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(desc) | Form Name | File Format | |
|---|---|---|---|
| 16-255 | For Field Use Only: Sex Offender Notification to Facility (Home and Community Services) | ||
| 16-274 | Exhibit B: School-to-Work County Mentorship Program Monthly Tracking and Reporting (Division of Vocational Rehabilitation) | ||
| 16-275 | Change of Circumstance: Community Behavioral Health Supports (CBHS) / 1915i (Home and Community Services) | ||
| 16-276 | Diversion Navigator Interview (Office of Forensic Mental Health Services (OFMHS)) | ||
| 16-278 | Exhibit E: School-to-Work Success Story (Division of Vocational Rehabilitation) | ||
| 16-279 | Your Responsibility for Participation Towards Costs of Care at a Youth Transitional Care Facility (Developmental Disabilities Administration) | ||
| 17-116 | AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion | ||
| 17-180 | Personal Information Release (Economic Services Administration) | ||
| 17-194 | Request for Mental Health Service Information | ||
| 17-261 | Assistive Communication Technology (ACT) Contractor Assignment Report (Office of Deaf and Hard of Hearing) | ||
| 17-263 | Background Check Review: Character, Competence, and Suitability for Contractor Employees / Volunteers (Division of Vocational Rehabilitation) | ||
| 17-264 | DVR Background Check Reporting (Division of Vocational Rehabilitation) | ||
| 17-265 | DSHS / DVR Request for Approval to Subcontract Checklist (Division of Vocational Rehabilitation) | ||
| 17-266 | Contractor Designated Contact(s) Background Check (Division of Vocational Rehabilitation) | ||
| 17-270 | Authorization for Use or Disclosure of Psychotherapy Notes | ||
| 17-284 | Preferred Sign Language Interpreter List (Office of Deaf and Hard of Hearing) | ||
| 17-292 | Assistive Communication Technology (ACT) Program Service Request / Work Order for Induction Loops (Office of the Deaf and Hard of Hearing) | ||
| 17-299 | Vendor Agreement Information (Behavioral Health Administration) | ||
| 17-300 | BHA Personal Information Release (Behavioral Health Administration) | ||
| 17-305 | DPI Authorization for Release of Information (Division of Program Integrity) | ||
| 17-345 | Transitional Care Management Exchange of Information (Developmental Disability Administration) | ||
| 18-097 | Statement of Resources and Expenses |
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| 18-176 | Address Release Information Letter | ||
| 18-176A | Address Release Information Letter |
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| 18-398B | Department of Children, Youth, and Families (DCYF) Client Overpayment Notice |
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