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 | Form Name(asc) | File Format | |
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06-124 | Cost of Care Adjustment (COCA) (Developmental Disabilities) | ||
10-393 | Cost Estimate Worksheet for Hearing Aids and Services | ||
16-202A | Corrective Action Plan (5-Day Investigation) (Developmental Disabilities Administration) | ||
27-044A | Contractor Information Update (for existing DSHS contractors) | ||
17-266 | Contractor Designated Contact(s) Background Check (Division of Vocational Rehabilitation) | ||
11-084 | Contracted Employee(s) to Provide IL Services and Service(s) Approved (Division of Vocational Rehabilitation) | ||
10-415 | Contract Monitoring Checklist On-Site Review (Office of Refugee and Immigrant Assistance) | ||
14-544 | Continuing Education Summary for DVPT Providers (Domestic Violence Intervention Treatment) | ||
15-547 | Continuing Education Event Approval Application (Aging and Long-Term Support Administration) | ||
15-556 | Continuing Care Retirement Community (CCRC) Registration Renewal Addendum (Aging and Long-Term Support Administration) | ||
14-547 | Continuing Care Retirement Community (CCRC) Registration Application | ||
27-222 | Consent to Release and/or Use Confidential Information for Completing an Adult Home License Application | ||
14-012 | Consent |
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09-989 | Confidentiality Statement - Tribal Employee | ||
10-489 | Confidential Health Information Consent Agreement |
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10-349 | Comprehensive Regional Review Tool | ||
10-589 | Comprehensive Functional Assessment of Recreation | ||
10-590 | Comprehensive Functional Assessment of Physical Therapy | ||
10-595 | Comprehensive Functional Assessment of Occupational Therapy | ||
10-594 | Comprehensive Functional Assessment of Communication | ||
10-596 | Comprehensive Functional Assessment of Adult Training Programs | ||
10-642 | Components of Your 75 Hour Home Care Aide Training Program (Home and Community Services) | ||
27-194 | Complimentary Therapies Agreement (Developmental Disabilities Administration) | ||
27-194 | Complimentary Therapies Agreement (Developmental Disabilities Administration) | ||
15-516 | Companion Home Quarterly Report (Developmental Disabilities Administration) |