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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 09-004C
for the current year.
DSHS Form 09-004C Out-Of-Home Services Acknowledgement - Washington
What Is DSHS Form 09-004C?
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 09-004C?
A: DSHS Form 09-004C is the Out-Of-Home Services Acknowledgement form used in Washington state.
Q: What is the purpose of DSHS Form 09-004C?
A: The purpose of DSHS Form 09-004C is to acknowledge and provide consent for out-of-home services in Washington state.
Q: Who uses DSHS Form 09-004C?
A: DSHS Form 09-004C is used by individuals or families who are receiving or seeking out-of-home services in Washington state.
Q: Is DSHS Form 09-004C mandatory?
A: Yes, if you are receiving or seeking out-of-home services in Washington state, completing DSHS Form 09-004C is mandatory.
Q: How do I fill out DSHS Form 09-004C?
A: You must provide your personal information, acknowledge the terms and conditions of out-of-home services, and sign the form to complete DSHS Form 09-004C.
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;
- Available in Spanish;
- 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 09-004C by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
