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(desc) Form Name File Format
15-549 Community Instructor Application: DSHS Adult Education (Home and Community Services)
15-550 Community Instructor Application (Home and Community Services)
15-551 Community Instructor Training Program Application and Updates (Home and Community Services)
15-552 Curriculum Approval Application (Home and Community Services)
15-554 Facility Instructor Application (Home and Community Services)
15-555 Facility Training Program Application and Updates (Home and Community Services)
15-556 Continuing Care Retirement Community (CCRC) Registration Renewal Addendum (Aging and Long-Term Support Administration)
15-560 Room Requirements Checklist (Home and Community Services)
15-567 On-the-Job Facility Training Plan Application and Updates (Home and Community Services)
15-591 High School Home Care Aide Instructor Application (Home and Community Services)
15-596 Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Referral (Home and Community Services)
15-599 Early Engagement of Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services)
16-201 New Case / Resource Manager Assessment (Developmental Disabilities Administration)
16-243 Community Services Office (CSO) Compliments and Concerns (Economic Services Administration)
16-245 Skills Practice Procedure Checklist for Home Care Aides DSHS Approved (Home and Community Services)
16-253 For Field Staff Use: Sex Offender Notification to Home Care Agency and Consumer Directed Employer (Home and Community Services)
16-255 For Field Use Only: Sex Offender Notification to Facility (Home and Community Services)
16-266 Integrated Settings Survey: Employment or Community Inclusion Settings (Developmental Disabilities Administration)
16-267 Integrated Settings Review for Resource Managers (Developmental Disabilities Administration)
16-275 Change of Circumstance: Community Behavioral Health Supports (CBHS) / 1915i (Home and Community Services)
17-226 AAA DSHS / HCS Systems Access Request (Aging and Long-Term Support Administration)
17-301 Medical Expense Examples (Community Services Division, Economic Services Administration)
18-097 Statement of Resources and Expenses
18-433 Declaration of Support Payments (Division of Child Support)
18-720 Client Responsibility Notice (Home and Community Services)