This version of the form is not currently in use and is provided for reference only. Download this version of DSHS Form 09-995 for the current year.

DSHS Form 09-995 Companion Home Certification Evaluation - Washington

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What Is DSHS Form 09-995?

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?
A: DSHS stands for the Department of Social and Health Services.

Q: What is Form 09-995?
A: Form 09-995 is a Companion Home Certification Evaluation form used in Washington.

Q: What is a Companion Home?
A: A Companion Home is a certified private residence where an individual with developmental disabilities can live and receive support services.

Q: Who completes the Form 09-995?
A: The form is completed by the applicant or their representative.

Q: What is the purpose of the Form 09-995?
A: The purpose of the form is to assess the suitability of a private residence for certification as a Companion Home.

Q: What information is required on the form?
A: The form requires information about the applicant, the residence, and the support services that will be provided.

Q: How long is the certification period for a Companion Home?
A: The certification period is typically two years.

Form Details:

Released on August 1, 2022;
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 09-995 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.