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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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 | ||
27-081 | Employment and Day Program Services Providers: Mandatory Reporting of Abuse, Improper Use of Restraint, Neglect, Personal or Financial Exploitation, Abandonment of a Child or Vulnerable Adult (Developmental Disability Administration) | ||
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 | ||
27-144 | CSD Disability Eligibility Review Contractor Self-Assessment Monitoring Tool | ||
27-147A | In-Home Environmental Adaptations General Utility and Repair Property Release Agreement (Aging and Long-Term Support Administration) | ||
27-156 | Notice and Consent of Communication via Text or Unencrypted Email |
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27-175 | DVR Additional Contractor Information (Division of Vocational Rehabilitation) | ||
27-176 | Release of Liability (Developmental Disabilities Administration) | ||
27-179 | Adult Family Home (AFH) Informal Dispute Resolution (IDR) Request (Residential Care Services) |