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
18-484 Automatic Payment Authorization and Electronic Funds Transfer Information
18-544 Transmittal of Resident Personal Funds
18-555 Financial Information Sheet
18-681 Request for Collection of Uninsured Health Care Expenses
18-701 Request for Income Information for Purposes of Entering or Enforcing a Child Support Order
19-074 Transfer / Loan / Recovery Agreement (Division of Vocational Rehabilitation)
20-332 Appropriate Level of Forensic Services (ALFS) Screening Tool
20-334 Washington State Learning Center (LC) New Course Request (Division of Developmental Disabilities)
27-044A Contractor Information Update (for existing DSHS contractors)
27-053 Paternity Information
27-063 Out-of-Home Services Agreement for Youth (Age 18-21) (Developmental Disabilities Administration)
27-076 Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult
27-096 Permission to Share Documents for Reimbursement of Health Care Expenses
27-110 Applicant Request for a Copy of Background Check Information
27-123 Provider Owned Housing Memorandum of Understanding Renter Attestation
27-124 Provider Owned Housing Memorandum of Understanding Residential Provider Attestation
27-147 Housing Modification Property Release Agreement
27-147A In-Home Environmental Adaptations General Utility and Repair Property Release Agreement (Aging and Long-Term Support Administration)
27-156 Notice and Consent of Communication via Text or Unencrypted Email
27-175 DVR Additional Contractor Information (Division of Vocational Rehabilitation)
27-176 Release of Liability (Developmental Disabilities Administration)
27-210 DDA Authorization for Release of Referral Video (Developmental Disabilities Administration)
27-220 Disposition of Remains / Release of Body Permit (Developmental Disabilities Administration)
27-222 Consent to Release and/or Use Confidential Information for Completing an Adult Home License Application
27-226 Adult Family Home Management Agreement: Attestation Information and Attachments (Residential Care Services)