You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
|
FAA-1004A-XLP | Designation of EBT Alternate Card Holder - Extra Large Print (English) | 05/01/2023 |
|
FAA-0412A-XLP | Change Report - Extra Large Print (English) | 05/01/2023 |
|
FAA-0098C | EBT Transaction Adjustment Hearing Request | 05/01/2023 |
|
FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request (Large Print) | 05/01/2023 |
|
FAA-1725A | Verification of Other Income | 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 |
|
FAA-0257A | Individual Development Account Agreement | 05/01/2023 |
|
GCI-1041A-S | Consentimiento para el Uso del Seguro de Salud | 05/01/2023 |
|
FAA-1004A-SLP | Designation of EBT Alternate Card Holder - Large Print (Spanish) | 05/01/2023 |
|
FAA-0412A-LP | Change Report - Large Print (English) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
DDD-2106A-S | Círculos de Apoyo del Miembro | 06/01/2021 |
|
UIB-0098C | Eligibility Investigation Record - WC ALT. Base Period | 06/01/2021 |
|
CCA-1287A-S | Registro de Simulacros de Evacuación de Emergencia | 05/01/2021 |
|
DDD-1530A | Managed Risk Agreement Services and/or Placement (English) | 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 |
|
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 |
|
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