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.

Choose search option and begin typing the form #
Keyword Search
Number(asc) Form Name File Format
17-266 Contractor Designated Contact(s) Background Check (Division of Vocational Rehabilitation)
17-265 DSHS / DVR Request for Approval to Subcontract Checklist (Division of Vocational Rehabilitation)
17-264 DVR Background Check Reporting (Division of Vocational Rehabilitation)
17-263 Background Check Review: Character, Competence, and Suitability for Contractor Employees / Volunteers (Division of Vocational Rehabilitation)
17-262 Companion Home Physical and Safety Requirements Review (Developmental Disabilities Administration)
17-261 Assistive Communication Technology (ACT) Contractor Assignment Report (Office of Deaf and Hard of Hearing)
17-260 Companion Home Gift Card or Pre-paid Credit Card Ledger (Developmental Disabilities Administration)
17-259 Companion Home Client Inventory Record
17-258 Companion Home Client Cash Ledger (Developmental Disabilities Administration)
17-257 Companion Home Client Budget Worksheet (Developmental Disabilities Administration)
17-253 DSHS Background Check System (BCS) Access Request
17-238 ODHH Approved Sign Language Interpreter Complaints
17-231 Mental Incapacity Evaluation (MIE) Contractor Travel Plan
17-230 Non-Emergency Medical Transportation (NEMT) for PASRR Program Request
17-229 Pre-Admission Screening and Resident Review (PASRR) Records Request
17-227 DSHS / HCA Systems Access Request
17-226 AAA DSHS / HCS Systems Access Request (Aging and Long-Term Support Administration)
17-211 Authorization for SSI Facilitation Records (Economic Services Administration)
17-208A PRISM Access Request for Multiple Organizations
17-194 Request for Mental Health Service Information
17-180 Personal Information Release (Economic Services Administration)
17-123 Spoken Language Interpreter Service Appointment Record
17-116 AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion
17-063 Authorization
17-041 Request for Records