You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Number | Document Name | Effective Date |
---|---|---|
DDD-1426A | Request for Incontinence Briefs for Members Ages 3 and Above (English) | 08/01/2023 |
DES-1024A | Request for Identity & Citizenship or Immigration Status Determination Turn-Around Document (TAD) (English) | 07/01/2022 |
APS-1043A | Request for an Untimely Hearing (English) | 12/01/2024 |
DDD-2173A | Request for Amended/Correction of Protected Health Information (PHI) | 02/01/2023 |
DCS-1377A-S | Request for Administrative Review Received (Spanish) | 01/01/2025 |
DCS-1339A | Request for Administrative Review (Seizure of Property) | 06/01/2022 |
DDD-2082A-S | Reportando Sospechas de Abuso, Negligencia, o Explotación | 09/01/2020 |
DDD-2082A | Report Suspected Abuse, Neglect or Exploitation | 09/01/2020 |
UB-296-S | Report of Illness or Physical Disability (Spanish) | 05/01/2018 |
UB-296 | Report of Illness or Physical Disability (English) | 05/01/2018 |
Number | Document Name | Effective Date |
---|---|---|
UB-010-S | Eligibility Review Questionnaire (Spanish) | 02/01/2021 |
UB-010 | Eligibility Review Questionnaire (English) | 02/01/2021 |
FAA-1366A | Eligibility Requirements | 05/01/2023 |
UIB-0098G | Eligibility Investigation Record -Vacation, Holiday, Sick or Severance Pay (English) | 07/01/2018 |
UIB-0098C | Eligibility Investigation Record - WC ALT. Base Period | 06/01/2021 |
UIB-0098K | Eligibility Investigation Record - Transient Lodging Seasonal Employment | 06/01/2021 |
UIB-0098B | Eligibility Investigation Record - Pension | 06/01/2021 |
UIB-0098E | Eligibility Investigation Record - Education/School Bus Wages | 06/01/2021 |
UIB-0098D | Eligibility Investigation Record - Administrative Penalty | 09/01/2018 |
UIB-0098A | Eligibility Investigation Record | 08/01/2019 |
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