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 | |
|---|---|---|---|
| 10-611 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Face Sheet (Residential Care Services) | ||
| 10-699 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Exit Preparation / Exit Conference (Residential Care Services) | ||
| 10-677 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Record Review | ||
| 10-614 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Interview (Residential Care Services) | ||
| 10-676 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Finances Record Review | ||
| 10-698 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Administrator Record Review and Interview (Residential Care Services) | ||
| 15-389 | Certified Community Residential Services and Support (CCRSS) Initial Application | ||
| 10-720 | Certified Children’s Residential Services Initial Application (Developmental Disabilities Administration) | ||
| 10-647 | Certification Evaluation Staff Interview (Developmental Disabilities Administration) | ||
| 10-646 | Certification Evaluation Legal Representative Interview (Developmental Disabilities Administration) | ||
| 10-645 | Certification Evaluation Client Interview (Developmental Disabilities Administration) | ||
| 15-605 | Certification Evaluation Checklist Intensive Habilitation Services for Children Providers (Home and Community Living Administration (HCLA) | ||
| 10-666 | Certification Evaluation Checklist for Overnight Planned Respite Services Providers (Home and Community Living Administration) | ||
| 17-295 | Certification Evaluation Checklist for Companion Homes Providers (Home and Community Living Administration) | ||
| 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 | ||
| 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.) | ||
| 27-231 | CCLS Source Contract Justification | ||
| 27-229 | CCLS Sole Source Amendment Justification | ||
| 27-234 | CCLS Small Business Self-Certification Statement | ||
| 27-233 | CCLS General Terms and Conditions (GTC) Change Request |
