DSHS Form 17-260 Companion Home Gift Card or Pre-paid Credit Card Ledger - Washington

DSHS Form 17-260 Companion Home Gift Card or Pre-paid Credit Card Ledger - Washington

What Is DSHS Form 17-260?

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 17-260?
A: DSHS Form 17-260 is a form used in Washington to document gift cards or pre-paid credit cards given to companion home providers.

Q: What is a companion home provider?
A: A companion home provider is someone who provides care and support to individuals with developmental disabilities or mental health conditions in their own home as part of a licensed program.

Q: Why would someone receive a gift card or pre-paid credit card as a companion home provider?
A: Gift cards or pre-paid credit cards may be given to companion home providers as a thank-you or as a form of compensation for their services.

Q: What is the purpose of the ledger?
A: The ledger is used to track and document the use of gift cards or pre-paid credit cards provided to companion home providers.

Q: Do companion home providers need to submit this form to DSHS?
A: Yes, companion home providers are required to submit the completed ledger to the Washington State Department of Social and Health Services (DSHS).

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Form Details:

  • Released on December 1, 2018;
  • 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 17-260 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.

Download DSHS Form 17-260 Companion Home Gift Card or Pre-paid Credit Card Ledger - Washington

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