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
15-381 Respite Assessment Worksheet
15-382 Positive Behavior Support Plan (PBSP)
15-383 Functional Behavioral Assessment (FA)
15-384 Provider Progress Report of Behavior Management and Consultation and Staff/Family Training and Consultation Services (DDA)
15-388 Alternative Living Certification Evaluation (Home and Community Living Administration)
15-389 Certified Community Residential Services and Support (CCRSS) Initial Application
15-398 Medically Intensive Children's Program (MICP) Application
15-419 Refusal of Services Statement
15-422 How to Request Services (Developmental Disabilities Community Services)
15-424 Staffed Residential Cost of Care Adjustment Request