If you're unable to complete this form today, start the process by submitting your name, address, and signature. You will still need to complete the application before benefits can be approved.
Food assistance right away: if you need food assistance right away, fill in Questions 1 through 14 and take this form to your local office.
Cash assistance: if applying for cash assistance, all adults (or authorized representatives) in the household must sign.
Food assistance: both the applicant and authorized representative must sign unless there is a current authorized representative document on file.
Authorized Representative: an Authorized Representative is someone you allow DSHS to talk with about your benefits.
| Question | Answer |
|---|---|
| Form Name | Form DSHS 14-001 |
| Form Length | 6 pages |
| Fillable? | Yes |
| Fillable fields | 323 |
| Avg. time to fill out | 54 min |
| Edition | Rev 08/2025 |
| Issuing agency | DSHS |
| Where to send | In person at a community services office; by fax to 1-888-338-7410; by mail to DSHS CSD-Customer Service Center, PO Box 11699, Tacoma, WA 98411-6699; or online at www.washingtonconnection.org |
| Other names | DSHS 14-001, 14-001, DSHS 14001, DSHS form 14-001, Application for Cash or Food Assistance |
| Official source | Form DSHS 14-001 (Rev 08/2025), DSHS |
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