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(asc) File Format
16-072 NonAssistance Support Enforcement Information (Division of Child Support)
18-399A Non-SSPS Client / Provider Overpayment AFRS Coding Computation
14-440 Non-Profit Organization Application for Reconditioned Telecommunications Equipment (Office of the Deaf and Hard of Hearing)
13-925A Non-Formulary Drug Use Request (Behavioral Health Administration)
17-230 Non-Emergency Medical Transportation (NEMT) for PASRR Program Request
15-422 No Paid Services Group
10-664 New or Update Provider Information Worksheet (Developmental Disabilities Administration)
18-463 New Hire Reporting Methods and Instructions (Division of Child Support)
16-244 New Freedom Participant Responsibility Agreement
27-043 New Contractor Intake
16-199 New Case/Resource Manager Technology Training Checklist
16-201 New Case / Resource Manager Assessment (Developmental Disabilities Administration)
10-382 Naturalization Services Pre-Screening
14-495 Naturalization Letter
10-661 Music Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration)
11-067 Monthly Budget Worksheet (Division of Vocational Rehabilitation)
10-334 Monitoring of Side Effects Scale (MOSES) (DDA)
14-467 Mid-Certification Review
17-231 Mental Incapacity Evaluation (MIE) Contractor Travel Plan
10-634 Medication Assistant Endorsement (Aging and Long-Term Support Administration)
15-398 Medically Intensive Children's Program (MICP) Application
17-301 Medical Expense Examples (Community Services Division, Economic Services Administration)
06-173 Medical Evidence Reimbursement
14-144A Medical Disability Decision
14-431 Medical / Dental Services Authorization (Voluntary Placement Services) (Developmental Disabilities Administration)