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(asc) File Format
18-398A Vendor / Provider Overpayment Notice
10-628 Trust Fund Review (Aging and Long-Term Support Administration)
11-058 Trial Work Experience (TWE) Agreement (Division of Vocational Rehabilitation)
18-544 Transmittal of Resident Personal Funds
01-210 Transmittal of Client Funds from the Protective Payee
10-574B Transitional Care Planning Tracking: Part B. Active Coordinator of Transition (ACT) (Developmental Disabilities Administration)
13-906 Therapy Evaluation for Bed Transfer / Positioning Devices (Typically Bed or Side Rails) (Home and Community Services)
10-437 Temporary Manager and/or Receiver Application Nursing Home and Assisted Living Facility
02-586 Temporary Employment Hours Tracking Log
14-552 TED Program Pilot Project: Application for Emergency Alerting Device KIT (Office of the Deaf and Hard of Hearing)
10-632 TB Testing Review for Staff (Aging and Long-Term Support Administration)
10-633 TB Testing Review for Resident (Aging and Long-Term Support Administration)
04-449A Survivors Feedback (Domestic Violence Intervention Treatment)
10-604 Supported Living Information Changes (Residential Care Services)
11-146 Supported Employment Referral (Economic Services Administration)
14-527 Substance Use Disorder Requirements (HEN Referral Program)
14-529 Substance Use Disorder Requirements (ABD / PWA)
11-114 Student Workshop Roster
02-690 Student Evaluation Summary Report
14-438 Stop Work
02-611 Statement of Understanding: Mid-Certification Review
18-097 Statement of Resources and Expenses
14-050 Statement of Health, Education, and Employment
14-436 Statement of Adult Acting in Loco Parentis (As a Parent)
14-223 Statement from School