Get Wa Dshs 27-122 2018-2026
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How to fill out the WA DSHS 27-122 online
This guide provides comprehensive instructions for filling out the WA DSHS 27-122 online, designed for individual providers who want to contract with the Department of Social and Health Services. Understanding this process can simplify your experience and ensure that you provide the required information accurately.
Follow the steps to successfully complete the WA DSHS 27-122 online.
- Click ‘Get Form’ button to access the form and open it in the editor.
- Fill in Part A with your personal information: include your contractor name, Social Security number, and birth date. Ensure to use the name as it appears on your Social Security card.
- Provide your current contact information including home and mailing addresses, as well as phone numbers.
- In the specific client information section, enter the name of the client you will be providing services for, and specify your relationship to them.
- Complete the suitability questions regarding your previous contracts and any legal issues related to providing services. Answer truthfully.
- Fill out the license information, if applicable, by providing details of any relevant licenses.
- Proceed to Part B to indicate whether you are a current or former state employee, providing any relevant dates of employment.
- If necessary, complete Part C for ethics certification if you are a current or former state employee.
- Review all your input for accuracy and completeness before signing the document.
- Once all sections are filled out, save your changes or download the document as needed for printing, sharing, or submitting to the appropriate agency.
Begin filling out the WA DSHS 27-122 online today to streamline your contracting process.
You can submit documents to DSHS Washington State in several ways. You can upload them through the online portal, mail them to your local DSHS office, or drop them off in person. Make sure to keep copies of all documents you submit, as this will help you track your application status and streamline any follow-up with the DSHS regarding WA DSHS 27-122.