Adaptation Property Release Agreement | ||
| 27-258 | Exhibit 358: Initial Report (Residential Care Services) | ||
| 27-257 | Exhibit 359 Follow-Up Investigation Report (Residential Care Services) | ||
| 27-253 | New Freedom Authorized Representative (Home and Community Services) | ||
| 27-252 | Adult Family Home Applicant Attestation Concerning Household Members and Background Check Requirements (Residential Care Services) | ||
| 27-248 | Residential Habilitation for Dependent Youth Acknowledgement (Developmental Disabilities Administration) | ||
| 27-247 | Residential Habilitation for Dependent Agreement for Youth (Age 18-20) (Developmental Disabilities Administration) | ||
| 27-245 | Central Contracts and Legal Services (CCLS) Vendor Agreement Review | ||
| 27-240 | Medicaid Provider Disclosure Statement for Nursing Facility | ||
| 27-235 | Adult Family Home Confidential Identifier List (Residential Care Services) | ||
| 27-234 | CCLS Small Business Self-Certification Statement | ||
| 27-232 | Central Contracts and Legal Services (CCLS) Department of Enterprise Services (DES) Late Filing Justification | ||
| 27-231 | Central Contracts and Legal Services (CCLS) Source Contract Justification | ||
| 27-230 | Central Contracts and Legal Services (CCLS) Emergency Contract Justification | ||
| 27-229 | CCLS Sole Source Amendment Justification | ||
| 27-228 | CCLS Additional Delegated Authority Request | ||
| 27-226 | Adult Family Home Management Agreement: Attestation Information and Attachments (Residential Care Services) |
