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.
| Number | Form Name(asc) | File Format | |
|---|---|---|---|
| 14-535 | Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration) | ||
| 14-460 | Notice of Insufficient Information (Developmental Disabilities Administration) |
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| 15-342 | Notice of Exception to Rule Decision | ||
| 15-429A | Notice of Decision on Request for School Break Personal Care Exception to Rule | ||
| 05-256 | Notice of Action Exception to Rule for AFH Daily Rates | ||
| 05-246 | Notice of Action Exception to Rule (Excluding AFH) | ||
| 14-515 | Notice and Finding of Responsibility |
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| 27-156 | Notice and Consent of Communication via Text or Unencrypted Email |
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| 03-374E | Nondisclosure of Confidential Information Agreement for Non-Employee (eJAS Access) | ||
| 14-057B | Noncustodial Parent Child Support Enforcement Application | ||
| 16-072 | NonAssistance Support Enforcement Information (Division of Child Support) |
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| 14-440 | Non-Profit Organization Application for Reconditioned Telecommunications Equipment (Office of the Deaf and Hard of Hearing) | ||
| 13-925A | Non-Formulary Drug Use Request (Behavioral Health Administration) | ||
| 17-230 | Non-Emergency Medical Transportation (NEMT) for PASRR Program Request | ||
| 10-664 | New or Update Provider Information Worksheet (Developmental Disabilities Administration) | ||
| 18-463 | New Hire Reporting Methods and Instructions (Division of Child Support) | ||
| 27-043 | New Contractor Intake | ||
| 10-661 | Music Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration) | ||
| 11-067 | Monthly Budget Worksheet (Division of Vocational Rehabilitation) | ||
| 10-334 | Monitoring of Side Effects Scale (MOSES) (DDA) | ||
| 17-231 | Mental Incapacity Evaluation (MIE) Contractor Travel Plan | ||
| 10-634 | Medication Assistant Endorsement (Aging and Long-Term Support Administration) | ||
| 14-431 | Medical / Dental Services Authorization (Voluntary Placement Services) (Developmental Disabilities Administration) | ||
| 15-492 | Medicaid Transformation Project Service Notice | ||
| 05-255 | Medicaid Transformation Project Notice of Action Exception to Rule |
