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(desc) | File Format | |
|---|---|---|---|
| 15-215 | AFH Quality Improvement Visit Assessment | ||
| 14-478 | Aged, Blind, or Disabled (ABD) Program Medical Treatment Participation |
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| 03-374B | Agreement on Nondisclosure of Confidential Information - Non-Employee | ||
| 17-116 | AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion | ||
| 15-388 | Alternative Living Certification Evaluation (Developmental Disabilities Administration) | ||
| 10-665 | Alternative Living Provider Application (Developmental Disabilities Administration) | ||
| 10-679 | Alternative Living Provider Application, Contracting, and Certification Overview Checklist (Developmental Disabilities Administration) | ||
| 10-269 | Alternative Living Services Plan and Provider Progress Report (Developmental Disabilities Administration) | ||
| 10-269A | Alternative Living Services Plan and Provider Progress Report Supplement to DSHS form 10-269 (Developmental Disabilities Administration) | ||
| 10-467 | ALTSA Sentence / Copy Design Folstein MMSE (Home and Community Services) | ||
| 15-331 | Annual Assessment Checklist (Developmental Disability Administration) | ||
| 27-110 | Applicant Request for a Copy of Background Check Information | ||
| 19-237 | Application Budget Summary (Residential Care Services) | ||
| 02-592 | Application for Approval of Interpreter and Translator Continuing Education Activity | ||
| 14-001 | Application for Cash or Food Assistance |
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| 10-413 | Application For Contract For Currently Licensed Assisted Living Facility | ||
| 12-207 | Application for Disaster Cash Assistance | ||
| 12-206 | Application for Disaster Food Benefits | ||
| 14-542 | Application for New Program Certification (Domestic Violence Intervention Treatment) | ||
| 18-078 | Application for Nonassistance Support Enforcement Services |
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| 14-543 | Application for Renewal Program Certification (Domestic Violence Intervention Treatment) | ||
| 14-264 | Application for Telecommunications Equipment | ||
| 15-517 | Application for Transition from Group Home to Group Training Home | ||
| 11-022 | Application for Vocational Rehabilitation Services |
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| 14-341 | Application to Convert Payment Services Only (PSO) Case to Full Collection Services |
