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 | |
|---|---|---|---|
| 09-653 | Background Check Authorization | ||
| 17-263 | Background Check Review: Character, Competence, and Suitability for Contractor Employees / Volunteers (Division of Vocational Rehabilitation) | ||
| 12-008 | Basic Food Affidavit Replacement for Household Disaster |
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| 11-034B | Basic Food Eligibility Requirements: What You Need to Know |
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| 07-103 | Basic Food Employment and Training (BFET) Participant Reimbursement |
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| 27-109 | BCCU Applicant Affidavit | ||
| 13-712 | Behavioral Health Wraparound Support (BHWS) Request (Aging and Long-Term Support Administration (ALTSA) | ||
| 17-300 | BHA Personal Information Release (Behavioral Health Administration) | ||
| 13-952 | Bowel Protocol (Developmental Disabilities Administration) | ||
| 05-272 | Case Manager Instructions Following a Hearing Decision | ||
| 27-228 | CCLS Additional Delegated Authority Request | ||
| 27-232 | CCLS DES Late Filing Justification | ||
| 27-230 | CCLS Emergency Contract Justification | ||
| 27-233 | CCLS General Terms and Conditions (GTC) Change Request | ||
| 27-234 | CCLS Small Business Self-Certification Statement | ||
| 27-229 | CCLS Sole Source Amendment Justification | ||
| 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) |
