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(desc) | File Format | |
|---|---|---|---|
| 07-104 | Financial Communication to Social Services | ||
| 18-555 | Financial Information Sheet | ||
| 06-186 | Financial Solvency Information (Aging and Long-Term Support Administration) | ||
| 14-068 | Financial Statement (Division of Vocational Rehabilitation) |
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| 27-059 | Fingerprint Appointment |
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| 27-089 | Fingerprint-Based Background Check Notice | ||
| 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) | ||
| 13-926 | Forensic (6358) Consultation (Behavioral Health Administration) | ||
| 11-152 | Forensic Navigator to Inpatient - Referral Information Form (RIF) (Office of Forensic Mental Health Services) | ||
| 17-011 | Forms and Publications Request | ||
| 15-383 | Functional Behavioral Assessment (FA) | ||
| 06-171 | Funding and Expenditure Data (Tribal) | ||
| 10-442 | Goal Setting and Action Planning Worksheet | ||
| 11-153 | Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services) | ||
| 10-681 | Group Home (GT) / Client Home Sample Packet (Residential Care Services) | ||
| 10-693 | Group Training Home (GTH) Client Sample Packet (Residential Care Services) | ||
| 10-692 | Group Training Home (GTH) Team Coordinator (TC) Packet (Residential Care Services) | ||
| 16-182 | Guidelines for Completing the ICAP / SIB-R Adaptive Behavior Scale (Developmental Disabilities Administration) | ||
| 15-304 | HCBS Waiver Enrollment Database Update (Developmental Disabilities Administration) |
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| 10-468 | HCS / AAA / ODHH / DDA Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults | ||
| 13-776 | HCS / AAA Nursing Services Referral (Home and Community Services) | ||
| 10-481 | Health Action Plan (HAP) | ||
| 02-756 | High School Home Care Aide Class List Tracking Log (Home and Community Services) | ||
| 15-591 | High School Home Care Aide Instructor Application (Home and Community Services) |
