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 | |
|---|---|---|---|
| 11-022 | Application for Vocational Rehabilitation Services | ||
| 10-728 | Agency Alternative Living Provider Supplemental Information (Developmental Disabilities Community Services) | ||
| 10-724 | Enhanced Respite Services for Children (ERS) Certification Evaluation (Home and Community Living Administration) | ||
| 10-7223 | State-Operated Community Residential Transitions Program (SOCR-T) Quality Assurance Review | ||
| 10-722 | Quality Assurance Review Checklist State-Operated Community Residential Transitions Program (Home and Community Living Administration) | ||
| 10-721 | Children’s Residential Habilitation Services Certification Evaluation (Home and Community Living Administration) | ||
| 10-720 | Certified Children’s Residential Services Initial Application (Developmental Disabilities Administration) | ||
| 10-719 | Integrated Settings Survey Site Contact Interview Adult Family Homes (AFH) / Assisted Living Facilities (ALF) (Developmental Disabilities Community Services (DDCS) | ||
| 10-718 | Integrated Settings Survey Client Interview Adult Family Homes (AFH) / Assisted Living Facilities (ALF) (Developmental Disabilities Community Services (DDCS) | ||
| 10-717 | Assisted Living Facility Staff Interview - Attachment F (Home and Community Living Administration) | ||
| 10-713 | Nursing Care Consultant (NCC) Focused Assessment (Developmental Disabilities Administration) | ||
| 10-711 | Adult Family Homes Program Training Plan (Residential Care Services) | ||
| 10-709 | Request for Residential Habilitation for Dependent Youth Services (Developmental Disabilities Administration) | ||
| 10-708 | Planning for Youth Aged 18-21 Receiving RHDY Services (Developmental Disabilities Administration) | ||
| 10-707 | Residential Habilitation for Dependent Youth (RHDY) Engagement Plan (Developmental Disabilities Administration) | ||
| 10-706 | Lake Burien Transitional Care Facility Dedicated Review Committee (DRC) Determination (Developmental Disabilities Administration) | ||
| 10-705 | Lake Burien Transitional Facility Specialized Treatment Referral and Application (Developmental Disabilities Community Services) | ||
| 10-703 | Enhanced Services Facility (ESF) Staff Interview (Residential Care Services) | ||
| 10-701 | Enhanced Respite Services School Notification (Developmental Disabilities Administration) | ||
| 10-700 | CCRSS Follow-Up Visit (Certified Community Residential Services and Supports, Residential Care Services.) | ||
| 10-699 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Exit Preparation / Exit Conference (Residential Care Services) | ||
| 10-698 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Administrator Record Review and Interview (Residential Care Services) | ||
| 10-697 | Emergency Transitional Support Services Certification Evaluation (Developmental Disabilities Administration) | ||
| 10-696 | Assisted Living Facility Medication Observation Worksheet (Home and Community Living Administration) | ||
| 10-695 | Adult Family Home (AFH) Initial Inspection Preparation Checklist (Residential Care Services) |
