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 | |
|---|---|---|---|
| 27-182 | DSHS Request for Positive Identification – Thumbprint | ||
| 27-179 | Adult Family Home (AFH) Informal Dispute Resolution (IDR) Request (Residential Care Services) | ||
| 27-178 | Adult Protective Services (APS) Administrative Hearing Request | ||
| 27-176 | Release of Liability (Developmental Disabilities Administration) | ||
| 27-175 | DVR Additional Contractor Information (Division of Vocational Rehabilitation) | ||
| 27-156 | Notice and Consent of Communication via Text or Unencrypted Email |
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| 27-155 | Declaration on Commercial Purposes | ||
| 27-147A | In-Home Environmental Adaptations General Utility and Repair Property Release Agreement (Aging and Long-Term Support Administration) | ||
| 27-147 | Housing Modification Property Release Agreement | ||
| 27-143 | CSD ABD Medical Evidence Review Contractor Self-Assessment Monitoring Tool | ||
| 27-130 | Authorization for Alternate EBT Cardholder |
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| 27-124 | Provider Owned Housing Memorandum of Understanding Residential Provider Attestation | ||
| 27-123 | Provider Owned Housing Memorandum of Understanding Renter Attestation |
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| 27-115 | Privacy Complaint | ||
| 27-110 | Applicant Request for a Copy of Background Check Information | ||
| 27-109 | BCCU Applicant Affidavit | ||
| 27-096 | Permission to Share Documents for Reimbursement of Health Care Expenses | ||
| 27-094 | Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration) | ||
| 27-089 | Fingerprint-Based Background Check Notice | ||
| 27-076 | Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult | ||
| 27-063 | Out-of-Home Services Agreement for Youth (Age 18-21) (Developmental Disabilities Administration) | ||
| 27-059 | Fingerprint Appointment |
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| 27-053 | Paternity Information | ||
| 27-044A | Contractor Information Update (for existing DSHS contractors) | ||
| 27-043 | New Contractor Intake |
