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
11-193 Request to Provide CRP-IL Services and Background Check: Update Account (Division of Vocational Rehabilitation)
11-194 Waiver Stabilization Services Progress and Transition Report (Developmental Disabilities Administration)
11-200 Health Related Social Needs Nutrition Services Referral (Health and Community Living Administration)
12-008 Basic Food Affidavit Replacement for Household Disaster
12-195 Disqualification Consent Agreement
12-206 Application for Disaster Food Benefits
12-207 Application for Disaster Cash Assistance
12-209 Client Fraud Report
12-210 Medicaid Provider Fraud Referral
12-212 Waiver of Administrative Disqualification Hearing (Community Services Division)