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-1004A-XLP | Designation of EBT Alternate Card Holder - Extra Large Print (English) | 05/01/2023 |
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FAA-0065A | Verification of Living Arrangements/Residential Address (English) | 05/01/2023 |
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FAA-0098C | EBT Transaction Adjustment Hearing Request | 05/01/2023 |
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FAA-1701A | Verification of Terminated Employment (English) | 05/01/2023 |
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DDD-1678A | Home Modifications Service Assessment (English) | 05/01/2023 |
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FAA-0053A-LP | Verification of New/Current Employment - Large Print (English) | 05/01/2023 |
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GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
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FAA-1004A-SLP | Designation of EBT Alternate Card Holder - Large Print (Spanish) | 05/01/2023 |
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FAA-0257A | Individual Development Account Agreement | 05/01/2023 |
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FAA-0574A | Withdrawal or Stop Benefits/Appeal Request | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CCA-1186A | Authority to Release Information | 11/01/2021 |
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CCA-0041A | Fair Hearing Request | 11/01/2021 |
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DDD-1984A | Behavior Plan / Packet Requirements (English) | 11/01/2021 |
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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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DDD-1984A-S | Behavior Plan / Packet Requirements (Spanish) | 11/01/2021 |
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CCA-0044A | Verification of Shelter Case Plan (English) | 11/01/2021 |
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SNA-1066A | Voluntary Participation Agreement | 10/01/2021 |
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DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
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DDD-2102A | Electronic Visit Verification (EVV) Designee Attestation (English) | 09/01/2021 |
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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