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
27-226 Adult Family Home Management Agreement: Attestation Information and Attachments (Residential Care Services)
15-458 Adult Family Home Notice of Transfer or Change
02-516 Adult Family Home Resident Personal Belongings Inventory (Residential Care Services)
06-188 Adult Protective Services (APS) Investigations Fact Sheet (Aging and Long-Term Support Administration)
05-249 Adult Residential Care Services Notice of a Change
09-052 Affidavit of Forged Endorsement
10-638 AFH Meaningful Day - Monthly Activities and Challenging Behavior Log
14-478 Aged, Blind, or Disabled (ABD) Program Medical Treatment Participation
03-374B Agreement on Nondisclosure of Confidential Information - Non-Employee
17-116 AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion
10-269 Alternative Living Services Plan and Provider Progress Report (Developmental Disabilities Administration)
10-269A Alternative Living Services Plan and Provider Progress Report Supplement to DSHS form 10-269 (Developmental Disabilities Administration)
27-110 Applicant Request for a Copy of Background Check Information
02-592 Application for Approval of Interpreter and Translator Continuing Education Activity
14-001 Application for Cash or Food Assistance
10-413 Application For Contract For Currently Licensed Assisted Living Facility
12-207 Application for Disaster Cash Assistance
12-206 Application for Disaster Food Benefits
14-542 Application for New Program Certification (Domestic Violence Intervention Treatment)
18-078 Application for Nonassistance Support Enforcement Services
14-543 Application for Renewal Program Certification (Domestic Violence Intervention Treatment)
14-264 Application for Telecommunications Equipment
15-517 Application for Transition from Group Home to Group Training Home
11-022 Application for Vocational Rehabilitation Services
14-475 Appointment Letter for Division of Child Support (DCS) Good Cause Determination