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Hcs intake and referral

Dshs intake form 2025

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The document provides intake instructions for Individual Providers (IPs) contracted with the Department of Social and Health Services (DSHS) in Washington State. It outlines the requirements for completing the Contractor Intake form, including personal identification, client information, suitability checks, and ethics certification for current or former state employees. The form is mandatory for individuals providing personal care or respite care to DSHS clients and must be submitted to the appropriate agency (HCS, AAA, or DDA) before any contract can be offered.

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Click ‘Get Form’ to open the dshs intake form in the editor.
Begin with Part A, where you will enter your Contractor Information. Fill in your name as it appears on your Social Security card, along with your gender, birth date, and contact details.
Provide identification details by selecting an unexpired picture ID type and entering your Social Security number. Ensure that the names match appropriately.
In the Specific Client Information section, indicate if you are providing services to a specific individual and state your relationship to them if applicable.
Complete the Suitability section by answering questions regarding any past contract terminations or criminal offenses. Attach additional explanations if necessary.
If applicable, fill out Part B regarding State Employee Information and ensure all required signatures are provided at the end of each part.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (191 Votes)
2015	4 Satisfied (26 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who qualifies for cash assistance in Washington state?

Who is eligible. Washington state residents who are responsible for the care of children or who are pregnant. Some of the requirements you must meet include: Income and resource requirements.

How do I apply for DSHS benefits in Washington state?

You may complete an online application by using the WashingtonConnection.org website, applying by phone at 877-501-2233 or going to your local Community Services Office. On WashingtonConnection.org you can: Start a new application. Report a change, such as address, income or family situation.

What is the DSHS stop work form for Washington state?

Stop Work Questionnaire (form 14-438) This form is used when you stop work or self employment. The form should be signed by you but must be completed by your employer. Your employer can also complete this form On-Line.

Where can I create an intake form?

Create a client intake form using Google Forms. In Google Forms, click the plus sign. Click the Untitled form header box. Enter a name and description for the form.

How do I submit documents to DSHS Washington state?

Look for a second email with subject line: [SECURE] Email Documents to MyDocs@DSHS.WA.GOV Then follow the steps in that message to attach and send your documents. In the future, you can respond to this email to send documents electronically, so you may want to store it in your email inbox.

home and community services intake and referral

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How long does it take to get approved for food stamps in Washington?

We try to process your application as quickly as possible. A lot depends on how soon were able to get the information we need to determine if youre eligible. Generally, most food stamp and TANF cash benefits are processed within 30 days.

What is the income limit for DSHS in Washington state?

Basic Food Eligibility and Benefits Household SizeMonthly Gross Income 3 $4,442 4 $5,358 5 $6,275 6 $7,1927 more rows