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 Form Name(desc) File Format
13-943 Certified Community Residential Supports and Services (CCRSS) Infection Prevention and Control (IPC) Complaint Investigation Pathway
15-366 Change of Address
05-260 Change of Address for an Existing DVIT Certification (Domestic Violence Intervention Treatment)
16-275 Change of Circumstance: Community Behavioral Health Supports (CBHS) / 1915i (Home and Community Services)
14-076 Change of Circumstances
03-506 Character, Competence, and Suitability Assessment
10-244 Child and Family Engagement Plan (Developmental Disabilities)
10-471 Child and Family Team (CFT) Care Plan (Developmental Disabilities Administration)
18-607 Child Care Verification
09-741 Child Support Order Review Request
14-057 Child Support Referral
14-057D Child Support Referral Continuation
16-230 Children's Residential Services
21-059 Children's Staffed Residential Quality Assurance Assessment
10-649 Children's State Operated Living Alternatives (SOLA) Certification Evaluation (Developmental Disabilities Administration)
15-387 Children’s Respite Application
21-060 Children’s State Operated Living Alternative (SOLA) Quality Assurance Assessment
12-209 Client Fraud Report
14-238 Client Income Report
15-314 Client Necessary Supplemental Accommodation Representative Requirement Checklist
18-398 Client Overpayment Notice
15-358 Client Referral Summary (Developmental Disabilities Administration)
18-720 Client Responsibility Notice (Home and Community Services)
14-310 Client Status Change Report
05-252 Code of Ethics and Standards of Practice (Division of Vocational Rehabilitation)