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 | |
|---|---|---|---|
| 18-607 | Child Care Verification |
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| 18-681 | Request for Collection of Uninsured Health Care Expenses | ||
| 18-682 | Detail Sheet – Uninsured Health Care Expenses | ||
| 18-700 | Direct Deposit Authorization | ||
| 18-701 | Request for Income Information for Purposes of Entering or Enforcing a Child Support Order | ||
| 18-720 | Client Responsibility Notice (Home and Community Services) |
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| 19-074 | Loan Agreement for Tools, Equipment, Initial Stock and Supplies, and Devices (Division of Vocational Rehabilitation) |
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| 19-237 | Application Budget Summary (Residential Care Services) | ||
| 20-273 | Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program | ||
| 20-330 | Incident Report to DDA (Developmental Disabilities Administration) | ||
| 20-332 | Appropriate Level of Forensic Services (ALFS) Screening Tool | ||
| 20-333 | Outpatient Competency Restoration Program (OCRP) Transition Plan (Behavioral Health Administration) | ||
| 20-334 | Washington State Learning Center (LC) New Course Request (Division of Developmental Disabilities) | ||
| 21-059 | Children's Staffed Residential Quality Assurance Assessment | ||
| 21-060 | Children’s State Operated Living Alternative (SOLA) Quality Assurance Assessment | ||
| 21-061 | Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration) | ||
| 21-065 | Adult Family Home (AFH) Emergency Evacuation Drill | ||
| 23-045 | Community Services Division (CSD) Financial Confidence Wheel (Economic Services Division) | ||
| 27-043 | New Contractor Intake | ||
| 27-044A | Contractor Information Update (for existing DSHS contractors) | ||
| 27-053 | Paternity Information | ||
| 27-059 | Fingerprint Appointment |
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| 27-063 | Out-of-Home Services Agreement for Youth (Age 18-21) (Developmental Disabilities Administration) | ||
| 27-076 | Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult | ||
| 27-089 | Fingerprint-Based Background Check Notice |
