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 | |
|---|---|---|---|
| 14-535 | Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration) | ||
| 14-541 | ABAWD Requirement: Medical Report (Able Bodied Adults without Dependents) | ||
| 14-542 | Application for New Program Certification (Domestic Violence Intervention Treatment) | ||
| 14-543 | Application for Renewal Program Certification (Domestic Violence Intervention Treatment) | ||
| 14-544 | Continuing Education Summary for DVPT Providers (Domestic Violence Intervention Treatment) | ||
| 14-552 | TED Program Pilot Project: Application for Emergency Alerting Device KIT (Office of the Deaf and Hard of Hearing) | ||
| 14-553 | High School Home Care Aide Training Program and Instructor Application and Updates (Aging and Long-Term Support Administration) | ||
| 14-554 | Household Application for Sun Bucks |
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| 15-031 | Nursing Facility Notice of Action | ||
| 15-184 | Volunteer Chore Service Referral | ||
| 15-290 | Notification of Annual Assessment Review and Person Centered Services Planning Meeting | ||
| 15-291 | Person Centered Service Planning and Annual Assessment Meeting |
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| 15-295 | Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration) | ||
| 15-318 | DDA Crisis Diversion Bed Referral and Intake Information | ||
| 15-342 | Notice of Exception to Rule Decision | ||
| 15-360 | Residential Services Capacity Profile | ||
| 15-365 | Community Protection Treatment Worksheet Quarterly Review | ||
| 15-379 | Staff Add-on Request for Client Specific Need (Developmental Disabilities Administration)) | ||
| 15-380 | Individual and Family Services Assessment Worksheet (Developmental Disabilities Administration) | ||
| 15-381 | Respite Assessment Worksheet | ||
| 15-382 | Positive Behavior Support Plan (PBSP) | ||
| 15-383 | Functional Behavioral Assessment (FA) | ||
| 15-384 | Provider Progress Report of Behavior Management and Consultation and Staff/Family Training and Consultation Services (DDA) | ||
| 15-385 | Provider Consent For Use of Restrictive Procedures Requiring an ETP | ||
| 15-389 | Certified Community Residential Services and Support (CCRSS) Initial Application |
