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.

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Number(desc) Form Name File Format
13-915 Information for Respite Care Service Providers: Addendum to TCARE Assessment (Aging and Long-Term Support Administration)
13-917 Intensive Habilitation Services (IHS) Medical / Dental Services Authorization (Developmental Disabilities Administration)
13-919 Weekly Status Update (Competency Restoration Program) (Behavioral Rehabilitation Administration)
13-920 Outpatient Competency Restoration Program (OCRP) Discharge Summary
13-925 Request for Formulary Admission or Deletion (Behavioral Health Administration)
13-925A Non-Formulary Drug Use Request (Behavioral Health Administration)
13-926 Forensic (6358) Consultation (Behavioral Health Administration)
13-927 Involuntary Antipsychotic Medication Hearing Checklist (Behavioral Health Administration)
13-928 Withdrawal of Petition for Conditional Release or Unconditional Release (Behavioral Health Administration)
13-943 Certified Community Residential Supports and Services (CCRSS) Infection Prevention and Control (IPC) Complaint Investigation Pathway
13-945 RCS Certified Community Residential Services and Supports (CCRSS) Infection Prevention and Control (IPC) Assessment Notes (Residential Care Services)
14-001 Application for Cash or Food Assistance
14-050 Statement of Health, Education, and Employment
14-057 Child Support Referral
14-057B Noncustodial Parent Child Support Enforcement Application
14-057D Child Support Referral Continuation
14-068 Financial Statement (Division of Vocational Rehabilitation)
14-076 Change of Circumstances
14-105 Interview Appointment for Applicant (Community Services Division)
14-151 Request for DDA Eligibility Determination
14-155 Senior Citizens Service Application
14-223 Statement from School
14-224 Statement from Landlord/Manager
14-225 Acknowledgement of Services
14-238 Client Income Report