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(desc) Form Name File Format
18-682 Detail Sheet – Uninsured Health Care Expenses
18-700 Direct Deposit Authorization
18-701 Request for Income Information for Purposes of Entering or Enforcing a Child Support Order
18-720 Client Responsibility Notice (Home and Community Services)
19-074 Transfer / Loan / Recovery Agreement (Division of Vocational Rehabilitation)
19-237 Application Budget Summary (Residential Care Services)
20-273 Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program
20-332 Appropriate Level of Forensic Services (ALFS) Screening Tool
20-333 Outpatient Competency Restoration Program (OCRP) Transition Plan (Behavioral Health Administration)
20-334 Washington State Learning Center (LC) New Course Request (Division of Developmental Disabilities)
20-335 WA Care Fund Rights and Responsibilities
20-336 WA Cares Fund Application for Long-Term Care Benefits
20-337 WA Cares Fund 90-Day Certification
20-338 Limited Power of Attorney for WA Cares Fund Benefits
20-339 WA Cares Authorized User
20-340 Individualized Community Transition Planning Summary (Home and Community Services)
21-059 Children's Staffed Residential Quality Assurance Assessment
21-060 Children’s State Operated Living Alternative (SOLA) Quality Assurance Assessment
21-061 Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration)
21-065 Adult Family Home (AFH) Emergency Evacuation Drill
23-045 Community Services Division (CSD) Financial Confidence Wheel (Economic Services Division)
27-043 New Contractor Intake
27-044A Contractor Information Update (for existing DSHS contractors)
27-053 Paternity Information
27-059 Fingerprint Appointment