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
06-125C Residential Allowance Request - Shelter Expense (Developmental Disabilities Administration)
06-159 Specialized Evaluation and Consultation Provider Invoice (Developmental Disabilities Administration)
06-159A Specialized Evaluation and Treatment Provider Invoice (Developmental Disabilities Administration)
06-162 Division of Vocational Rehabilitation (DVR) Referral to Office of Financial Recovery Referral
06-168 AFH Change in Licensed Bed Capacity - Increase (Adult Family Home) (Residential Care Services)
06-169 AFH Change in Licensed Bed Capacity - Decrease (Adult Family Home) (Residential Care Services)
06-171 Funding and Expenditure Data (Tribal)
06-172 Domestic Violence Prevention Account
06-173 Medical Evidence Reimbursement
06-176 Assisted Living Facility (ALF) Change in Licensed Resident Bed Capacity or Use of Rooms