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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 |
|---|---|---|
| AAA-1296A | Protect Yourself and Medicare | 05/01/2023 |
| CCA-0221A-S | Declaración de Servicios del Proveedor de Cuidado en Casa de Familia | 05/01/2023 |
| FAA-1494A-SXLP | Remoción de un(a) Representante Autorizado(a) (Letra Extra Grande) | 05/01/2023 |
| GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
| FAA-0257A | Individual Development Account Agreement (English) | 05/01/2023 |
| FAA-1353A-S | Afidávit que Certifica la Ciudadanía para recibir Asistencia en Efectivo y Asistencia Nutricional | 05/01/2023 |
| FAA-1494A-XLP | Authorized Representative Removal (Extra Large Print) | 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 |
|---|---|---|
| LCR-1007A | Home Visit Report Supplement to Notice of Inspection and Due Process Rights | 07/01/2019 |
| RSA-1312A | Authorization for Disclosure of Health Information to RSA | 07/01/2019 |
| CCA-1261A-S | Solicitud de Proveedor Certificado de Cuidado de Niños Familiar | 07/01/2019 |
| LCR-1007A-S | Informe de Visita al Hogar Suplemento Al Aviso de Derechos De Inspección y Debido Proceso | 07/01/2019 |
| GCI-1049A | No Contact Letter | 07/01/2019 |
| RSA-1312A-S | Autorización Para Divulgación De Información De Salud a RSA | 07/01/2019 |
| CCA-1260A | Back Up Provider Application | 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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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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