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Documents Center
Reports, Forms, Pamphlets and Policies
You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Find a Document
- Click on the tab that corresponds with the type of document type you are looking for, or click on the "All Documents" tab to search through all available documents. You can refine your search by selecting a category from the Filter by Category drop-down.
- Type in a number or keyword in the "Search by Name, Number, or Keyword" box and click the Search button. When searching for a document by the exact title (form name), place the title within quotation marks.
- You can click on the column headers to sort the search results.
| Number | Document Name | Effective Date |
|---|---|---|
| FAA-1565A-S | Acuerdo de Prueba de Drogas para recibir Asistencia Nutricional | 05/01/2023 |
| CCA-0221A-S | Declaración de Servicios del Proveedor de Cuidado en Casa de Familia | 05/01/2023 |
| FAA-1799A | Drug/Alcohol Treatment Center Training Acknowledgment | 05/01/2023 |
| FAA-1353A | Affidavit Attesting Citizenship for Cash Assistance and Nutrition Assistance | 05/01/2023 |
| FAA-0065A | Verification of Living Arrangements/Residential Address (English) | 05/01/2023 |
| FAA-1725A | Verification of Other Income | 05/01/2023 |
| FAA-1701A | Verification of Terminated Employment (English) | 05/01/2023 |
| FAA-1494A-XLP | Authorized Representative Removal (Extra Large Print) | 05/01/2023 |
| GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
| FAA-0574A | Withdrawal or Stop Benefits/Appeal Request | 05/01/2023 |
| Number | Document Name | Effective Date |
|---|---|---|
| DDD-0524A-S | Authorization for Release of Information (Spanish) | 08/01/2019 |
| UIA-1060A | Filing of Weekly Claims (English/Spanish) | 08/01/2019 |
| DDD-0524A | Authorization for Release of Information (English) | 08/01/2019 |
| DDD-1328A | Referral to Vocational Rehabilitation (English) | 08/01/2019 |
| RSA-1376A | Request for Vending Services Placement | 08/01/2019 |
| UIB-0098A | Eligibility Investigation Record | 08/01/2019 |
| RSA-1312A | Authorization for Disclosure of Health Information to RSA | 07/01/2019 |
| RSA-1312A-S | Autorización Para Divulgación De Información De Salud a RSA | 07/01/2019 |
| CCA-0206A-S | Cuestionario para la Entrevista de Certificación Inicial | 07/01/2019 |
| UB-099-Y | Certification of Understanding (English / Spanish) | 07/01/2019 |
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Arizona State Resources
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
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