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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CCA-1163A | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger | 05/01/2023 |
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FAA-1353A-S | Afidávit que Certifica la Ciudadanía para recibir Asistencia en Efectivo y Asistencia Nutricional | 05/01/2023 |
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FAA-1494A-XLP | Authorized Representative Removal (Extra Large Print) | 05/01/2023 |
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AzEIP-TAB-05012023 | Updated Consent to Bill Health Insurance form (GCI-1041A) Guidance Technical Assistance Bulletin | 05/01/2023 |
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FAA-0574A-S | Retirar o Suspender Beneficios/Solicitud de Apelación | 05/01/2023 |
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FAA-1249A-LP | Verification of Disability (Large Print) | 05/01/2023 |
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FAA-1004A-S | Designation of EBT Alternate Card Holder (Spanish) | 05/01/2023 |
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FAA-1494A-S | Remoción de un(a) Representante Autorizado(a) | 05/01/2023 |
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GCI-1037A-S | Aviso o Recomendación de la Agencia de Educación Pública (PEA) | 05/01/2023 |
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CCA-1163A-S | Afidávit de Exención de Vacunación - Para Miembros del Hogar de 13 años de edad y Menores | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
DERS-1057A | Direct Service Position | 08/01/2021 |
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AAA-1344A | Direct Service Position | 08/01/2021 |
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CCA-1212A | Direct Service Position (Certification Form) | 07/01/2021 |
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CCA-1212A-S | Puesto de Servicio Directo (Formulario de certificación) | 07/01/2021 |
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DDD-2104A | Member Interdisciplinary Team Summary | 07/01/2021 |
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DDD-2106A | Member's Circles of Support | 06/01/2021 |
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UIB-0126A-S | Request for Reconsideration/Appeal (Spanish) | 06/01/2021 |
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DDD-2107A-S | Hoja de Trabajo Sobre lo que Funciona y lo que no Funciona | 06/01/2021 |
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UIB-0098C | Eligibility Investigation Record - WC ALT. Base Period | 06/01/2021 |
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DDD-2106A-S | Círculos de Apoyo del Miembro | 06/01/2021 |
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