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 Form Name(desc) File Format
09-693 Declaration of Lawful Custody
18-433 Declaration of Support Payments (Division of Child Support)
27-155 Declaration on Commercial Purposes
27-208 Declaration to Adult Protective Services
18-398B Department of Children, Youth, and Families (DCYF) Client Overpayment Notice
18-682 Detail Sheet – Uninsured Health Care Expenses
18-700 Direct Deposit Authorization
14-432 Direct Deposit Enrollment
14-332 Disability Assessment
14-530 Disability Review
10-351 Disclosure of Services Required by RCW 18.20.300
11-180 Discovery Profile Report (Developmental Disabilities Administration)
27-220 Disposition of Remains / Release of Body Permit (Developmental Disabilities Administration)
12-195 Disqualification Consent Agreement
16-276 Diversion Navigator Interview (Office of Forensic Mental Health Services (OFMHS))
11-149 Division of Vocational Rehabilitation (DVR) Customer Job Seeker Accommodation Worksheet
06-162 Division of Vocational Rehabilitation (DVR) Referral to Office of Financial Recovery Referral
15-435 Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration
10-353 Documentation Request for Medical Condition and Residual Functional Capacity
06-172 Domestic Violence Prevention Account
17-265 DSHS / DVR Request for Approval to Subcontract Checklist (Division of Vocational Rehabilitation)
17-227 DSHS / HCA Systems Access Request
17-253 DSHS Background Check System (BCS) Access Request
27-225 DSHS Claim of Stolen EBT Benefits: Food (Community Services Division)
04-452A DSHS Community Services Customer Survey (Community Services Division)