Electronic DSHS Forms

The Electronic DSHS Forms page is a centralized repository where the public can find and download official forms for Washington Department of Social and Health Services programs.

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 Form File
10-668 PASRR Level 2 Evaluation and Determination (Developmental Disabilities Administration)
10-670 Nursing Home Facility License Application (Home and Community Living Administration)
10-671 Intensive Habilitation Services for Children Certification Evaluation (Developmental Disabilities Administration)
10-672 Meaningful Day Eligibility Checklist (Home and Community Services)
10-676 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Finances Record Review
10-677 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Record Review
10-678 Stabilization, Assessment, and Intervention Facility (SAIF) Program Evaluation (Developmental Disabilities Administration)
10-679 Alternative Living Provider Application, Certification, and Contracting Checklist (Home and Community Living Administration)
10-680 Certified Community Residential Services and Supports (CCRSS) Group Home (GH) / Client Home Team Coordinator Packet (Residential Care Services)
10-681 Group Home (GT) / Client Home Sample Packet (Residential Care Services)