You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
|
FAA-0051A | Verification of Financial Accounts (English) | 05/01/2023 |
|
FAA-1004A | Designation of EBT Alternate Card Holder (English) | 05/01/2023 |
|
FAA-0574A-SLP | Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Grande) | 05/01/2023 |
|
FAA-1506A | Statement of No Income (English) | 05/01/2023 |
|
FAA-1799A | Drug/Alcohol Treatment Center Training Acknowledgment | 05/01/2023 |
|
GCI-1041A-S | Consentimiento para el Uso del Seguro de Salud | 05/01/2023 |
|
FAA-0412A-LP | Change Report - Large Print (English) | 05/01/2023 |
|
FAA-0098C | EBT Transaction Adjustment Hearing Request | 05/01/2023 |
|
CCA-1163A-S | Afidávit de Exención de Vacunación - Para Miembros del Hogar de 13 años de edad y Menores | 05/01/2023 |
|
FAA-1353A-S | Afidávit que Certifica la Ciudadanía para recibir Asistencia en Efectivo y Asistencia Nutricional | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
GCI-1098A | AzEIP Public Awareness Materials Order Form | 11/01/2021 |
|
CCA-0044A | Verification of Shelter Case Plan (English) | 11/01/2021 |
|
CCA-0024A | Employment and Wage Verification Statement (English) | 11/01/2021 |
|
DDD-1984A | Behavior Plan / Packet Requirements (English) | 11/01/2021 |
|
DDD-1984A-S | Behavior Plan / Packet Requirements (Spanish) | 11/01/2021 |
|
DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
|
SNA-1066A | Voluntary Participation Agreement | 10/01/2021 |
|
CSE-1129A | Electronic Payment Authorization (English) | 09/01/2021 |
|
CSE-1129A-S | Electronic Payment Authorization (Spanish) | 09/01/2021 |
|
DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 09/01/2021 |
Stay up-to-date with news and updates delivered straight to your inbox
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