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-0412A | Change Report (English) | 05/01/2023 |
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FAA-1799A | Drug/Alcohol Treatment Center Training Acknowledgment | 05/01/2023 |
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FAA-0259A-S | Denuncia de Abuso o Negligencia de un Padre Soltero que es Menor de Edad | 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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CCA-1163A | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger | 05/01/2023 |
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FAA-1506A-S | Statement of No Income (Spanish) | 05/01/2023 |
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FAA-0255A-S | Afirmación De Hogares Por Separado | 05/01/2023 |
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FAA-0574A-S | Retirar o Suspender Beneficios/Solicitud de Apelación | 05/01/2023 |
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FAA-1546A | Sponsor Deeming Information | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CCA-0024A-S | Employment and Wage Verification Statement (Spanish) | 11/01/2021 |
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CCA-0024A | Employment and Wage Verification Statement (English) | 11/01/2021 |
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CCA-0044A | Verification of Shelter Case Plan (English) | 11/01/2021 |
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DDD-1984A | Behavior Plan / Packet Requirements (English) | 11/01/2021 |
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GCI-1098A | AzEIP Public Awareness Materials Order Form | 11/01/2021 |
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DDD-1984A-S | Behavior Plan / Packet Requirements (Spanish) | 11/01/2021 |
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CCA-1186A | Authority to Release Information | 11/01/2021 |
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DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
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SNA-1066A | Voluntary Participation Agreement | 10/01/2021 |
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DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 09/01/2021 |
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