Rights and Responsibilities

Created on: 
Jan 22 2019

Revised December 31, 2013


The department and the clients have a shared responsibility to determine and maintain eligibility for cash, medical or food assistance programs.

WAC 388-472-0005 What are my rights and responsibilities?

 Clarifying information - WAC 388-472-0005


Worker Responsibilities - WAC 388-472-0005

  1. Review form DSHS 14-113(X), Client Rights and Responsibilities with the household at every:
    1. Application; and
    2. Eligibility review or recertification.
  2. Face to Face Interviews:

    When conducting a face-to-face interview, explain the rights and responsibilities to the client and ask them to sign the form to acknowledge that they understand them. Send the document as file only to be scanned into the client’s Electronic Case Record (ECR).

  3. Phone Interviews:
    1. When conducting phone interviews, explain the rights and responsibilities to the client, send them a copy of form DSHS 14-113, and request them to sign and return the document. 

      We are required to provide households a copy of the DSHS 14-113, Client Rights and Responsibilities and request that they sign the document.  Signing the form is not a condition of eligibility.  Do not deny an application for benefits or terminate assistance if the household refuses to sign the form.


      The DSHS 13-411, Rights & Responsibilities form submitted with an online Application or Eligibility Review form is considered electronically signed. Another paper form does not need to be sent to the client.

    2. When a client applies for or has a review for medical assistance and submits an Application for Benefits, mail a HCA Health Care Coverage Rights and Responsibilities form and document the action in the ACES narrative.