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Download Number Form Name Effective Date
DD-099-B Pre-PAS Screening Tool for Members at Least 2 Years 10 Months Old, But Less than 6 Years Old 03/01/2018
DD-099-C Pre-PAS Screening Tool Only for Members between 6 and 11 Years Old 03/01/2018
DD-099-D Pre-PAS Screening Tool for Members At Least 12 Years Old 03/01/2018
FAA-1353A Affidavit Attesting Citizenship for Cash Assistance and Nutrition Assistance 03/01/2018
UB-092 Request for Waiver of Overpayment 03/01/2018
DES-1076AS Solicitud Para La Búsqueda En El Registro Central Con Objetivo De Verificar Antecedentes 03/01/2018
WIO-1031A Training Provider Assurances 03/01/2018
UB-092-A Confidential Financial Statement 03/01/2018
WIO-1040A Training Provider Assurances 03/01/2018
UB-092-A-S Declaración Financiera Confidencial 03/01/2018

Download Number Form Name Effective Date
Tribal Consultation Report 2012 Tribal Consultation Report 2012 09/17/2012
30th Month 13th 2012 30th Month Report 13th Fiscal Year 2012 09/11/2012
DES Welfare-2012 DES Welfare Report 2012 09/01/2012
Statistical Bulletin July 2012 Statistical Bulletin July 2012 08/15/2012
30th Month Jun-2012 30th Month Report June Fiscal Year 2012 08/08/2012
Statistical Bulletin June 2012 Statistical Bulletin June 2012 07/30/2012
Application for Federal Funds FFY 2012 Arizona's Part C FFY 2012 Application for Federal Funds 07/27/2012
30th Month May-2012 30th Month Report May Fiscal Year 2012 07/23/2012
SSBG Plan 2012-2013 Social Services Block Grant Plan 2012-2013 07/01/2012
30th Month Apr-2012 30th Month Report April Fiscal Year 2012 06/14/2012

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Download Number Form Name Effective Date
FAA-1217A Request for Verification of Godparent Specified Relative 09/01/2018
AAA-1304A Home and Community Based Services 09/01/2018
J-020-LP Client Discrimination Complaint (Large Print) 09/01/2018
FAA-1402A San Carlos Apache Tribe TANF Referral Notice 09/01/2018
DES-1059A Authorization to Release Information 09/01/2018
UB-010 Eligibility Review Questionnaire 09/01/2018
DDD-1749A Support Coordinator Guide to AAC Evaluation Referrals 09/01/2018
SNA-1000A Rights and Responsibilities 09/01/2018
UB-010-S Cuestionario para Revisión de Admisibilidad 09/01/2018
DES-1077A Notice of Privacy Practices 09/01/2018

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