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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FAA-0051A | Verification of Financial Accounts (English) | 05/01/2023 |
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FAA-1004A | Designation of EBT Alternate Card Holder (English) | 05/01/2023 |
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FAA-1546A | Sponsor Deeming Information | 05/01/2023 |
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FAA-1494A-XLP | Authorized Representative Removal (Extra Large Print) | 05/01/2023 |
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FAA-0098C | EBT Transaction Adjustment Hearing Request | 05/01/2023 |
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FAA-0065A-SXLP | Verification of Living Arrangements/Residential Address - Extra Large Print (Spanish) | 05/01/2023 |
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DDD-1345A | Medical Justification for Home Modifications (English) | 05/01/2023 |
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FAA-1249A-LP | Verification of Disability (Large Print) | 05/01/2023 |
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CCA-1170AS | Petición para el Retiro o Terminación de Solicitud - Para Proveedores de Cuidado de Niños | 05/01/2023 |
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FAA-1494A-S | Remoción de un(a) Representante Autorizado(a) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CCA-0041A-S | Solicitud De Audiencia Imparcial | 11/01/2021 |
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CCA-0024A-S | Employment and Wage Verification Statement (Spanish) | 11/01/2021 |
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GCI-1098A | AzEIP Public Awareness Materials Order Form | 11/01/2021 |
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CCA-0024A | Employment and Wage Verification Statement (English) | 11/01/2021 |
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CCA-0044A | Verification of Shelter Case Plan (English) | 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 |
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DDD-2101A | Electronic Visit Verification (EVV) Paper Timesheet Attestation (English) | 09/01/2021 |
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DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 09/01/2021 |
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DDD-2099A-S | Plan de contingencia/respaldo del miembro para la verificación de visita electrónica (EVV) | 09/01/2021 |
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