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(asc) | Form Name | File Format | |
|---|---|---|---|
| 06-177 | Residential Training Roster / Reimbursement (Developmental Disabilities Administration) | ||
| 06-176 | Assisted Living Facility (ALF) Change in Licensed Resident Bed Capacity or Use of Rooms | ||
| 06-173 | Medical Evidence Reimbursement | ||
| 06-172 | Domestic Violence Prevention Account | ||
| 06-171 | Funding and Expenditure Data (Tribal) | ||
| 06-169 | AFH Change in Licensed Bed Capacity - Decrease (Adult Family Home) (Residential Care Services) | ||
| 06-168 | AFH Change in Licensed Bed Capacity - Increase (Adult Family Home) (Residential Care Services) | ||
| 06-162 | Division of Vocational Rehabilitation (DVR) Referral to Office of Financial Recovery Referral | ||
| 06-159A | Specialized Evaluation and Treatment Provider Invoice (Developmental Disabilities Administration) | ||
| 06-159 | Specialized Evaluation and Consultation Provider Invoice (Developmental Disabilities Administration) | ||
| 06-125C | Residential Allowance Request - Shelter Expense (Developmental Disabilities Administration) | ||
| 06-125B | Residential Allowance Request - Damages (Developmental Disabilities Administration) | ||
| 06-125A | Residential Allowance Request - Start Up Costs (Developmental Disabilities Administration) | ||
| 06-125 | Residential Allowance Request / Insufficient Income (Developmental Disabilities Administration) | ||
| 06-124 | Cost of Care Adjustment (COCA) (Developmental Disabilities) | ||
| 06-123 | Nursing Assistant Training and Testing Reimbursement | ||
| 05-277 | Companion Home DCYF Weekly Schedule (Developmental Disability Administration) | ||
| 05-274 | Residential Referral Transition (Developmental Disabilities Administration) | ||
| 05-273 | Private Duty Nursing (PDN) Pre-Contract Education Attestation (Home and Community Services) | ||
| 05-272 | Case Manager Instructions Following a Hearing Decision | ||
| 05-262 | Add or Remove a Service for an Existing DVIT Certification (Domestic Violence Intervention Treatment) | ||
| 05-261 | Add, Change, or Remove Direct Service Staff for a Certified DVIT Program (Domestic Violence Intervention Treatment) | ||
| 05-260 | Change of Address for an Existing DVIT Certification (Domestic Violence Intervention Treatment) | ||
| 05-259 | Risk, Needs, and Responsivity for Assessments and Treatment Planning (Domestic Violence Intervention Treatment) | ||
| 05-258 | Level 4 Questionnaire for Supervisors Applying to Facilitate Level 4 Domestic Violence Intervention Treatment |
