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 | |
|---|---|---|---|
| 27-226 | Adult Family Home Management Agreement: Attestation Information and Attachments (Residential Care Services) | ||
| 27-228 | CCLS Additional Delegated Authority Request | ||
| 27-229 | CCLS Sole Source Amendment Justification | ||
| 27-230 | CCLS Emergency Contract Justification | ||
| 27-231 | CCLS Source Contract Justification | ||
| 27-232 | CCLS DES Late Filing Justification | ||
| 27-233 | CCLS General Terms and Conditions (GTC) Change Request | ||
| 27-234 | CCLS Small Business Self-Certification Statement | ||
| 27-240 | Medicaid Provider Disclosure Statement for Nursing Facility | ||
| 27-245 | Central Contracts and Legal Services (CCLS) Vendor Agreement Review | ||
| 27-247 | Residential Habilitation for Dependent Agreement for Youth (Age 18-20) (Developmental Disabilities Administration) | ||
| 27-248 | Residential Habilitation for Dependent Youth Acknowledgement (Developmental Disabilities Administration) | ||
| 27-252 | Adult Family Home Applicant Attestation Concerning Household Members and Background Check Requirements (Residential Care Services) | ||
| 27-253 | New Freedom Authorized Representative (Home and Community Services) |
