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 Form Name(asc) File Format
16-255 For Field Use Only: Sex Offender Notification to Facility (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)
27-089 Fingerprint-Based Background Check Notice
27-059 Fingerprint Appointment
14-068 Financial Statement (Division of Vocational Rehabilitation)
06-186 Financial Solvency Information (Aging and Long-Term Support Administration)
18-555 Financial Information Sheet
07-104 Financial Communication to Social Services
14-443 Financial / Social Services Communication
13-713 Fast Track Service Agreement
20-273 Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program
02-528 Fair Hearing Withdrawal
02-753 Facility Virtual Classroom Training Application and Attestation (Home and Community Services)
15-555 Facility Training Program Application and Updates (Home and Community Services)
15-554 Facility Instructor Application (Home and Community Services)
10-488 Extended Foster Care Program Consent
10-562 Exit Preparation Worksheet (Residential Care Services)
10-663 Existing Companion Home (CH) Movers Checklist (Developmental Disabilities Administration)
16-278 Exhibit E: School-to-Work Success Story (Division of Vocational Rehabilitation)
16-274 Exhibit B: School-to-Work County Mentorship Program Monthly Tracking and Reporting (Division of Vocational Rehabilitation)
27-257 Exhibit 359 Follow-Up Investigation Report (Residential Care Services)
27-258 Exhibit 358: Initial Report (Residential Care Services)
07-107 Exception to Rule and Notice Guardianship Fees and Related Costs (Aging and Long-Term Support Administration and Developmental Disabilities Administration)
14-454 Estate Recovery: Repaying the State for Medical and Long Term Services and Supports
03-374D ESA Non-Dislcosure of Confidential Information Agreement - Non Employee