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 | |
|---|---|---|---|
| 17-266 | Contractor Designated Contact(s) Background Check (Division of Vocational Rehabilitation) | ||
| 17-265 | DSHS / DVR Request for Approval to Subcontract Checklist (Division of Vocational Rehabilitation) | ||
| 17-264 | DVR Background Check Reporting (Division of Vocational Rehabilitation) | ||
| 17-263 | Background Check Review: Character, Competence, and Suitability for Contractor Employees / Volunteers (Division of Vocational Rehabilitation) | ||
| 17-262 | Companion Home Physical and Safety Requirements Review (Developmental Disabilities Administration) | ||
| 17-261 | Assistive Communication Technology (ACT) Contractor Assignment Report (Office of Deaf and Hard of Hearing) | ||
| 17-260 | Companion Home Gift Card or Pre-paid Credit Card Ledger (Developmental Disabilities Administration) | ||
| 17-259 | Companion Home Client Inventory Record | ||
| 17-258 | Companion Home Client Cash Ledger (Developmental Disabilities Administration) | ||
| 17-257 | Companion Home Client Budget Worksheet (Developmental Disabilities Administration) | ||
| 17-253 | DSHS Background Check System (BCS) Access Request | ||
| 17-238 | ODHH Approved Sign Language Interpreter Complaints | ||
| 17-231 | Mental Incapacity Evaluation (MIE) Contractor Travel Plan | ||
| 17-230 | Non-Emergency Medical Transportation (NEMT) for PASRR Program Request | ||
| 17-229 | Pre-Admission Screening and Resident Review (PASRR) Records Request | ||
| 17-227 | DSHS / HCA Systems Access Request | ||
| 17-226 | AAA DSHS / HCS Systems Access Request (Aging and Long-Term Support Administration) | ||
| 17-211 | Authorization for SSI Facilitation Records (Economic Services Administration) | ||
| 17-208A | PRISM Access Request for Multiple Organizations | ||
| 17-194 | Request for Mental Health Service Information | ||
| 17-180 | Personal Information Release (Economic Services Administration) | ||
| 17-123 | Spoken Language Interpreter Service Appointment Record | ||
| 17-116 | AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion | ||
| 17-063 | Authorization |
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| 17-041 | Request for Records |
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