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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 |
|---|---|---|
| J-930-A | Request for Modification/Accomodation to Participate in A Program, Service, or Activity (Confidential) (English) | 07/01/2020 |
| J-930-A-LP | Request for Modification/Accomodation to Participate in A Program, Service, or Activity (Confidential) - Large Print (English) | 07/01/2024 |
| 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 |
| 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 |
| Number | Document Name | Effective Date |
|---|---|---|
| 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 |
| 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 |
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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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