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Applications & Forms

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Download or Fill-in Blank Applications

The following applications and forms are used by professionals who work with low-income families. Some of the applications and forms are available in multiple languages.

Fill-in Applications

Type your client’s information onto the application on your computer and print it out.

Children’s Health Insurance – Medicaid & S-CHIP – NEW! Apple Health for Kids
First Steps – Pregnancy Medicaid
Basic Food – Food Stamps – (use this application for cash and Family Medical)
Basic Health Insurance
WIC Nutrition Program – there is no application – use the WIC Search Tool to find your client’s local WIC office.
RENEWAL Form for Children’s Health Insurance – NEW

Download & Print Blank Applications (PDF)

Children’s Health Insurance (Apple Health for Kids) – Medicaid & S-CHIP
- English
- Spanish
- Russian
- Vietnamese
- For other languages, select form 14-380 from the DSHS Electronic Forms webpage

RENEWAL Form for Children’s Health Insurance
- English
- Spanish
- Russian
- Vietnamese
- For other languages, select form 13-836 from the DSHS Electronic Forms webpage

First Steps – Pregnancy Medicaid
- English
- Spanish
- Russian
- Vietnamese
- For other languages, select form 14-429 from the DSHS Electronic Forms webpage

Hey Mom! – Filing for medical for babies born to moms on Medicaid
- English

Application for Benefits (can be used for food, cash, and Family Medical)
- English
- Spanish
- Russian
- Vietnamese
- For other languages, select form 14-001 from the DSHS Electronic Forms webpage

Basic Health Insurance (for adults)
- English
- Spanish

Basic Health Plus (for children)
- English
- Spanish

Download & Print Authorization Forms (PDF)

The following are authorization forms to assist clients in the application process.

DSHS Authorization Form
- English
- Spanish
- Russian
- Vietnamese
- For other languages, select form 17-063 from the DSHS Electronic Forms webpage

Basic Health Insurance Permission Form
- English
- Spanish

Additional Forms

DSHS Citizenship Documentation and Identity Declaration
- English
- Spanish
- Russian
- Vietnamese
- For other languages, select form 13-789 from the DSHS Electronic Forms webpage

Change of Circumstance Form – report an address, income, etc. change
- English
- Spanish
- Russian
- Vietnamese
- For other languages, select form 14-076 from the DSHS Electronic Forms webpage