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Reports, Forms, Pamphlets and Policies

You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services. 

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Download Number Name Effective Date
FAA-0065A Verification of Living Arrangements/Residential Address 05/01/2023
FAA-1004A-S Designation of EBT Alternate Card Holder (Spanish) 05/01/2023
​FAA-0412A-XLP ​Change Report - Extra Large Print (English) 05/01/2023
FAA-1768A Overpayment Compromise Request Form 05/01/2023
FAA-1494A Authorized Representative Removal 05/01/2023
​FAA-0412A-LP ​Change Report - Large Print (English) 05/01/2023
FAA-1768A-S Formulario de Solicitud de Reducción de Pago en Exceso 05/01/2023
FAA-0574A Withdrawal or Stop Benefits/Appeal Request 05/01/2023
FAA-0574A-XLP Withdrawal or Stop Benefits/Appeal Request (Large Extra Print) 05/01/2023
​FAA-0412A ​Change Report (English) 05/01/2023

Download Number Name Effective Date
​FAA-0412A-LP ​Change Report - Large Print (English) 05/01/2023
FAA-1506A Statement of No Income 05/01/2023
FAA-0620A Treatment Center Change Report 05/01/2023
FAA-0051A Verification of Financial Accounts 05/01/2023
FAA-0001U Notice of Non-Discrimination/Aviso De No Discriminación AH-1000 02/01/2023
FAA-1701A-XLP Verification of Terminated Employment (Extra Large Print) 05/01/2022
FAA-1442A Tribal-Authority to Release Information / Autoridad Tribal para Divulgar Información 12/01/2019
FAA-0075A Verification of School Attendance/Verificación de Asistencia Escolar 12/01/2019
AH-800 AHCCCS Information for Applicants 11/01/2018
AH-800-S ¿Qué Servicios Cubre el Seguro de Salud de AHCCCS? 11/01/2018

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