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(asc) | File Format | |
|---|---|---|---|
| 16-213 | Verification of Legal Status | ||
| 17-299 | Vendor Agreement Information (Behavioral Health Administration) | ||
| 09-013 | Vendor Affidavit of Lost, Stolen, or Destroyed Warrant | ||
| 18-398A | Vendor / Provider Overpayment Notice |
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| 14-449 | Unmet Need Breakdown | ||
| 10-628 | Trust Fund Review (Aging and Long-Term Support Administration) | ||
| 11-058 | Trial Work Experience (TWE) Agreement (Division of Vocational Rehabilitation) | ||
| 18-544 | Transmittal of Resident Personal Funds | ||
| 01-210 | Transmittal of Client Funds from the Protective Payee | ||
| 10-574C | Transitional Care Planning Tracking: Part C. Post Move and Stabilization (Developmental Disabilities Administration) | ||
| 10-574B | Transitional Care Planning Tracking: Part B. Active Coordinator of Transition (ACT) (Developmental Disabilities Administration) | ||
| 10-574A | Transitional Care Planning Tracking: Part A. Transition Preparation (Developmental Disabilities Administration) | ||
| 17-345 | Transitional Care Management Exchange of Information (Developmental Disability Administration) | ||
| 13-906 | Therapy Evaluation for Bed Transfer / Positioning Devices (Typically Bed or Side Rails) (Home and Community Services) | ||
| 10-437 | Temporary Manager and/or Receiver Application Nursing Home and Assisted Living Facility | ||
| 02-586 | Temporary Employment Hours Tracking Log | ||
| 27-215 | Teleservice Agreement (Developmental Disabilities Administration) | ||
| 14-427 | Teen Parent Living Assessment | ||
| 14-552 | TED Program Pilot Project: Application for Emergency Alerting Device KIT (Office of the Deaf and Hard of Hearing) | ||
| 10-632 | TB Testing Review for Staff (Aging and Long-Term Support Administration) | ||
| 10-633 | TB Testing Review for Resident (Aging and Long-Term Support Administration) | ||
| 04-449A | Survivors Feedback (Domestic Violence Intervention Treatment) | ||
| 10-604 | Supported Living Information Changes (Residential Care Services) | ||
| 11-146 | Supported Employment Referral (Economic Services Administration) |
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| 14-528 | Substance Use Good Cause Appointment Letter (HEN Referral) |
