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
17-337 Personal Service Request / Standard Referral (Behavioral Health Administration)
17-345 Transitional Care Management Exchange of Information (Developmental Disability Administration)
18-078 Application for Nonassistance Support Enforcement Services
18-097 Statement of Resources and Expenses
18-176 Address Release Information Letter
18-176A Address Release Information Letter
18-235 Initial payment (Interim Assistance Reimbursement Authorization)
18-334 How You Must Help with Child Support Collection for Temporary Assistance for Needy Families (TANF) and Medical Assistance Programs
18-398 Client Overpayment Notice
18-398A Vendor / Provider Overpayment Notice