PDF
Word
DSHS Form 15-424 Staffed Residential Home Cost of Care Adjustment Request - Washington
What Is DSHS Form 15-424?
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 15-424?
A: DSHS Form 15-424 is a form used for a Staffed Residential Home Cost of Care Adjustment Request in Washington.
Q: What is the purpose of DSHS Form 15-424?
A: The purpose of DSHS Form 15-424 is to request an adjustment in the cost of care for a staffed residential home in Washington.
Q: Who uses DSHS Form 15-424?
A: DSHS Form 15-424 is used by individuals or organizations operating staffed residential homes in Washington.
Q: What information is required in DSHS Form 15-424?
A: DSHS Form 15-424 requires information such as the provider's name, address, and license number, as well as details about the cost of care and reasons for the adjustment.
Form Details:
- Released on July 1, 2021;
- 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 15-424 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
