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 | |
|---|---|---|---|
| 27-053 | Paternity Information | ||
| 27-044A | Contractor Information Update (for existing DSHS contractors) | ||
| 27-043 | New Contractor Intake | ||
| 23-045 | Community Services Division (CSD) Financial Confidence Wheel (Economic Services Division) | ||
| 21-065 | Adult Family Home (AFH) Emergency Evacuation Drill | ||
| 21-061 | Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration) | ||
| 21-060 | Children’s State Operated Living Alternative (SOLA) Quality Assurance Assessment | ||
| 21-059 | Children's Staffed Residential Quality Assurance Assessment | ||
| 20-334 | Washington State Learning Center (LC) New Course Request (Division of Developmental Disabilities) | ||
| 20-333 | Outpatient Competency Restoration Program (OCRP) Transition Plan (Behavioral Health Administration) | ||
| 20-332 | Appropriate Level of Forensic Services (ALFS) Screening Tool | ||
| 20-330 | Incident Report to DDA (Developmental Disabilities Administration) | ||
| 20-273 | Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program | ||
| 19-237 | Application Budget Summary (Residential Care Services) | ||
| 19-074 | Loan Agreement for Tools, Equipment, Initial Stock and Supplies, and Devices (Division of Vocational Rehabilitation) |
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| 18-720 | Client Responsibility Notice (Home and Community Services) | ||
| 18-701 | Request for Income Information for Purposes of Entering or Enforcing a Child Support Order | ||
| 18-700 | Direct Deposit Authorization | ||
| 18-682 | Detail Sheet – Uninsured Health Care Expenses | ||
| 18-681 | Request for Collection of Uninsured Health Care Expenses | ||
| 18-627 | SSP Client Overpayment Notice (State Supplementary Program) | ||
| 18-607 | Child Care Verification |
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| 18-555 | Financial Information Sheet | ||
| 18-551 | School Statement |
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| 18-544 | Transmittal of Resident Personal Funds |
