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
17-296 Certification Evaluation Checklist for Alternative Living Providers (Developmental Disabilities Administration)
27-245 Central Contracts and Legal Services (CCLS) Vendor Agreement Review
15-515 CCSS Family Agreement (Community Crisis Stabilization Services) (Developmental Disabilities Administration)
13-942 CCRSS Infection Prevention and Control (IPC) Complaint Investigation Tool (Residential Care Services)
10-700 CCRSS Follow-Up Visit (Certified Community Residential Services and Supports, Residential Care Services.)
27-231 CCLS Source Contract Justification
27-229 CCLS Sole Source Amendment Justification
27-234 CCLS Small Business Self-Certification Statement
27-233 CCLS General Terms and Conditions (GTC) Change Request
27-230 CCLS Emergency Contract Justification
27-232 CCLS DES Late Filing Justification
27-228 CCLS Additional Delegated Authority Request
02-760 Case Mix Index Detail (CMID) Report Authorization (Home and Community Living Administration (HCLA))
05-272 Case Manager Instructions Following a Hearing Decision
13-952 Bowel Protocol (Developmental Disabilities Administration)
17-300 BHA Personal Information Release (Behavioral Health Administration)
13-712 Behavioral Health Wraparound Support (BHWS) Request (Aging and Long-Term Support Administration (ALTSA)
27-109 BCCU Applicant Affidavit
07-103 Basic Food Employment and Training (BFET) Participant Reimbursement
11-034B Basic Food Eligibility Requirements: What You Need to Know
12-008 Basic Food Affidavit Replacement for Household Disaster
17-263 Background Check Review: Character, Competence, and Suitability for Contractor Employees / Volunteers (Division of Vocational Rehabilitation)
09-653 Background Check Authorization
18-484 Automatic Payment Authorization and Electronic Funds Transfer Information
14-532 Authorized Representative