Get Dshs23 041

Filling out the Dshs23 041 form is an essential step for individuals or agencies requesting founded findings of child abuse and neglect in Washington State. This guide provides clear instructions to ensure the process is straightforward and efficient.

Follow the steps to successfully complete the Dshs23 041 form online.

1. Press the ‘Get Form’ button to obtain the Dshs23 041 and open it in the editor for completion.
2. In section A, enter the requestor information. This includes the full name, title, agency or business name, mailing address, city, state, zip code, telephone number, fax number, and e-mail address of the individual or agency making the request.
3. In section B, the requestor must sign in the designated field and date the signature to authenticate the request.
4. Move to section C to provide information about the subject of the records requested. Enter the full name, previous names used, date of birth, social security number, and current or last mailing address in Washington State.
5. In section D, the subject of the records must authorize the release of information by signing and dating the authorization. This signature is mandatory unless you have independent legal authority to access the records.
6. Once all sections are completed, save your changes, and prepare to print the document.
7. Mail the completed Dshs23 041 form along with the payment of $20.00, which should be made via check or money order payable to DSHS Children’s Administration, to the specified address.

Begin the process of completing your Dshs23 041 form online today.