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Download Number Form Name Effective Date
FAA-1493A-S Solicitud de Representante Autorizado 08/01/2019
FAA-1493A-XLPS Solicitud de Representante Autorizado (Letra Extra Grande) 08/01/2019
FAA-1493A-LPS Solicitud de Representante Autorizado (Letra Grande) 08/01/2019
FAA-1362A-S Solicitud para reemplazo / suplemento de asistencia nutricional 11/01/2017
FAA-1546A Sponsor Deeming Information 08/01/2016
FAA-1055A Spread the Word (Eng/Span) 05/01/2015
FA-065-FFS Verificación de Arreglos de Vivienda/Dirección Residencial 07/01/2017
FAA-1249A Verification of Disability 07/01/2019
FAA-1249A-XLP Verification of Disability 07/01/2019
FAA-1249A-LP Verification of Disability (Large Print) 07/01/2019

Download Number Form Name Effective Date
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
30th Month Aug-2015 30th Month Report August Fiscal Year 2015 10/27/2014
30th Month Aug-2016 30th Month Report August Fiscal Year 2016 10/14/2015
30th Month Aug-2016 30th Month Report August Fiscal Year 2017 10/27/2016
30th Month Dec-2010 30th Month Report December Fiscal Year 2010 12/01/2009
30th Month Dec-2011 30th Month Report December Fiscal Year 2011 02/11/2011
30th Month Dec-2012 30th Month Report December Fiscal Year 2012 02/15/2012

No results available.

Download Number Form Name Effective Date
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
DDD-1795APAMPD Dental Care Adult (Ages 21+) 12/01/2016
DDD-1698A Dental Care Ages Birth-21 04/01/2015
GCI-1070A-S Derechos del Menor y la Familia bajo en Programa de Intervención Temprana de Arizona (AzEIP) 07/01/2013
CCA-1182A DES Certified Family Child Care Home Providers 09/01/2013
CC-046 DES Child Care Services Information 09/01/2016
DIR-1022C-S DES en Movimiento 01/01/2017


Download Number Form Name
 		Effective Date
POF-126-S Preguntas Frecuentes Sobre La Asistencia Nutricional 03/01/2018
EN-025-S Programas de Asistencia Alimenticia en Arizona 09/01/2013
PAF-001-B-S Programas de Asistencia, Lo Que Usted Necesite Saber 04/01/2018
FA-009-FF Referral for Benefits 03/01/2010
FA-020-FF Referral for Social Security Number 06/01/2009
FAA-1494A-S Remoción de un Representante Autorizado 08/01/2019
FAA-1494A-XLPS Remoción de un Representante Autorizado (Letra Extra Grande) 08/01/2019
FAA-1494A-LPS Remoción de un Representante Autorizado (Letra Grande) 08/01/2019
FAA-1362A Request for Nutrition Assistance Replacement / Supplement 11/01/2017
FAA-0574A-S Retirar o Suspender Beneficios/Solicitud de Apelación 07/01/2019

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