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
05-010 Rule Exception Request
05-013 Request for Hearing
05-246 Notice of Action Exception to Rule (Excluding AFH)
05-248 On-Site Review (Office of Refugee and Immigrant Assistance)
05-249 Adult Residential Care Services Notice of a Change
05-252 Code of Ethics and Standards of Practice (Division of Vocational Rehabilitation)
05-254 Federal Subminimum Wage Certificate Holder
05-255 Medicaid Transformation Project Notice of Action Exception to Rule
05-256 Notice of Action Exception to Rule for AFH Daily Rates
05-258 Level 4 Questionnaire for Supervisors Applying to Facilitate Level 4 Domestic Violence Intervention Treatment
05-259 Risk, Needs, and Responsivity for Assessments and Treatment Planning (Domestic Violence Intervention Treatment)
05-260 Change of Address for an Existing DVIT Certification (Domestic Violence Intervention Treatment)
05-261 Add, Change, or Remove Direct Service Staff for a Certified DVIT Program (Domestic Violence Intervention Treatment)
05-262 Add or Remove a Service for an Existing DVIT Certification (Domestic Violence Intervention Treatment)
05-272 Case Manager Instructions Following a Hearing Decision
05-273 Private Duty Nursing (PDN) Pre-Contract Education Attestation (Home and Community Services)
05-274 Residential Referral Transition (Developmental Disabilities Administration)
06-123 Nursing Assistant Training and Testing Reimbursement
06-124 Cost of Care Adjustment (COCA) (Developmental Disabilities)
06-125 Residential Allowance Request / Insufficient Income (Developmental Disabilities Administration)
06-125A Residential Allowance Request - Start Up Costs (Developmental Disabilities Administration)
06-125B Residential Allowance Request - Damages (Developmental Disabilities Administration)
06-125C Residential Allowance Request - Shelter Expense (Developmental Disabilities Administration)
06-159 Specialized Evaluation and Consultation Provider Invoice (Developmental Disabilities Administration)
06-159A Specialized Evaluation and Treatment Provider Invoice (Developmental Disabilities Administration)