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 | |
|---|---|---|---|
| 10-657 | Initial Specialized Habilitation Plan (Developmental Disabilities Administration) |
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| 10-658 | Specialized Habilitation 90-Day (Quarterly) Report (Developmental Disabilities Administration) |
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| 10-660 | Community Engagement Quarterly Progress Report (Developmental Disabilities Administration) |
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| 10-661 | Music Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration) | ||
| 10-662 | Equine Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration) | ||
| 10-663 | Existing Companion Home (CH) Movers Checklist (Developmental Disabilities Administration) | ||
| 10-664 | New or Update Provider Information Worksheet (Developmental Disabilities Administration) | ||
| 10-665 | Alternative Living Provider Application (Developmental Disabilities Administration) | ||
| 10-666 | Residential Quality Assurance Certification Evaluation Checklist for Overnight Planned Respite Services Providers (Developmental Disabilities Administration) | ||
| 10-668 | PASRR Level 2 Evaluation and Determination (Developmental Disabilities Administration) | ||
| 10-669 | Out-of-Home Services (OHS) Transition Checklist (Developmental Disabilities Administrations) | ||
| 10-670 | Nursing Home Facility License Application (Aging and Long-Term Support Administration) | ||
| 10-671 | Intensive Habilitation Services for Children Certification Evaluation (Developmental Disabilities Administration) | ||
| 10-672 | Meaningful Day Eligibility Checklist (Home and Community Services) | ||
| 10-676 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Finances Record Review | ||
| 10-677 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Record Review | ||
| 10-678 | Stabilization, Assessment, and Intervention Facility (SAIF) Program Evaluation (Developmental Disabilities Administration) | ||
| 10-679 | Alternative Living Provider Application, Contracting, and Certification Overview Checklist (Developmental Disabilities Administration) | ||
| 10-680 | Certified Community Residential Services and Supports (CCRSS) Group Home (GH) / Client Home Team Coordinator Packet (Residential Care Services) | ||
| 10-681 | Group Home (GT) / Client Home Sample Packet (Residential Care Services) | ||
| 10-682 | Childrens Stabilization Habilitation Plan (Developmental Disabilities Administration) | ||
| 10-683 | Enhanced Services Facility (ESF) Follow-Up (Residential Care Services) | ||
| 10-685 | Companion Home Provider Supplemental Information (Developmental Disabilities Administration) | ||
| 10-687 | DDA Specialty Adult Family Home (AFH) Pilot: Strengths, Abilities, Interests, Learn (SAIL) (Developmental Disabilities Administration) | ||
| 10-688 | DDA Specialty Adult Family Home (AFH) Pilot Monthly Client Goal and Progress Report (Developmental Disabilities Administration) |
