Transmittal of Client Funds from the Protective Payee - DSHS - dshs wa Preview on Page 1

Transmittal of Client Funds from the Protective Payee - DSHS - dshs wa 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Enter the transmittal number for tracking your transaction. This is essential for your records.
  3. Fill in your name and address as the protective payee, ensuring accuracy for correspondence.
  4. For each client you are returning funds for, use a separate line. Include their name and ACES client identification number.
  5. Complete each column, specifying the period of time for which funds are being returned. Enter the reason code corresponding to why the money is being returned; if 'Other', provide an explanation.
  6. In the check number space, enter your check's number. Ensure that this matches the total amount transmitted.
  7. Sign and date the form to certify that all information provided is correct.
  8. Mail the top copy of the form along with your check to the address listed on the front of the form.
  9. Send one copy to your Community Service Office (CSO) for their records.
  10. Keep a copy for your files to maintain a record of transactions.

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Basic Food Eligibility and Benefits Household SizeMonthly Gross Income 1 $2,510 2 $3,407 3 $4,303 4 $5,2005 more rows
Washington State Department of Social and Health Services.
United States Department of Health and Human Services Department overview Jurisdiction Federal Government of the United States Headquarters Hubert H. Humphrey Building Washington, D.C. Employees 83,500 Annual budget $1.631 trillion (2022)7 more rows
The agency has its headquarters in Office Building Two (OB-2) in Olympia, the state capital. Annually, 2.2 million children, families, vulnerable adults and seniors come to the department for protection, comfort, food assistance, financial aid, medical and behavioral health care and other services.
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.

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Services are available at your local Community Services Office and by phone through the Customer Service Contact Center at 877-501-2233: TTY/TDD users dial 1-800-833-6384 for Washington Relay Service.

Related links

Transmittal of Client Funds from the Protective Payee

Transmittal of Client Funds from the Protective Payee. Number: 01-210. Washington State Department of Social Health Services. Connect with DSHS. Staff AccessRead more

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