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
23-045 Community Services Division (CSD) Financial Confidence Wheel (Economic Services Division)
27-155 Declaration on Commercial Purposes
27-189 Asset Verification Authorization (Home and Community Services)
27-192 Home and Community Services (HCS) Resumption of Training Attestation
27-203 Individual Provider (IP) Attestation of Informal Support (Home and Community Services)
27-207 Acknowledgement Statement (Meaningful Day) (Home and Community Services)
27-208 Declaration to Adult Protective Services
27-225 DSHS Claim of Stolen EBT Benefits: Food (Community Services Division)