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
15-435 Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration
15-436 Request for Adult Family Home Application Fee Waiver Change of Ownership (Home and Community Living Administration)
15-447 Resident Choice Regarding Assisted Living Facility (ALF) Room Requirements (Home and Community Services)
15-449 Adult Family Home Disclosure of Charges Required by RCW 70.128.280
15-456 RCS Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults
15-458 Notice of Transfer or Discharge (Residential Care Services)
15-484 Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities (ICF/IID) Survey and Revisit Skill Building Tool
15-492 Medicaid Transformation Project Service Notice
15-501 Service Request Contact Notice (Developmental Disabilities Community Services)
15-512 Companion Home and Alternative Living Services Incident Report (Developmental Disabilities Administration)