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DSHS Form 17-292 Act Program Service Request / Work Order for Induction Loops - Washington
What Is DSHS Form 17-292?
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. Check the official instructions before completing and submitting the form.
FAQ
Q: What is DSHS Form 17-292?
A: DSHS Form 17-292 is the Act Program Service Request / Work Order for Induction Loops in Washington.
Q: What is the Act Program?
A: The Act Program is a program implemented by the Washington State Department of Social and Health Services (DSHS) to provide assistive communication technology services to individuals with hearing loss.
Q: What is an induction loop?
A: An induction loop is a technology that transmits audio signals directly to hearing aids or cochlear implants with a telecoil (T-coil) feature, allowing individuals with hearing loss to hear more clearly.
Q: Who can use the Act Program?
A: The Act Program is available for individuals with hearing loss who reside in Washington and are eligible for DSHS services.
Q: What is the purpose of DSHS Form 17-292?
A: DSHS Form 17-292 is used to request the installation or repair of induction loops through the Act Program in Washington.
Q: What information is required on DSHS Form 17-292?
A: DSHS Form 17-292 requires information such as the individual's name, contact information, location of the installation or repair, and details about the requested service.
Q: Is there a cost for the Act Program services?
A: The Act Program services are provided at no cost to eligible individuals with hearing loss.
Q: What should I do if I have questions about DSHS Form 17-292 or the Act Program?
A: If you have questions about DSHS Form 17-292 or the Act Program, you can contact the Washington State Department of Social and Health Services (DSHS) for assistance.
Form Details:
- Released on April 1, 2020;
- 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 17-292 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 17-292 Act Program Service Request / Work Order for Induction Loops - Washington
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