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(asc) Form Name File Format
14-460 Notice of Insufficient Information (Developmental Disabilities Administration)
14-459 Eligible Conditions With Age and Type of Evidence (Developmental Disabilities Administration)
14-454 Estate Recovery: Repaying the State for Medical and Long Term Services and Supports
14-453 Protective Payee Decision
14-449 Unmet Need Breakdown
14-443 Financial / Social Services Communication
14-440 Non-Profit Organization Application for Reconditioned Telecommunications Equipment (Office of the Deaf and Hard of Hearing)
14-439 Washington State Combined Application Program (WASHCAP) Application
14-438 Stop Work
14-436 Statement of Adult Acting in Loco Parentis (As a Parent)
14-432 Direct Deposit Enrollment
14-431A Community Crisis Stabilization Services (CCSS) Medical / Dental Services Authorization (Developmental Disabilities Administration)
14-431 Medical / Dental Services Authorization (Voluntary Placement Services) (Developmental Disabilities Administration)
14-427 Teen Parent Living Assessment
14-426 Protective Payee Payment Plan, Case Assignment, and Closure Notice
14-416 Eligibility Review for Long Term Services and Supports
14-402 Notice to Parents (WorkFirst)
14-401A Notification of Address Disclosure Request - Part 2
14-401 Notification of Address Disclosure Request - Part 1
14-381 WorkFirst Individual Responsibility Plan
14-349 Protective Payee Assessment
14-341 Application to Convert Payment Services Only (PSO) Case to Full Collection Services
14-332 Disability Assessment
14-310 Client Status Change Report
14-300 Level One Pre-Admission Screening and Resident Review (PASRR)