This version of the form is not currently in use and is provided for reference only. Download this version of DSHS Form 14-416 for the current year.
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.
Q: What is the DSHS Form 14-416?
A: The DSHS Form 14-416 is an Eligibility Review form for Long Term Services and Supports in Washington.
Q: What is the purpose of the DSHS Form 14-416?
A: The purpose of the DSHS Form 14-416 is to review an individual's eligibility for long-term services and supports in Washington.
Q: Who is eligible for long-term services and supports in Washington?
A: Eligibility for long-term services and supports in Washington is based on various factors, including income, assets, and need for assistance with daily activities.
Q: What does the eligibility review process involve?
A: The eligibility review process involves completing the DSHS Form 14-416, providing documentation of income and assets, and undergoing an assessment of need for services.
Q: What happens after the eligibility review?
A: After the eligibility review, the individual will be notified of their eligibility status and the services they are approved for.
Q: Are there any fees associated with long-term services and supports in Washington?
A: There may be fees associated with long-term services and supports in Washington, depending on the individual's income and assets. These fees are based on a sliding scale.
Q: What if I disagree with the eligibility decision?
A: If you disagree with the eligibility decision, you have the right to appeal the decision and request a fair hearing.
Form Details:
Download a printable version of DSHS Form 14-416 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.