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
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
02-615 Social Services Invoice / Receipt Packet Cover (Home and Community Services)
16-191 SOLA Vehicle Trip Log (Developmental Disabilities Administration)
14-465 Sources for Eligibility Information (Developmental Disabilities Administration)
06-159 Specialized Evaluation and Consultation Provider Invoice (Developmental Disabilities Administration)
06-199 Specialized Evaluation and Consultation Quarterly Report (Developmental Disabilities Administration) n
06-159A Specialized Evaluation and Treatment Provider Invoice (Developmental Disabilities Administration)
10-658 Specialized Habilitation 90-Day (Quarterly) Report (Developmental Disabilities Administration)
17-123 Spoken Language Interpreter Service Appointment Record
10-396 SSI Letter (DDA)
14-489 SSIF Introduction Letter
10-678 Stabilization, Assessment, and Intervention Facility (SAIF) Program Evaluation (Developmental Disabilities Administration)
15-379 Staff Add-on Request for Client Specific Need (Developmental Disabilities Administration))
10-656 Staff and Family Consultation (SFC) 90-Day (Quarterly) Progress Report (Developmental Disabilities Administration)
10-561 Staff Interview (Residential Care Services)
10-552 Staff List (Residential Care Services)
10-631 Staff Qualification and Background Review (Aging and Long-Term Support Administration)
10-210 Staff Statement of Qualifications