You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
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CCA-1163A | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger | 05/01/2023 |
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FAA-1004A-SLP | Designation of EBT Alternate Card Holder - Large Print (Spanish) | 05/01/2023 |
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FAA-1506A-S | Statement of No Income (Spanish) | 05/01/2023 |
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FAA-1506A | Statement of No Income (English) | 05/01/2023 |
|
FAA-1494A-S | Remoción de un(a) Representante Autorizado(a) | 05/01/2023 |
|
CCA-1163A-S | Afidávit de Exención de Vacunación - Para Miembros del Hogar de 13 años de edad y Menores | 05/01/2023 |
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FAA-1004A-SXLP | Designation of EBT Alternate Card Holder - Extra Large Print (Spanish) | 05/01/2023 |
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FAA-1494A-XLP | Authorized Representative Removal (Extra Large Print) | 05/01/2023 |
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FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request (Large Print) | 05/01/2023 |
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FAA-0051A | Verification of Financial Accounts (English) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CCA-0041A-S | Solicitud De Audiencia Imparcial | 11/01/2021 |
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CCA-0044A | Verification of Shelter Case Plan (English) | 11/01/2021 |
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CCA-0024A-S | Employment and Wage Verification Statement (Spanish) | 11/01/2021 |
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CCA-1186A | Authority to Release Information | 11/01/2021 |
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DDD-1984A | Behavior Plan / Packet Requirements (English) | 11/01/2021 |
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GCI-1098A | AzEIP Public Awareness Materials Order Form | 11/01/2021 |
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DDD-1984A-S | Behavior Plan / Packet Requirements (Spanish) | 11/01/2021 |
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DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
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SNA-1066A | Voluntary Participation Agreement | 10/01/2021 |
|
DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 09/01/2021 |
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Pursuant to Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA) and other nondiscrimination laws and authorities, ADES does not discriminate on the basis of race, color, national origin, sex, age, or disability. Persons that require a reasonable modification based on language or disability should submit a request as early as possible to ensure the State has an opportunity to address the modification. The process for requesting a reasonable modification can be found at Equal Opportunity and Reasonable Modification