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(desc) File Format
27-231 CCLS Source Contract Justification
10-700 CCRSS Follow-Up Visit (Certified Community Residential Services and Supports, Residential Care Services.)
13-942 CCRSS Infection Prevention and Control (IPC) Complaint Investigation Tool (Residential Care Services)
15-515 CCSS Family Agreement (Community Crisis Stabilization Services) (Developmental Disabilities Administration)
27-245 Central Contracts and Legal Services (CCLS) Vendor Agreement Review
17-296 Certification Evaluation Checklist for Alternative Living Providers (Developmental Disabilities Administration)
17-295 Certification Evaluation Checklist for Companion Homes Providers (Developmental Disabilities Administration)
10-645 Certification Evaluation Client Interview (Developmental Disabilities Administration)
10-646 Certification Evaluation Legal Representative Interview (Developmental Disabilities Administration)
10-647 Certification Evaluation Staff Interview (Developmental Disabilities Administration)
15-389 Certified Community Residential Services and Support (CCRSS) Initial Application
10-698 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Administrator Record Review and Interview (Residential Care Services)
10-676 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Finances Record Review
10-614 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Interview (Residential Care Services)
10-677 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Record Review
10-699 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Exit Preparation / Exit Conference (Residential Care Services)
10-611 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Face Sheet (Residential Care Services)
10-615 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Representative Interview (Residential Care Services)
10-616 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Staff Interview (Residential Care Services)
10-618 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Staff Sample / Record Review (Residential Care Services)
10-691 Certified Community Residential Services and Supports (CCRSS) Client Characteristics (Residential Care Services)
10-680 Certified Community Residential Services and Supports (CCRSS) Group Home (GH) / Client Home Team Coordinator Packet (Residential Care Services)
10-617B Certified Community Residential Services and Supports (CCRSS) Group Training Home (GTH) Client Environment and Safety Worksheet (Residential Care Services)
10-617A Certified Community Residential Services and Supports (CCRSS) Group Training Home (GTH) General Environment and Safety Worksheet (Residential Care Services)
10-617 Certified Community Residential Services and Supports (CCRSS) Home Environment and Safety Worksheet (Residential Care Services)