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
11-067 Monthly Budget Worksheet (Division of Vocational Rehabilitation)
10-661 Music Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration)
27-043 New Contractor Intake
18-463 New Hire Reporting Methods and Instructions (Division of Child Support)
10-664 New or Update Provider Information Worksheet (Developmental Disabilities Administration)
17-230 Non-Emergency Medical Transportation (NEMT) for PASRR Program Request
13-925A Non-Formulary Drug Use Request (Behavioral Health Administration)
14-440 Non-Profit Organization Application for Reconditioned Telecommunications Equipment (Office of the Deaf and Hard of Hearing)
16-072 NonAssistance Support Enforcement Information (Division of Child Support)
14-057B Noncustodial Parent Child Support Enforcement Application
03-374E Nondisclosure of Confidential Information Agreement for Non-Employee (eJAS Access)
27-156 Notice and Consent of Communication via Text or Unencrypted Email
14-515 Notice and Finding of Responsibility
05-246 Notice of Action Exception to Rule (Excluding AFH)
05-256 Notice of Action Exception to Rule for AFH Daily Rates
15-429A Notice of Decision on Request for School Break Personal Care Exception to Rule
15-342 Notice of Exception to Rule Decision
14-460 Notice of Insufficient Information (Developmental Disabilities Administration)
14-535 Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration)
06-189 Notice of Suspension of Supported Living Services (Developmental Disabilities Administration)
15-569 Notice of Termination of Service (Developmental Disabilities Administration)
14-402 Notice to Parents (WorkFirst)
14-401 Notification of Address Disclosure Request - Part 1
14-401A Notification of Address Disclosure Request - Part 2
10-377 Notification of Age Four (4) Eligibility Expiration-