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(asc) Form Name File Format
14-438 Stop Work
14-436 Statement of Adult Acting in Loco Parentis (As a Parent)
14-431A Community Crisis Stabilization Services (CCSS) Medical / Dental Services Authorization (Developmental Disabilities Administration)
14-431 Medical / Dental Services Authorization (Voluntary Placement Services) (Developmental Disabilities Administration)
14-416 Eligibility Review for Long Term Services and Supports
14-402 Notice to Parents (WorkFirst)
14-401A Notification of Address Disclosure Request - Part 2
14-401 Notification of Address Disclosure Request - Part 1
14-381 WorkFirst Individual Responsibility Plan
14-310 Client Status Change Report
14-264 Application for Telecommunications Equipment
14-238 Client Income Report
14-225 Acknowledgement of Services
14-224 Statement from Landlord/Manager
14-223 Statement from School
14-155 Senior Citizens Service Application
14-151 Request for DDA Eligibility Determination
14-105 Interview Appointment for Applicant (Community Services Division)
14-076 Change of Circumstances
14-068 Financial Statement (Division of Vocational Rehabilitation)
14-057D Child Support Referral Continuation
14-057B Noncustodial Parent Child Support Enforcement Application
14-057 Child Support Referral
14-050 Statement of Health, Education, and Employment
14-001 Application for Cash or Food Assistance