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
02-528 Fair Hearing Withdrawal
02-516 Adult Family Home Resident Personal Belongings Inventory (Residential Care Services)
01-212 Nurse Delegation Referral and Communication
01-210 Transmittal of Client Funds from the Protective Payee
01-205 Able Bodied Adults Without Dependents (ABAWD) Activity Report
01-110C Protective Payee Report Continuation
01-110A Protective Payee Periodic Social Services Report
01-110 Protective Payee Report