DSHS Form 14-503 Interim Assistance Reimbursement Agreement Cover - Washington

What Is DSHS Form 14-503?

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 14-503?
A: DSHS Form 14-503 is a form used by the Washington State Department of Social and Health Services (DSHS) for the Interim Assistance Reimbursement Agreement.

Q: What is an Interim Assistance Reimbursement Agreement?
A: An Interim Assistance Reimbursement Agreement is a contract between the individual receiving public assistance and the state's department responsible for administering the assistance program.

Q: What is the purpose of the Interim Assistance Reimbursement Agreement?
A: The purpose of the agreement is to ensure that if the individual later receives a payment or settlement from a third party for their injury or medical condition, the state can recover the public assistance funds provided during the interim period.

Q: Who needs to complete DSHS Form 14-503?
A: The individual receiving public assistance and their legal representative, if applicable, need to complete the form.

Q: Is there a deadline for completing DSHS Form 14-503?
A: The form should be completed as soon as possible after the injury or medical condition occurs. However, it is best to contact the DSHS office for specific deadline information.