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Download Number Form Name Effective Date
FAA-1573A Rights and Responsibilities 12/01/2019
FAA-1573A-XLP Rights and Responsibilities (Extra Large Print) 12/01/2019
FAA-1573A-LP Rights and Responsibilities (Large Print) 12/01/2019
FAA-1439A Self-Employment Income Statement 09/01/2019
FAA-1439A-XLP Self-Employment Income Statement (Extra Large Print) 09/01/2019
FAA-1439A-LP Self-Employment Income Statement (Large Print) 09/01/2019
FAA-0255A Separate Household Status Statement 12/01/2019
FAA-0098A-S Solicitud de Apelación 12/01/2019
FAA-0098A-XLPS Solicitud de Apelación (Letra Extra Grande) 12/04/2019
FAA-0098A-LPS Solicitud de Apelación (Letra Grande) 12/31/2019

Download Number Form Name Effective Date
30th Month April 2013 30th Month Report April Fiscal Year 2013 06/10/2013
30th Month April 2014 30th Month Report April Fiscal Year 2014 07/09/2014
30th Month Apr-2015 30th Month Report April Fiscal Year 2015 07/30/2015
30th Month Apr-2016 30th Month Report April Fiscal Year 2016 06/09/2016
30th Month Apr-2017 30th Month Report April Fiscal Year 2017 06/21/2017
30th Month Aug-2010 30th Month Report August Fiscal Year 2010 08/01/2009
30th Month Aug-2011 30th Month Report August Fiscal Year 2011 10/13/2010
30th Month Aug-2012 30th Month Report August Fiscal Year 2012 10/13/2011
30th Month Aug-2013 30th Month Report August Fiscal Year 2013 10/16/2012
30th Month Aug-2014 30th Month Report August Fiscal Year 2014 10/30/2013

No results available.

Download Number Form Name Effective Date
CSE-1276A DCSS Hardship Program 04/01/2019
CSE-1299A DCSS Resource Customer Guide 01/01/2020
DDD-1713A DDD Customer Service Center 07/01/2019
DDD-1759A DDD Eligibility Redetermination 10/01/2019
DDD-1954A DDD Engagement 07/01/2019
DDD-2045A DDD Member Councils 12/04/2019
PAD-588-PDS Decisiones sobre el cuidado de su salud 11/01/2011
PAD-588-PD Decisions About Your Health Care 11/01/2011
PAD-195-S Declaración de Derechos 08/01/2013
PAD-465-C Definitions for AHCCCS Members 01/01/2018


Download Number Form Name
 		Effective Date
FAA-1759A-S No se arriesgue...¡Informe los cambios! 01/01/2020
FA-001-U Notice of Non-Discrimination/Aviso De No Discriminación AH-1000 03/01/2017
FAA-1493A-LP Nutrition Assistance Authorized Representative Request (Large Print) 08/01/2019
FAA-1403A Nutrition Assistance Benefits Increase Poster 03/01/2009
FAA-1565A Nutrition Assistance Drug Testing Agreement 12/01/2018
POF-126 Nutrition Assistance Frequently Asked Questions 03/01/2018
FAA-1375A Nutrition Assistance Posters 04/01/2019
OPE-1008A Office of Program Evaluation 09/01/2009
OPE-1008AS Office of Program Evaluation (Spanish) 09/01/2009
FAA-1724A-S Páginas de Firma de la Solicitud 12/01/2019

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