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.
Number | Form Name(asc) | File Format | |
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15-381 | Respite Assessment Worksheet | ||
10-635 | Residential Transition Exchange of Information (Developmental Disabilities Administration) | ||
15-596 | Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Referral (Home and Community Services) | ||
11-130 | Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Eligibility Determination (Home and Community Services) | ||
10-403 | Residential Services Provider: Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult | ||
15-360 | Residential Services Capacity Profile | ||
15-564 | Residential Quarterly Report for Children's Residential Services (Developmental Disabilities Administration) | ||
10-666 | Residential Quality Assurance Certification Evaluation Checklist for Overnight Planned Respite Services Providers (Developmental Disabilities Administration) | ||
17-295 | Residential Quality Assurance Certification Evaluation Checklist for Companion Homes Providers (Developmental Disabilities Administration) | ||
17-296 | Residential Quality Assurance Certification Evaluation Checklist for Alternative Living Providers (Developmental Disabilities Administration) | ||
02-632 | Residential Provider's Report of Weapon Ownership in Residential Setting | ||
15-494 | Residential Habilitation Center (RHC) / Individual Habilitation Plan (IHP) / Individual Plan of Care (IPOC) Meeting Notification (Developmental Disabilities Administration) | ||
17-041 | Request for Records |
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17-194 | Request for Mental Health Service Information | ||
18-701 | Request for Income Information for Purposes of Entering or Enforcing a Child Support Order | ||
10-673 | Request for ICF/IID or SONF Services at an RHC Administration Application | ||
05-013 | Request for Hearing |
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13-925 | Request for Formulary Admission or Deletion (Behavioral Health Administration) | ||
02-556 | Request for Exception to Policy (ETP) for Use of Restrictive Procedures (Developmental Disabilities Administration) | ||
15-282A | Request for Enrollment in Developmental Disabilities Administration (DDA) Home and Community Based Services (HCBS) Waiver or Request to Change from One DDA HCBS Waiver to Another | ||
14-151 | Request for DDA Eligibility Determination |
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09-520 | Request for Conference Board |
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18-681 | Request for Collection of Uninsured Health Care Expenses | ||
10-277 | Request for Children's Out-of-Home Services (Developmental Disabilities Administration) | ||
10-238 | Request for an Administrative Hearing (Residential Care Services) |