WA DSHS 16-193 2009 free printable template
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AGING AND DISABILITY SERVICES ADMINISTRATION NURSE AIDE REGISTRY PO BOX 45600 OLYMPIA WA 98504-5600 (360) 725-2570 Fax Number: 360-493-2581 DSS web address: www.adsa.dshs.wa.gov/professional/nat/default.htm
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How to fill out WA DSHS 16-193
01
Begin by downloading the WA DSHS 16-193 form from the official website.
02
Fill in your personal information at the top of the form including your name, address, and date of birth.
03
Provide information regarding your household members, including their names, birth dates, and relationship to you.
04
Indicate your income details such as your employment information and any other sources of income.
05
Complete the section regarding your expenses like rent, utilities, and medical costs.
06
Review the completed form for accuracy and ensure all required signatures are included.
07
Submit the form as instructed, either online or by mailing it to the appropriate address.
Who needs WA DSHS 16-193?
01
Individuals or families applying for assistance programs offered by the Washington State Department of Social and Health Services (DSHS).
02
People seeking financial aid, food assistance, or other social service support.
03
New applicants who are submitting their information for the first time to access DSHS benefits.
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What is WA DSHS 16-193?
WA DSHS 16-193 is a specific form used by the Washington Department of Social and Health Services (DSHS) for reporting certain information related to health services or financial assistance.
Who is required to file WA DSHS 16-193?
Individuals or organizations that provide medical or financial services and receive funding or reimbursement from DSHS may be required to file WA DSHS 16-193.
How to fill out WA DSHS 16-193?
To fill out WA DSHS 16-193, you should provide accurate and complete information as requested in the form, including details about the services provided and the recipients.
What is the purpose of WA DSHS 16-193?
The purpose of WA DSHS 16-193 is to ensure the proper documentation and reporting of services and funding related to healthcare or social services in Washington State.
What information must be reported on WA DSHS 16-193?
The information reported on WA DSHS 16-193 typically includes details about the service provider, the services rendered, client information, and any other relevant data that DSHS requires for assessment or reimbursement.
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