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 Form Name(desc) File Format
11-030 Service Delivery Outcome Report (Community Rehabilitation Program - CRP)
16-245 Skills Practice Procedure Checklist for Home Care Aides DSHS Approved (Home and Community Services)
02-615 Social Services Invoice / Receipt Packet Cover (Home and Community Services)
10-653 State Civil Penalty Reinvestment Program Grant (SCPRP) Community Residential Services and Supports (CCRSS) Grant Application
18-097 Statement of Resources and Expenses
13-906 Therapy Evaluation for Bed Transfer / Positioning Devices (Typically Bed or Side Rails) (Home and Community Services)
12-212 Waiver of Administrative Disqualification Hearing (Community Services Division)
14-521 Your Rights (Home and Community Services)