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
27-144 CSD Disability Eligibility Review Contractor Self-Assessment Monitoring Tool
11-068 Customer Internship Program Internship Application (Division of Vocational Rehabilitation)
10-584 Data Summary Report and Recommendations (Developmental Disabilities Administration)
13-738 DDA / DCYF Request to Cost Share (Developmental Disabilities Administration) (Department of Children, Youth, and Families)
15-568 DDA Alternative Living Provider Orientation (Developmental Disabilities Administration)
27-210 DDA Authorization for Release of Referral Video (Developmental Disabilities Administration)
15-318 DDA Crisis Diversion Bed Referral and Intake Information
10-331 DDA Mortality Review Provider Report (Developmental Disabilities Administration)
13-903 DDA Request for Additional Units Nurse Delegation (Developmental Disability Administration)
10-688 DDA Specialty Adult Family Home (AFH) Pilot Monthly Client Goal and Progress Report (Developmental Disabilities Administration)
11-134 Deaf - Blind Referral Criteria Checklist for Level 4 Community Rehabilitation Program (CRP) Services (Division of Vocational Rehabilitation)
27-219 Death Notification Checklist for Medical Providers (Developmental Disabilities Administration)
27-218 Death Notification Checklist for Residential Habilitation Center (RHC) Staff (Developmental Disabilities Administration)
09-693 Declaration of Lawful Custody
18-433 Declaration of Support Payments (Division of Child Support)
18-398B Department of Children, Youth, and Families (DCYF) Client Overpayment Notice
18-700 Direct Deposit Authorization
10-351 Disclosure of Services Required by RCW 18.20.300
11-180 Discovery Profile Report (Developmental Disabilities Administration)
27-220 Disposition of Remains / Release of Body Permit (Developmental Disabilities Administration)
16-276 Diversion Navigator Interview (Office of Forensic Mental Health Services (OFMHS))
11-149 Division of Vocational Rehabilitation (DVR) Customer Job Seeker Accommodation Worksheet
06-162 Division of Vocational Rehabilitation (DVR) Referral to Office of Financial Recovery Referral
15-435 Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration
10-353 Documentation Request for Medical Condition and Residual Functional Capacity