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.
| Number(desc) | Form Name | File Format | |
|---|---|---|---|
| 05-010 | Rule Exception Request | ||
| 05-013 | Request for Hearing |
|
|
| 05-246 | Notice of Action Exception to Rule (Excluding AFH) | ||
| 05-248 | On-Site Review (Office of Refugee and Immigrant Assistance) | ||
| 05-249 | Adult Residential Care Services Notice of a Change | ||
| 05-252 | Code of Ethics and Standards of Practice (Division of Vocational Rehabilitation) | ||
| 05-254 | Federal Subminimum Wage Certificate Holder | ||
| 05-255 | Medicaid Transformation Project Notice of Action Exception to Rule | ||
| 05-256 | Notice of Action Exception to Rule for AFH Daily Rates | ||
| 05-258 | Level 4 Questionnaire for Supervisors Applying to Facilitate Level 4 Domestic Violence Intervention Treatment | ||
| 05-259 | Risk, Needs, and Responsivity for Assessments and Treatment Planning (Domestic Violence Intervention Treatment) | ||
| 05-260 | Change of Address for an Existing DVIT Certification (Domestic Violence Intervention Treatment) | ||
| 05-261 | Add, Change, or Remove Direct Service Staff for a Certified DVIT Program (Domestic Violence Intervention Treatment) | ||
| 05-262 | Add or Remove a Service for an Existing DVIT Certification (Domestic Violence Intervention Treatment) | ||
| 05-272 | Case Manager Instructions Following a Hearing Decision | ||
| 05-273 | Private Duty Nursing (PDN) Pre-Contract Education Attestation (Home and Community Services) | ||
| 05-274 | Residential Referral Transition (Developmental Disabilities Administration) | ||
| 05-277 | Companion Home DCYF Weekly Schedule (Developmental Disability Administration) | ||
| 06-123 | Nursing Assistant Training and Testing Reimbursement | ||
| 06-124 | Cost of Care Adjustment (COCA) (Developmental Disabilities) | ||
| 06-125 | Residential Allowance Request / Insufficient Income (Developmental Disabilities Administration) | ||
| 06-125A | Residential Allowance Request - Start Up Costs (Developmental Disabilities Administration) | ||
| 06-125B | Residential Allowance Request - Damages (Developmental Disabilities Administration) | ||
| 06-125C | Residential Allowance Request - Shelter Expense (Developmental Disabilities Administration) | ||
| 06-159 | Specialized Evaluation and Consultation Provider Invoice (Developmental Disabilities Administration) |
