You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Number | Document Name | Effective Date |
---|---|---|
DES-1024A | Request for Identity & Citizenship or Immigration Status Determination Turn-Around Document (TAD) (English) | 07/01/2022 |
DDD-2173A | Request for Amended/Correction of Protected Health Information (PHI) | 02/01/2023 |
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 |
UC-514 | Report of Changes Form (English) | 03/01/2018 |
FAA-1842A | Replacement of Nutrition Assistance Benefits - Food Destroyed in a Disaster/Misfortune | 10/01/2023 |
DDD-2323A-S | Repair or Replacement of the Augmentative and Alternative Communication (AAC) System (Spanish) | 11/01/2024 |
Number | Document Name | Effective Date |
---|---|---|
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 |
DDD-2101A-S | Electronic Visit Verification (EVV) Paper Timesheet Attestation (Spanish) | 09/01/2021 |
DDD-2101A | Electronic Visit Verification (EVV) Paper Timesheet Attestation (English) | 09/01/2021 |
DDD-2099A-S | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan (Spanish) | 09/01/2021 |
DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan (English) | 09/01/2021 |
DDD-2102A-S | Electronic Visit Verification (EVV) Designee Attestation (Spanish) | 09/01/2021 |
DDD-2102A | Electronic Visit Verification (EVV) Designee Attestation (English) | 09/01/2021 |
CSE-1129A-S | Electronic Payment Authorization (Spanish) | 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