WA DSHS 14-076 2014 free printable template
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YOUR NAMECLIENT ID OR SOCIAL
SECURITY NUMBERChange of CircumstancesRead all sections carefully. Check all boxes that apply to your household. Sign, date, and return this form to your
local office.
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How to fill out WA DSHS 14-076
01
Begin by downloading the WA DSHS 14-076 form from the official website.
02
Fill in your personal information at the top of the form, including your name, address, and contact details.
03
Provide details regarding your financial situation, including income sources and amounts.
04
List any relevant resources you have, such as bank accounts, property, or assets.
05
Indicate the type of assistance you are applying for or seeking.
06
Ensure that all information is accurate and complete to avoid delays in processing.
07
Review the form for any errors or missing information before submission.
08
Sign and date the form at the bottom.
Who needs WA DSHS 14-076?
01
Individuals or families seeking financial assistance from the Washington State Department of Social and Health Services (DSHS).
02
People applying for programs such as Temporary Assistance for Needy Families (TANF), food assistance, or medical benefits.
03
Any resident of Washington State needing to report changes in their circumstances that may affect their eligibility for assistance.
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What is WA DSHS 14-076?
WA DSHS 14-076 is a form used by the Washington Department of Social and Health Services for documenting necessary information regarding services and assistance programs.
Who is required to file WA DSHS 14-076?
Individuals and organizations that provide services related to social and health assistance programs in Washington State are required to file WA DSHS 14-076.
How to fill out WA DSHS 14-076?
To fill out WA DSHS 14-076, you need to provide accurate information about the services rendered, the recipients, and any relevant data as specified in the form instructions.
What is the purpose of WA DSHS 14-076?
The purpose of WA DSHS 14-076 is to collect and track information to ensure accountability and effectiveness of social and health services provided in Washington State.
What information must be reported on WA DSHS 14-076?
The form requires reporting information such as recipient details, service descriptions, service dates, and any outcomes or follow-up actions taken.
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