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 | |
|---|---|---|---|
| 27-124 | Provider Owned Housing Memorandum of Understanding Residential Provider Attestation | ||
| 27-123 | Provider Owned Housing Memorandum of Understanding Renter Attestation |
|
|
| 27-110 | Applicant Request for a Copy of Background Check Information | ||
| 27-096 | Permission to Share Documents for Reimbursement of Health Care Expenses | ||
| 27-094 | Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration) | ||
| 27-081 | Employment and Day Program Services Providers: Mandatory Reporting of Abuse, Improper Use of Restraint, Neglect, Personal or Financial Exploitation, Abandonment of a Child or Vulnerable Adult (Developmental Disability Administration) | ||
| 27-076 | Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult | ||
| 27-063 | Out-of-Home Services Agreement for Youth (Age 18-21) (Developmental Disabilities Administration) | ||
| 27-053 | Paternity Information | ||
| 27-044A | Contractor Information Update (for existing DSHS contractors) | ||
| 27-043 | New Contractor Intake | ||
| 21-061 | Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration) | ||
| 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 | ||
| 19-074 | Loan Agreement for Tools, Equipment, Initial Stock and Supplies, and Devices (Division of Vocational Rehabilitation) |
|
|
| 18-701 | Request for Income Information for Purposes of Entering or Enforcing a Child Support Order | ||
| 18-700 | Direct Deposit Authorization | ||
| 18-681 | Request for Collection of Uninsured Health Care Expenses | ||
| 18-555 | Financial Information Sheet | ||
| 18-551 | School Statement |
|
|
| 18-544 | Transmittal of Resident Personal Funds | ||
| 18-484 | Automatic Payment Authorization and Electronic Funds Transfer Information |
|
