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(asc) Form Name File Format
16-244 New Freedom Participant Responsibility Agreement
16-243 Community Services Office (CSO) Compliments and Concerns (Economic Services Administration)
16-242 Ask DSHS
16-237 DDA GovDelivery Communication Request (Developmental Disabilities Administration)
16-235 Photo Release
16-234A Vulnerable Adult Statement of Rights (Intended for use in CCRSS and ICF/IID (RHC))
16-234 Vulnerable Adult Statement of Rights (Intended for use in NH, ALF, AFH, ICF/IID (non RHC) and ESF)
16-230 Children's Residential Services
16-218 Intake Cover Letter to Tribes
16-213 Verification of Legal Status
16-205 Personal Emergency Plan Information (Developmental Disabilities Administration (DDA))
16-203 SIS-A Rating Key (Developmental Disabilities Administration)
16-202A Corrective Action Plan (Developmental Disabilities Administration)
16-202 5-Day Investigation Report (Developmental Disabilities Administration (DDA)
16-201 New Case / Resource Manager Assessment (Developmental Disabilities Administration)
16-197 Assisted Living Facility Policies and Procedures Attestation
16-195 Information About Your Role as the Identified Necessary Supplemental Accommodation (NSA) Representative
16-193 Nurse Aide Registry Inquiry (ADSA)
16-191 SOLA Vehicle Trip Log (Developmental Disabilities Administration)
16-182 Guidelines for Completing the ICAP / SIB-R Adaptive Behavior Scale (Developmental Disabilities Administration)
16-172 Your Rights and Responsibilities When You Receive Services Offered by Aging and Disability Services Administration and Developmental Disabilities Administration
16-107 Noncustodial Parent's Rights and Responsibilities
16-072 NonAssistance Support Enforcement Information (Division of Child Support)
15-601 New Freedom (NF) Notice of Exception to Rule (ETR) Decision (Goods and Services)
15-600 Respite, Stabilization, and Residential Health Center (RHC) Support Referral (Developmental Disabilities Administration)