You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Number | Document Name | Effective Date |
---|---|---|
FAA-1765A | Authority to Release Information | 05/01/2023 |
AAA-1296A | Protect Yourself and Medicare | 05/01/2023 |
FAA-1494A-LP | Authorized Representative Removal (Large Print) | 05/01/2023 |
FAA-1768A-S | Formulario de Solicitud de Reducción de Pago en Exceso | 05/01/2023 |
GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
FAA-0065A-S | Verification of Living Arrangements/Residential Address (Spanish) | 05/01/2023 |
FAA-1353A-S | Afidávit que Certifica la Ciudadanía para recibir Asistencia en Efectivo y Asistencia Nutricional | 05/01/2023 |
AzEIP-TAB-05012023 | Updated Consent to Bill Health Insurance form (GCI-1041A) Guidance Technical Assistance Bulletin | 05/01/2023 |
Statistical Bulletin March 2023 | Statistical Bulletin March 2023 | 04/21/2023 |
LIHEAP Plan FY23 | Low-Income Home Energy Assistance Program (LIHEAP) Plan | 04/19/2023 |
Number | Document Name | Effective Date |
---|---|---|
CCA-1260A-S | Solicitud de Proveedor Suplente | 07/01/2019 |
CCA-1261A-S | Solicitud de Proveedor Certificado de Cuidado de Niños Familiar | 07/01/2019 |
CCA-1260A | Back Up Provider Application | 07/01/2019 |
CCA-1261A | Certified Family Child Care Provider Application | 07/01/2019 |
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 |
UB-099-Y | Certification of Understanding (English / Spanish) | 07/01/2019 |
RSA-1367A | Appeal Rights | 06/01/2019 |
RSA-1367A-LP | Appeal Rights (Large Print) | 06/01/2019 |
RSA-1367A-S | Derechos de Apelación | 06/01/2019 |
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