You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
|
FAA-1353A-S | Afidávit que Certifica la Ciudadanía para recibir Asistencia en Efectivo y Asistencia Nutricional | 05/01/2023 |
|
FAA-0255A-S | Afirmación De Hogares Por Separado | 05/01/2023 |
|
AzEIP-TAB-05012023 | Updated Consent to Bill Health Insurance form (GCI-1041A) Guidance Technical Assistance Bulletin | 05/01/2023 |
|
FAA-0098C-S | Solicitud de Audiencia por Ajuste de Transacción EBT | 05/01/2023 |
|
FAA-1353A | Affidavit Attesting Citizenship for Cash Assistance and Nutrition Assistance | 05/01/2023 |
|
GCI-1037A | Public Education Agency (PEA) Notification/Referral | 05/01/2023 |
|
FAA-0255A | Separate Household Status Statement | 05/01/2023 |
|
FAA-1004A-XLP | Designation of EBT Alternate Card Holder - Extra Large Print (English) | 05/01/2023 |
|
CCA-1163A | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger | 05/01/2023 |
|
FAA-0098C | EBT Transaction Adjustment Hearing Request | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
UIB-0098F | Job Offer Development, Referral, Eligibility Investigation Record | 06/01/2021 |
|
DDD-2107A | What Works and What Doesn't Work Worksheet | 06/01/2021 |
|
AAA-1350B | Family Caregiver Support Program Evaluation | 05/01/2021 |
|
AAA-1350C | Annual Follow Up | 05/01/2021 |
|
CCA-1287A | Emergency Evacuation Drill Record | 05/01/2021 |
|
CCA-1287A-S | Registro de Simulacros de Evacuación de Emergencia | 05/01/2021 |
|
DDD-1530A-LP | Managed Risk Agreement Services and/or Placement (Large Print) | 05/01/2021 |
|
DDD-1530A-S | Managed Risk Agreement Services and/or Placement (Spanish) | 05/01/2021 |
|
DDD-1530A | Managed Risk Agreement Services and/or Placement (English) | 05/01/2021 |
|
DDD-1436A | Behavioral Health Professional Consultation Summary (English) | 04/01/2021 |
Stay up-to-date with news and updates delivered straight to your inbox
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