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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 |
|---|---|---|
| DDD-1580A | Reversal Adjustment Request Cover Sheet (English) | 02/01/2023 |
| CCA-1216A | Notice to All Families Enrolled at DES Child Care Facility/Aviso A Todas Las Familias Inscritas En Una Instalación De Cuidado De Niños Del DES | 02/01/2023 |
| DDD-2173A | Request for Amended/Correction of Protected Health Information (PHI) | 02/01/2023 |
| LCR-1084A-S | Application for Renewal or Amended HCBS Certificate for Independent Providers (Spanish) | 02/01/2023 |
| DDD-1883A-S | ¿Qué es PASRR? Una guía para las familias | 02/01/2023 |
| DDD-2171A | Accounting Disclosures Tracking | 02/01/2023 |
| DDD-2174A | Request for Restriction of Protected Health Information (PHI) | 02/01/2023 |
| DDD-1658A | Agency With Choice: Individual Representative (English) | 02/01/2023 |
| CSE-1225A | Caretakers Raising Children (English) | 02/01/2023 |
| DDD-1658A-S | Agency With Choice: Individual Representative (Spanish) | 02/01/2023 |
| Number | Document Name | Effective Date |
|---|---|---|
| UB-130A-S | Work History (Spanish) | 03/01/2018 |
| DD-099-A | Pre-PAS Screening Tool Ages 0 Through 2 Years and 10 Months Old | 03/01/2018 |
| DD-099-B | Pre-PAS Screening Tool for Members at Least 2 Years 10 Months Old, But Less than 6 Years Old | 03/01/2018 |
| UB-092-A | Confidential Financial Statement (English) | 03/01/2018 |
| DDD-1651A | COBV Waiver Request (English) | 03/01/2018 |
| DD-099-C | Pre-PAS Screening Tool Only for Members between 6 and 11 Years Old | 03/01/2018 |
| UB-092-A-S | Confidential Financial Statement (Spanish) | 03/01/2018 |
| UC-514 | Report of Changes Form (English) | 03/01/2018 |
| DD-099-D | Pre-PAS Screening Tool for Members At Least 12 Years Old | 03/01/2018 |
| CSE-1284A | Parent’s agreement to be bound by genetic test results (Eng/Spa) | 02/01/2018 |
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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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