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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 |
|---|---|---|
| FAA-0574A | Withdrawal or Stop Benefits/Appeal Request (English) | 05/01/2023 |
| CCA-1163A-S | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger (Spanish) | 05/01/2023 |
| FAA-1494A-S | Authorized Representative Removal (Spanish) | 05/01/2023 |
| FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request - Large Print (English) | 05/01/2023 |
| FAA-1799A | Drug/Alcohol Treatment Center Training Acknowledgment | 05/01/2023 |
| FAA-1366A | Eligibility Requirements | 05/01/2023 |
| DDD-0211A | Home Modifications Service Referral and Request (English) | 05/01/2023 |
| CCA-1164A | Affidavit of Immunization Exemption - For Children in Care (English) | 05/01/2023 |
| FAA-0574A-SLP | Withdrawal or Stop Benefits/Appeal Request - Large Print (Spanish) | 05/01/2023 |
| GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
| Number | Document Name | Effective Date |
|---|---|---|
| CCA-1260A-S | Solicitud de Proveedor Suplente | 07/01/2019 |
| CCA-1261A-S | Solicitud de Proveedor Certificado de Cuidado de Niños Familiar | 07/01/2019 |
| UB-099-Y | Certification of Understanding (English / Spanish) | 07/01/2019 |
| LCR-1007A | Home Visit Report Supplement to Notice of Inspection and Due Process Rights (English) | 07/01/2019 |
| CCA-1260A | Back Up Provider Application | 07/01/2019 |
| GCI-1049A | No Contact Letter | 07/01/2019 |
| LCR-1007A-S | Home Visit Report Supplement to Notice of Inspection and Due Process Rights (Spanish) | 07/01/2019 |
| CCA-1261A | Certified Family Child Care Provider Application | 07/01/2019 |
| RSA-1367A | Appeal Rights | 06/01/2019 |
| RSA-1367A-LP | Appeal Rights (Large Print) | 06/01/2019 |
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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