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This version of the form is not currently in use and is provided for reference only. Download this version of
DSHS Form 15-569
for the current year.
DSHS Form 15-569 Notice of Termination of Service - Washington
What Is DSHS Form 15-569?
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 Form 15-569?A: DSHS Form 15-569 is a Notice of Termination of Service form used in Washington.
Q: Who uses DSHS Form 15-569?A: The Department of Social and Health Services in Washington uses Form 15-569.
Q: What is the purpose of DSHS Form 15-569?A: The purpose of the form is to notify individuals or families receiving services from DSHS about the termination of those services.
Q: Why would services be terminated?A: Services may be terminated for various reasons, such as ineligibility, failure to meet program requirements or non-compliance with program rules.
Q: Is there a deadline for submitting the form?A: The form should be submitted as soon as possible after the decision to terminate services has been made.
Q: What information is required on the form?A: The form requires basic information about the individual or family receiving services, as well as details about the termination and any appeal rights.
Q: What should I do if I receive a Notice of Termination of Service?A: If you receive a notice, you should carefully review the information provided, and if you believe there has been an error, you have the right to appeal the decision within a specified timeframe.
Form Details:
- Released on December 1, 2020;
- 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 15-569 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
