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(asc) | File Format | |
|---|---|---|---|
| 13-939 | Residential Care Services (Adult Family Home, Assisted Living Facility, Enhanced Services Facility) Community Programs Infection Prevention and Control (ICP) InspectionTool | ||
| 06-125 | Residential Allowance Request / Insufficient Income (Developmental Disabilities Administration) | ||
| 06-125A | Residential Allowance Request - Start Up Costs (Developmental Disabilities Administration) | ||
| 06-125C | Residential Allowance Request - Shelter Expense (Developmental Disabilities Administration) | ||
| 06-125B | Residential Allowance Request - Damages (Developmental Disabilities Administration) | ||
| 15-447 | Resident Choice Regarding Assisted Living Facility (ALF) Room Requirements (Home and Community Services) | ||
| 14-493 | Requirement to Identify a Representative (Developmental Disabilities Administration) | ||
| 17-041 | Request for Records |
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| 17-194 | Request for Mental Health Service Information | ||
| 18-701 | Request for Income Information for Purposes of Entering or Enforcing a Child Support Order | ||
| 10-673 | Request for ICF/IID or SONF Services at an RHC Administration Application | ||
| 05-013 | Request for Hearing |
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| 13-925 | Request for Formulary Admission or Deletion (Behavioral Health Administration) | ||
| 02-556 | Request for Exception to Policy (ETP) for Use of Restrictive Procedures (Developmental Disabilities Administration) | ||
| 15-282A | Request for Enrollment in Developmental Disabilities Administration (DDA) Home and Community Based Services (HCBS) Waiver or Request to Change from One DDA HCBS Waiver to Another | ||
| 14-151 | Request for DDA Eligibility Determination |
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| 09-520 | Request for Conference Board |
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| 18-681 | Request for Collection of Uninsured Health Care Expenses | ||
| 10-277 | Request for Children's Out-of-Home Services (Developmental Disabilities Administration) | ||
| 10-238 | Request for an Administrative Hearing (Residential Care Services) | ||
| 15-436 | Request for Adult Family Home Application Fee Waiver | ||
| 03-391 | Report of Possible Client Assault | ||
| 17-297 | Removal and Transport Directive (Behavioral Health Administration) | ||
| 27-176 | Release of Liability (Developmental Disabilities Administration) | ||
| 03-077 | Release of All Claims |
