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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 10-664
for the current year.
DSHS Form 10-664 New or Update Provider Information Worksheet - Washington
What Is DSHS Form 10-664?
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 10-664?
A: DSHS Form 10-664 is a form for new or updated provider information in Washington.
Q: Who is required to fill out DSHS Form 10-664?
A: Providers in Washington who need to provide new or updated information.
Q: What information is needed on DSHS Form 10-664?
A: The form requires provider's personal and contact information, as well as information about their services and certifications.
Q: Is DSHS Form 10-664 only for healthcare providers?
A: No, the form is for all types of providers, including healthcare, child care, and adult care providers.
Q: Is there a deadline for submitting DSHS Form 10-664?
A: There is no specific deadline mentioned for submitting the form, but it is recommended to submit it as soon as there are any changes in provider information.
Q: What should I do if there are errors on my submitted DSHS Form 10-664?
A: You should contact the Washington State Department of Social and Health Services (DSHS) to make corrections.
Q: Are there any fees associated with submitting DSHS Form 10-664?
A: There are no fees mentioned specifically for submitting the form.
Q: How often should I update my information on DSHS Form 10-664?
A: It is recommended to update your information whenever there are any changes to ensure accurate records.
Form Details:
- Released on November 1, 2021;
- 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 10-664 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
