WA DSHS 13-628 2010-2025 free printable template

DSS 13-628 (REV. 12/2010). Involuntary Treatment Act Patient Claim Information. PURPOSE. The Involuntary Treatment Act Patient Claim Information form ...

How to fill out WA DSHS 13-628

How to fill out WA DSHS 13-628

1. Obtain the form WA DSHS 13-628 from the Washington State Department of Social and Health Services website or your local DSHS office.
2. Fill out your personal information at the top of the form, including your name, address, and contact details.
3. Provide information about your household members, including their names, ages, and relationships to you.
4. Indicate your income sources and amounts for each household member as instructed on the form.
5. Document any expenses you have, as required, such as housing costs, utility bills, or childcare expenses.
6. Review the form for accuracy and completeness before submitting it.
7. Submit the completed form to your designated DSHS office either by mail or in person.

Who needs WA DSHS 13-628?

1. Individuals or families seeking assistance with social and health services in Washington State may need to fill out the WA DSHS 13-628 form.
2. This form is typically required for those applying for benefits related to cash assistance, food assistance, or healthcare.

People Also Ask about

What is the P EBT customer service number in Washington state?

Families who aren't active on Basic Food assistance are encouraged to apply for food assistance by completing an application online at Washington Connectionor calling the Customer Service Contact Center at 877-501-2233.Households newly approved for Basic Food will be automatically reviewed for P-EBT eligibility in

Who do I call for food stamps in Washington state?

You can apply for Basic Food Assistance online, by phone at 877-501-2233 or at your local Community Services Office.

What is DSHS in Washington state?

Washington State Department of Social and Health Services.

How do I speak to someone at EBT Washington State?

Services are available at your local Community Services Office and by phone through the Customer Service Contact Center at 877-501-2233: TTY/TDD users dial 1-800-833-6384 for Washington Relay Service. Apply for benefits or submit documents. 9 a.m. to 4 p.m.: Pick up an EBT card in the office.

What is the DSHS stop work form for Washington state?

Stop Work Questionnaire (form 14-438) This form is used when you stop work or self employment. The form should be signed by you but must be completed by your employer. Your employer can also complete this form On-Line.

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What is WA DSHS 13-628?

WA DSHS 13-628 is a form used by the Washington State Department of Social and Health Services for reporting and documenting specific information regarding child welfare cases.

Who is required to file WA DSHS 13-628?

Individuals or entities involved in child welfare services, such as social workers, child protection agencies, and other related organizations, are required to file WA DSHS 13-628.

How to fill out WA DSHS 13-628?

To fill out WA DSHS 13-628, gather the necessary information regarding the case, complete each section of the form accurately, ensure that all required fields are filled, and submit the form according to the specified guidelines.

What is the purpose of WA DSHS 13-628?

The purpose of WA DSHS 13-628 is to collect and track information related to child welfare cases to ensure the safety and well-being of children in the state of Washington.

What information must be reported on WA DSHS 13-628?

The information that must be reported on WA DSHS 13-628 includes details about the child, family dynamics, the nature of the case, actions taken by agencies, and any other relevant information pertaining to the welfare of the child.