Washington WorkFirst requires adult TANF clients to work, look for work or train for up to 40 hours a week. When a client reports that their own condition, or a family member's they care for, limits that, DSHS sends this request to the treating provider. The answers set the client's required participation hours and any limits in their Individual Responsibility Plan.
A medical, mental health or other professional treating the client or family member answers questions 1 to 9 and signs. The client signs the authorization to release information on the last page, and the WorkFirst worker fills in the case details and deadline.
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Documentation Request for Medical Condition and Residual Functional Capacity
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The WorkFirst worker writes a deadline date on the cover letter. If the provider needs more time, the letter says to call the worker. If nothing arrives, DSHS may require full-time participation in work, job search or training, and the client's cash benefits may be reduced or terminated if requirements are not met.
Yes. Question 9 covers a child or adult relative whose condition requires the client to provide care at home. The provider marks how many hours per week the parent or caretaker can participate outside the home, in ranges from 0 to 10 up to more than 30, and how long that care will be needed.
Yes. DSHS posts the form in English and Spanish and lists about 25 other translations on its forms index. All versions ask the same nine questions and include the client's authorization to release information.