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Dshs intake form 2026
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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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