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 | |
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18-544 | Transmittal of Resident Personal Funds | ||
18-551 | School Statement |
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18-555 | Financial Information Sheet | ||
18-681 | Request for Collection of Uninsured Health Care Expenses | ||
18-700 | Direct Deposit Authorization | ||
18-701 | Request for Income Information for Purposes of Entering or Enforcing a Child Support Order | ||
19-074 | Loan Agreement for Tools, Equipment, Initial Stock and Supplies, and Devices (Division of Vocational Rehabilitation) |
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20-273 | Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program | ||
20-330 | Incident Report to DDA (Developmental Disabilities Administration) | ||
20-332 | Appropriate Level of Forensic Services (ALFS) Screening Tool | ||
20-333 | Outpatient Competency Restoration Program (OCRP) Transition Plan (Behavioral Health Administration) | ||
20-334 | Washington State Learning Center (LC) New Course Request (Division of Developmental Disabilities) | ||
21-061 | Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration) | ||
27-043 | New Contractor Intake | ||
27-044A | Contractor Information Update (for existing DSHS contractors) | ||
27-053 | Paternity Information | ||
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 | ||
27-094 | Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration) | ||
27-096 | Permission to Share Documents for Reimbursement of Health Care Expenses | ||
27-110 | Applicant Request for a Copy of Background Check Information | ||
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 |