Electronic DSHS Forms
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(desc) | Form Name | File Format | |
|---|---|---|---|
| 20-334 | Washington State Learning Center (LC) New Course Request (Division of Developmental Disabilities) | ||
| 21-059 | Children's Staffed Residential Quality Assurance Assessment | ||
| 21-060 | Children’s State Operated Living Alternative (SOLA) Quality Assurance Assessment | ||
| 21-061 | Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration) | ||
| 21-065 | Adult Family Home (AFH) Emergency Evacuation Drill | ||
| 23-045 | Community Services Division (CSD) Financial Confidence Wheel (Economic Services Division) | ||
| 27-043 | New Contractor Intake | ||
| 27-044A | Contractor Information Update (for existing DSHS contractors) | ||
| 27-053 | Paternity Information | ||
| 27-059 | Fingerprint Appointment |
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| 27-063 | Out-of-Home Services Agreement for Youth (Age 18-21) (Developmental Disabilities Administration) | ||
| 27-076 | Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult | ||
| 27-089 | Fingerprint-Based Background Check Notice | ||
| 27-094 | Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration) | ||
| 27-096 | Permission to Share Documents for Reimbursement of Health Care Expenses | ||
| 27-109 | BCCU Applicant Affidavit | ||
| 27-110 | Applicant Request for a Copy of Background Check Information | ||
| 27-115 | Privacy Complaint | ||
| 27-123 | Provider Owned Housing Memorandum of Understanding Renter Attestation |
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| 27-124 | Provider Owned Housing Memorandum of Understanding Residential Provider Attestation | ||
| 27-130 | Authorization for Alternate EBT Cardholder |
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| 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 |
