You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Number | Document Name | Effective Date |
---|---|---|
AAA-1296A | Protect Yourself and Medicare | 05/01/2023 |
FAA-1366A | Eligibility Requirements | 05/01/2023 |
FAA-0065A-LP | Verification of Living Arrangements/Residential Address - Large Print (English) | 05/01/2023 |
FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request - Large Print (English) | 05/01/2023 |
FAA-1506A-S | Statement of No Income (Spanish) | 05/01/2023 |
FAA-1353A-S | Affidavit Attesting Citizenship for Cash Assistance and Nutrition Assistance (Spanish) | 05/01/2023 |
AzEIP-TAB-05012023 | Updated Consent to Bill Health Insurance form (GCI-1041A) Guidance Technical Assistance Bulletin | 05/01/2023 |
FAA-0574A-SLP | Withdrawal or Stop Benefits/Appeal Request - Large Print (Spanish) | 05/01/2023 |
GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
FAA-0051A | Verification of Financial Accounts (English) | 05/01/2023 |
Number | Document Name | Effective Date |
---|---|---|
SNA-1012A | SNA E&T Referral to Provider | 11/01/2018 |
SNA-1045A | Acceptable Proof of Good Cause (English) | 11/01/2018 |
SNA-1045A-S | Acceptable Proof of Good Cause (Spanish) | 11/01/2018 |
SNA-1012AS | SNA E&T Referral to Provider (Spanish) | 11/01/2018 |
SNA-1023A-S | Acuerdo Para Prácticas Laborales | 11/01/2018 |
AH-800 | AHCCCS Information for Applicants | 11/01/2018 |
AH-800-S | ¿Qué Servicios Cubre el Seguro de Salud de AHCCCS? | 11/01/2018 |
CC-228 | Self-Employment Budget Record | 10/01/2018 |
CC-228-S | Registro Presupuestario de empleo propio | 10/01/2018 |
DD-524-FFS | Autorización para Entregar Información | 10/01/2018 |
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