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(asc) | File Format | |
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10-396 | SSI Letter (DDA) | ||
17-123 | Spoken Language Interpreter Service Appointment Record | ||
10-658 | Specialized Habilitation 90-Day (Quarterly) Report (Developmental Disabilities Administration) |
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06-159A | Specialized Evaluation and Treatment Provider Invoice (Developmental Disabilities Administration) | ||
06-199 | Specialized Evaluation and Consultation Quarterly Report (Developmental Disabilities Administration) n | ||
06-159 | Specialized Evaluation and Consultation Provider Invoice (Developmental Disabilities Administration) | ||
14-465 | Sources for Eligibility Information (Developmental Disabilities Administration) | ||
16-191 | SOLA Vehicle Trip Log (Developmental Disabilities Administration) | ||
02-615 | Social Services Invoice / Receipt Packet Cover (Home and Community Services) | ||
14-084 | Social Service Referral | ||
18-399 | Social Service Incorrect Payment Computation | ||
15-376 | Skin Observation Protocols | ||
16-245 | Skills Practice Procedure Checklist for Home Care Aides DSHS Approved (Home and Community Services) |
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16-203 | SIS-A Rating Key (Developmental Disabilities Administration) | ||
10-423 | Shared Planning for Youth Aged 18-21 Receiving Voluntary Placement Services | ||
10-104B | Service Verification / Attendance Record For Alternative Living Providers (Developmental Disabilities Administration) | ||
11-097 | Service Delivery Outcome Report (Independent Living Services - IL) | ||
11-030 | Service Delivery Outcome Report (Community Rehabilitation Program - CRP) | ||
11-125 | Service Delivery Outcome Plan: WBL - Experience C | ||
11-124 | Service Delivery Outcome Plan: WBL - Experience B | ||
11-123 | Service Delivery Outcome Plan: WBL - Experience A | ||
11-142 | Service Delivery Outcome Plan: Pre-ETS IL Skills Training | ||
14-155 | Senior Citizens Service Application | ||
07-098 | Self Employment Monthly Sales and Expense Worksheet |
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14-534 | SDCP Eligibility Checklist (Home and Community Services) |