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This version of the form is not currently in use and is provided for reference only. Download this version of
DSHS Form 15-424
for the current year.
DSHS Form 15-424 Staffed Residential Cost of Care Adjustment Request - Washington
What Is DSHS Form 15-424?
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 15-424?
A: DSHS Form 15-424 is a Staffed Residential Cost of Care Adjustment Request form in Washington.
Q: What is the purpose of DSHS Form 15-424?
A: The purpose of DSHS Form 15-424 is to request an adjustment in the cost of care for a staffed residential facility in Washington.
Q: Who should fill out DSHS Form 15-424?
A: DSHS Form 15-424 should be filled out by the operator of a staffed residential facility in Washington.
Q: What information is required on DSHS Form 15-424?
A: DSHS Form 15-424 requires information about the facility, the requested cost adjustment, and supporting documentation.
Q: Are there any fees associated with submitting DSHS Form 15-424?
A: No, there are no fees associated with submitting DSHS Form 15-424.
Q: What is the deadline for submitting DSHS Form 15-424?
A: The deadline for submitting DSHS Form 15-424 is typically on or before the first day of the month prior to the requested effective date of the adjustment.
Form Details:
- Released on August 1, 2014;
- The latest edition provided by the Washington State Department of Social and Health Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of DSHS Form 15-424 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
