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Form NumberForm NameEffective DatePDFWord
FA-001 Application for Benefits 05/01/2014 447 KB
FA-001-S Solicitud de Beneficios 05/01/2014 545 KB
FA-001-T-FF Application for Benefits - Additional Applicants 02/01/2012 219 KB
FA-009-FF Referral for Benefits 03/01/2010 212kbs
FA-020-FF Referral for Social Security Number 06/01/2009 71kbs
FA-051-FF Verification of Financial Accounts 02/01/2006 154KBS
FA-053-FF Verification of Employment History 09/01/2007 443KBS
FA-057-FF Land Operations Office Information Request 10/01/2005 527KBS
FA-058-FF Verification of Insurance Value 04/01/2010 91kbs
FA-059-FF Authority to Release Information 02/01/2006 88KBS
FA-060-FF Authority to Release Student Information 10/01/2007 261KBS
FA-065-FF Verification of Living Arrangements/Residential Address 04/01/2009 81kbs
FA-065-FFS Verificación de Arreglos de Vivienda/Dirección Residencial 04/01/2009 75kbs
FA-075-FF Verification of School Attendance 07/01/2003 56KBS
FA-077-FF Information Request and Pending Information Agreement 10/01/2012 125 KB
FA-077-FFS Solicitud de Información y Acuerdo para Proporcionar Información Que Falta 10/01/2012 134 KB
FA-077-PF Information Request and Pending Information Agreement 10/01/2012 149 KB
FA-077-PFS Solicitud de Información y Acuerdo para Proporcionar Información Que Falta 10/01/2012 150 KB
FA-100 Fair Hearing Request 08/01/2014 31 KB 66 KB
FA-100-S Petición para una Audiencia Imparcial 08/01/2014 32 KB 88 KB
FA-255-FF Separate Household Status Statement 04/01/2009 57kbs
FA-255-FFS Afirmación de Hogares por Separado 04/01/2009 56kbs
FA-412-FF Change Report (English) 02/01/2015 166 KB
FA-412-FFS Informe de Cambios 02/01/2015 182 KB
FA-501 Hearing Request Record 05/01/2011 113kbs
FA-559 Termination of Program (TOP) 08/01/2011 41 KB
FA-574-FF Withdrawal or Stop Benefits/Fair Hearing Request 03/01/2010 189kbs
FA-574-FFS Petición para Retirar o Terminar Beneficios/Audiencia Parcial 03/01/2010 205kbs
FA-808-FF Medical Assistance Financial Screen for Behavioral Health Services 10/01/2006 73KBS
FA-837-FF Authorization to Open an IDA 10/01/2006 49KBS
FAA-1004A Designation of EBT Alternate Card Holder (Eng/Span) 03/01/2010 70kbs
FAA-1055A Spread the Word 04/01/2010 168kbs
FAA-1208A Language Notification Flyer 11/01/2014 912 KB
FAA-1249A Verification of Disability 03/01/2010 178kbs
FAA-1340A Authorization for Release of Birth Records/Certificates 08/01/2009 28kbs
FAA-1340AS Autorización para la Liberación de los Archivos/Certificados de Nacimiento 08/01/2009 29kbs
FAA-1353A Affidavit Attesting Citizenship for Cash Assistance and Nutrition Assistance 03/01/2010 51kbs
FAA-1353A-S Afidavít Atestigando Ciudadanía para Asistencia en Efectivo y Asistencia Alimentacia 03/01/2010 53kbs
FAA-1395A Arizona Families F.I.R.S.T. Turn-Around Document 01/01/2009 217kbs
FAA-1436A Verification of Medical Expenses 02/01/2011 94kbs
FAA-1436AS Verificación de Gastos Médicos 02/01/2011 102kbs
FAA-1439A Self-Employment Income Statement 02/01/2011 234kbs
FAA-1439AS Estado de Resultados de Trabajo por Cuenta Propia 02/01/2011 248kbs
FAA-1475A Verification of Out-Of-State Benefits 04/01/2014 99 KB
FAA-1493A Nutrition Assistance Authorized Representative Request 10/01/2013 25 KB
FAA-1493A-S Solicitud de Representante autorizada para Asistencia Alimenticia 10/01/2013 25 KB
FAA-1494A Nutrition Assistance Authorized Representative Removal 10/01/2013 19 KB
FAA-1494A-S Asistencia Alimenticia Remoción de un Representante autorizado 10/01/2013 20 KB
FAA-1506A Customer Statement of No Income 02/01/2015 43 KB
FAA-1506A-S Declaración del Cliente de Qu No Tiene Ingresos 02/01/2015 34 KB
FNS-252-2 Application form - Meal Services 12/03/2014 710 KB
Restaurant Meal Program MOU AZ Restaurant Meals Program MOU 08/22/2011 25 KB
Restaurant Meals Program-Application AZ Restaurant Meals Program-Application 07/28/2009 398kbs
Restaurant Program Instructions AZ Governor's Letter - Restaurant Program Instructions 12/23/2013 100 KB

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