You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
|
CCA-1163A | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger | 05/01/2023 |
|
CSE-0258A | Affidavit of Paternity Rescission (English/Spanish) | 12/01/2020 |
|
CSE-1156A | Affidavit of Receipt of Direct Payments (English/Spanish) | 09/01/2023 |
|
FAA-1796A | Affidavit of Visually Viewed Documentation | 02/01/2021 |
|
CSE-0454A | Affidavit Supporting Paternity (English) | 03/01/2024 |
|
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 |
|
FAA-0255A-S | Afirmación De Hogares Por Separado | 05/01/2023 |
|
UB-101-B-FFS | Afirmación del Plan de Acción para Búsqueda de Trabajo | 11/01/2011 |
|
DDD-2250A | Age 18 Redetermination Packet (English) | 11/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
DDD-2089A | DDD Person Centered Service Plan (English) | 01/01/2024 |
|
DDD-2089A-S | DDD Person Centered Service Plan (Spanish) | 01/01/2024 |
|
DDD-2089A-LP | DDD Person Centered Service Plan - Large Print (English) | 01/01/2024 |
|
DDD-2089A-SLP | DDD Person Centered Service Plan - Large Print (Spanish) | 01/01/2024 |
|
DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
|
DDD-2113A | DDD-EVV Member Contingency / IP Model Back-up Plan (English) | 01/01/2022 |
|
DDD-2113A-S | DDD-EVV Member Contingency / IP Model Back-up Plan (Spanish) | 01/01/2022 |
|
DDD-2218A | Debarment, Suspension, Ineligibility, And Voluntary Exclusion Lower Tier Covered Transaction (English) | 08/01/2023 |
|
CCA-1161A-S | Declaración de Autosuficiencia | 09/01/2018 |
|
CCA-0201A-S | Declaración de Certificación para Proveer Servicios de Cuidado de Niños | 12/01/2020 |
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