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
27-124 Provider Owned Housing Memorandum of Understanding Residential Provider Attestation
27-130 Authorization for Alternate EBT Cardholder
27-143 CSD ABD Medical Evidence Review Contractor Self-Assessment Monitoring Tool
27-147 Housing Modification Property Release Agreement
27-147A In-Home Environmental Adaptations General Utility and Repair Property Release Agreement (Aging and Long-Term Support Administration)
27-155 Declaration on Commercial Purposes
27-156 Notice and Consent of Communication via Text or Unencrypted Email
27-175 DVR Additional Contractor Information (Division of Vocational Rehabilitation)
27-176 Release of Liability (Developmental Disabilities Administration)
27-178 Adult Protective Services (APS) Administrative Hearing Request