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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CCA-1163A | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger | 05/01/2023 |
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FAA-1725A-S | Verificación de Otros Ingresos | 05/01/2023 |
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FAA-0098C-S | Solicitud de Audiencia por Ajuste de Transacción EBT | 05/01/2023 |
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FAA-1506A-S | Statement of No Income (Spanish) | 05/01/2023 |
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FAA-1506A | Statement of No Income (English) | 05/01/2023 |
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FAA-0574A-XLP | Withdrawal or Stop Benefits/Appeal Request (Large Extra Print) | 05/01/2023 |
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FAA-1004A | Designation of EBT Alternate Card Holder (English) | 05/01/2023 |
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FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request (Large Print) | 05/01/2023 |
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CCA-1163A-S | Afidávit de Exención de Vacunación - Para Miembros del Hogar de 13 años de edad y Menores | 05/01/2023 |
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FAA-1765A-S | Autoridad para Divulgar Información | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CSE-1129A-S | Electronic Payment Authorization (Spanish) | 09/01/2021 |
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CSE-1281A | Agreement to Accept Service by Mail Paternity or Establishment (English/Spanish) | 09/01/2021 |
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DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 09/01/2021 |
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LCR-1085A | Adult Protective Services Records Check Request | 08/01/2021 |
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AAA-1369A | Quarterly Report Packet | 08/01/2021 |
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AAA-1344A | Direct Service Position | 08/01/2021 |
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AAA-1344A-S | Posición de Servicio Directo | 08/01/2021 |
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FAA-1810A | Register to vote (Bilingual) | 08/01/2021 |
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DERS-1057A | Direct Service Position | 08/01/2021 |
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CCA-1212A | Direct Service Position (Certification Form) | 07/01/2021 |
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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