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 | Form Name(desc) | File Format | |
|---|---|---|---|
| 27-208 | Declaration to Adult Protective Services | ||
| 27-225 | DSHS Claim of Stolen EBT Benefits: Food (Community Services Division) |
|
|
| 04-452A | DSHS Community Services Customer Survey (Community Services Division) | ||
| 04-452 | DSHS Community Services Survey (Community Services Division, Economic Services Administration) | ||
| 02-744 | DSHS Remote Skills Training Application: Virtual Classroom (Home and Community Services) | ||
| 02-714 | DSHS Virtual Classroom Training Application (Home and Community Services) | ||
| 02-714A | DSHS Virtual Classroom Training Application: Addendum to DSHS 02-714 (Home and Community Services) | ||
| 10-640 | Emphasis on Hands-On Skills Practice: Planning Attestation (Home and Community Services) | ||
| 15-554 | Facility Instructor Application (Home and Community Services) | ||
| 15-555 | Facility Training Program Application and Updates (Home and Community Services) | ||
| 16-253 | For Field Staff Use: Sex Offender Notification to Home Care Agency and Consumer Directed Employer (Home and Community Services) | ||
| 16-255 | For Field Use Only: Sex Offender Notification to Facility (Home and Community Services) | ||
| 11-153 | Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services) | ||
| 10-681 | Group Training Home (GTH) Certified Community Residential Services and Supports (CCRSS) Packet (Aging and Long-Term Support Administration) | ||
| 10-468 | HCS / AAA / ODHH / DDA Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults | ||
| 13-776 | HCS / AAA Nursing Services Referral (Home and Community Services) | ||
| 15-591 | High School Home Care Aide Instructor Application (Home and Community Services) | ||
| 27-192 | Home and Community Services (HCS) Resumption of Training Attestation | ||
| 10-644 | Home and Community-Based Services (HCBS) Waiver Approval Notification (DDA) |
|
|
| 27-203 | Individual Provider (IP) Attestation of Informal Support (Home and Community Services) | ||
| 10-258 | Individual With Possible Community Protection Issues (Developmental Disabilities Administration) | ||
| 10-659 | Initial Community Engagement Plan (Developmental Disabilities Administration) | ||
| 10-659 | Initial Community Engagement Plan (Developmental Disabilities Administration) | ||
| 16-267 | Integrated Settings Review for Resource Managers (Developmental Disabilities Administration) | ||
| 16-266 | Integrated Settings Survey: Employment or Community Inclusion Settings (Developmental Disabilities Administration) |
