Renters and landlords impacted by the COVID-19 pandemic in twelve Arizona counties may now apply for rent and utility assistance through the Emergency Rental Assistance Program. Learn more.
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| Download | Number | Name | Effective Date |
|---|---|---|---|
|
FAA-1004A-XLP | Designation of EBT Alternate Card Holder (Extra Large Print) | 06/01/2019 |
|
CCA-1259A-S | Formulario previo a la Solicitud de Proveedor de Cuidado de Niños Certificado por el DES | 06/01/2019 |
|
FAA-1004A-SXLP | Designación de Titular Sustituo para la Tarjeta de EBT (Letra Extra Grande) | 06/01/2019 |
|
UB-099-Y | Certification of Understanding (Eng/Span) | 07/01/2019 |
|
FAA-0574A | Withdrawal or Stop Benefits/Appeal Request | 07/01/2019 |
|
RSA-1312A | Authorization for Disclosure of Health Information to RSA | 07/01/2019 |
|
FAA-0574A-S | Retirar o Suspender Beneficios/Solicitud de Apelación | 07/01/2019 |
|
LCR-1007A | Home Visit Report Supplement to Notice of Inspection and Due Process Rights | 07/01/2019 |
|
RSA-1312A-S | Autorización Para Divulgación De Información De Salud a RSA | 07/01/2019 |
|
GCI-1049A | No Contact Letter | 07/01/2019 |
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