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-0098C-S | Solicitud de Audiencia por Ajuste de Transacción EBT | 05/01/2023 |
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FAA-1249A | Verification of Disability | 05/01/2023 |
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FAA-1565A-S | Acuerdo de Prueba de Drogas para recibir Asistencia Nutricional | 05/01/2023 |
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FAA-1506A-S | Statement of No Income (Spanish) | 05/01/2023 |
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FAA-1353A-S | Afidávit que Certifica la Ciudadanía para recibir Asistencia en Efectivo y Asistencia Nutricional | 05/01/2023 |
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FAA-1533A | Verification of Unfitness for Work for Adults | 05/01/2023 |
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AzEIP-TAB-05012023 | Updated Consent to Bill Health Insurance form (GCI-1041A) Guidance Technical Assistance Bulletin | 05/01/2023 |
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FAA-1249A-LP | Verification of Disability (Large Print) | 05/01/2023 |
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FAA-0065A-LP | Verification of Living Arrangements/Residential Address - Large Print (English) | 05/01/2023 |
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FAA-1004A-XLP | Designation of EBT Alternate Card Holder - Extra Large Print (English) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
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UIB-0098F | Job Offer Development, Referral, Eligibility Investigation Record | 06/01/2021 |
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DDD-2107A | What Works and What Doesn't Work Worksheet | 06/01/2021 |
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DDD-2106A | Member's Circles of Support | 06/01/2021 |
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DDD-2107A-S | Hoja de Trabajo Sobre lo que Funciona y lo que no Funciona | 06/01/2021 |
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UIB-0098C | Eligibility Investigation Record - WC ALT. Base Period | 06/01/2021 |
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DDD-2106A-S | Círculos de Apoyo del Miembro | 06/01/2021 |
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UIB-0126A | Request for Reconsideration/Appeal (English) | 06/01/2021 |
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UIB-0126A-S | Request for Reconsideration/Appeal (Spanish) | 06/01/2021 |
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UIB-0098K | Eligibility Investigation Record - Transient Lodging Seasonal Employment | 06/01/2021 |
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UIB-0098M | Record of Employment | 06/01/2021 |
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