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 | |
|---|---|---|---|
| 15-304 | HCBS Waiver Enrollment Database Update (Developmental Disabilities Administration) |
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| 15-295 | Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration) | ||
| 15-291 | Person Centered Service Planning and Annual Assessment Meeting |
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| 15-290 | Notification of Annual Assessment Review and Person Centered Services Planning Meeting | ||
| 15-282A | Request for Enrollment in Developmental Disabilities Administration (DDA) Home and Community Based Services (HCBS) Waiver or Request to Change from One DDA HCBS Waiver to Another | ||
| 15-274 | Assistance Available Schedule (DDA) | ||
| 15-215 | AFH Quality Improvement Visit Assessment | ||
| 15-184 | Volunteer Chore Service Referral | ||
| 15-031 | Nursing Facility Notice of Action | ||
| 14-553 | High School Home Care Aide Training Program and Instructor Application and Updates (Aging and Long-Term Support Administration) | ||
| 14-552 | TED Program Pilot Project: Application for Emergency Alerting Device KIT (Office of the Deaf and Hard of Hearing) | ||
| 14-551 | Adult Family Homes (AFH) State Civil Penalty Reinvestment Program Grant Application | ||
| 14-550 | Job Foundation Application (Developmental Disabilities Administration) | ||
| 14-549 | DDA Companion Home Provider Application (Developmental Disabilities Administration) | ||
| 14-547 | Continuing Care Retirement Community (CCRC) Registration Application | ||
| 14-544 | Continuing Education Summary for DVPT Providers (Domestic Violence Intervention Treatment) | ||
| 14-543 | Application for Renewal Program Certification (Domestic Violence Intervention Treatment) | ||
| 14-542 | Application for New Program Certification (Domestic Violence Intervention Treatment) | ||
| 14-541 | ABAWD Requirement: Medical Report (Able Bodied Adults without Dependents) | ||
| 14-538 | Pre-Admission Screening and Resident Review (PASRR) Addendum | ||
| 14-535 | Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration) | ||
| 14-534 | SDCP Eligibility Checklist (Home and Community Services) | ||
| 14-532 | Authorized Representative |
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| 14-530 | Disability Review |
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| 14-529 | Substance Use Disorder Requirements (ABD / PWA) |
