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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 |
|---|---|---|
| FAA-0255A | Separate Household Status Statement | 05/01/2023 |
| GCI-1041A-S | Consentimiento para el Uso del Seguro de Salud | 05/01/2023 |
| AzEIP-TAB-05012023 | Updated Consent to Bill Health Insurance form (GCI-1041A) Guidance Technical Assistance Bulletin | 05/01/2023 |
| FAA-0574A-S | Retirar o Suspender Beneficios/Solicitud de Apelación | 05/01/2023 |
| FAA-1701A | Verification of Terminated Employment (English) | 05/01/2023 |
| FAA-1725A | Verification of Other Income | 05/01/2023 |
| FAA-1768A-S | Formulario de Solicitud de Reducción de Pago en Exceso | 05/01/2023 |
| FAA-1799A | Drug/Alcohol Treatment Center Training Acknowledgment | 05/01/2023 |
| CCA-1163A | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger (English) | 05/01/2023 |
| FAA-1353A-S | Afidávit que Certifica la Ciudadanía para recibir Asistencia en Efectivo y Asistencia Nutricional | 05/01/2023 |
| Number | Document Name | Effective Date |
|---|---|---|
| DDD-1532A | Hardship Reduction Request (English) | 09/01/2019 |
| DDD-1532A-S | Hardship Reduction Request (Spanish) | 09/01/2019 |
| CSE-1007 | Customer Satisfaction Survey | 09/01/2019 |
| DDD-0403A | Reference Request (English) | 09/01/2019 |
| RSA-1376A | Request for Vending Services Placement | 08/01/2019 |
| UIB-0098A | Eligibility Investigation Record | 08/01/2019 |
| DDD-0524A | Authorization for Release of Information (English) | 08/01/2019 |
| UIA-1060A | Filing of Weekly Claims (English/Spanish) | 08/01/2019 |
| DDD-0524A-S | Authorization for Release of Information (Spanish) | 08/01/2019 |
| DDD-1328A | Referral to Vocational Rehabilitation (English) | 08/01/2019 |
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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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