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 | |
|---|---|---|---|
| 14-534 | SDCP Eligibility Checklist (Home and Community Services) | ||
| 13-954 | Seizure Protocol (Developmental Disabilities Administration) | ||
| 07-098 | Self Employment Monthly Sales and Expense Worksheet |
|
|
| 14-155 | Senior Citizens Service Application | ||
| 11-112A | Service Delivery Outcome Plan (SDOP) Job Shadow (Division of Vocational Rehabilitation) | ||
| 11-182 | Service Delivery Outcome Plan (SDOP): Customized Employment - Discovery (Division of Vocational Rehabilitation) | ||
| 11-181 | Service Delivery Outcome Plan (SDOP): Customized Job Placement (Division of Vocational Rehabilitation) | ||
| 11-106 | Service Delivery Outcome Plan (SDOP): IL Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation)) | ||
| 11-182 | Service Delivery Outcome Plan (SDOP): WRT- Experience D (Division of Vocational Rehabilitation) | ||
| 11-110 | Service Delivery Outcome Plan (SDOP): Informational Interview Pre-ETS (Pre-Employment Transition Services) (Division of Vocational Rehabilitation) | ||
| 11-112 | Service Delivery Outcome Plan: Job Shadow - Pre-ETS (Pre-Employment Transition Services) (Division of Vocational Rehabilitation) | ||
| 11-142 | Service Delivery Outcome Plan: Pre-ETS IL Skills Training | ||
| 11-123 | Service Delivery Outcome Plan: WBL - Experience A | ||
| 11-124 | Service Delivery Outcome Plan: WBL - Experience B | ||
| 11-125 | Service Delivery Outcome Plan: WBL - Experience C | ||
| 11-030 | Service Delivery Outcome Report (SDOR) (Division of Vocational Rehabilitation) | ||
| 11-097 | Service Delivery Outcome Report: IL (Independent Living Services) (Division of Vocational Rehabilitation) | ||
| 15-501 | Service Request Contact Notice (Developmental Disabilities Administration) |
|
|
| 10-104B | Service Verification / Attendance Record For Alternative Living Providers (Developmental Disabilities Administration) | ||
| 10-423 | Shared Planning for Youth Aged 18-21 Receiving Voluntary Placement Services | ||
| 16-245 | Skills Practice Procedure Checklist for Home Care Aides DSHS Approved (Home and Community Services) |
|
|
| 13-956 | Skin Observation (Developmental Disabilities Administration) | ||
| 15-376 | Skin Observation Protocols | ||
| 18-399 | Social Service Incorrect Payment Computation | ||
| 14-084 | Social Service Referral |
