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 | |
|---|---|---|---|
| 02-716 | Rapid Response Team 2 Request (Residential Care Services) (Aging and Long-Term Support Administration) | ||
| 02-709 | Adult Family Home (AFH) Personnel Changes (Aging and Long-Term Support Administration) | ||
| 02-692 | Community Instructor Class List Tracking Log | ||
| 02-690 | Student Evaluation Summary Report | ||
| 02-632 | Residential Provider's Report of Weapon Ownership in Residential Setting | ||
| 02-611 | Statement of Understanding: Mid-Certification Review |
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| 02-592 | Application for Approval of Interpreter and Translator Continuing Education Activity | ||
| 02-586 | Temporary Employment Hours Tracking Log | ||
| 02-566 | Protected Health Information (PHI) Amendment | ||
| 02-556 | Request for Exception to Policy (ETP) for Use of Restrictive Procedures (Developmental Disabilities Administration) | ||
| 02-516 | Adult Family Home Resident Personal Belongings Inventory (Residential Care Services) | ||
| 01-210 | Transmittal of Client Funds from the Protective Payee | ||
| 01-205 | Able Bodied Adults Without Dependents (ABAWD) Activity Report | ||
| 01-110C | Protective Payee Report Continuation | ||
| 01-110A | Protective Payee Periodic Social Services Report | ||
| 01-110 | Protective Payee Report | ||
| 00-399 | Phase 2 Higher Education and Workforce Training COVID-19 Requirements (Home and Community Services) | ||
| 00-398 | Phase 1 Higher Education and Workforce Training COVID-19 Requirements (Home and Community Services) |
