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Form NumberForm NameEffective DatePDFWord
FA-001 Application for Benefits 03/01/2014 448 KB
FA-001-S Solicitud de Beneficios 03/01/2014 517 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-061-FF Tribal Records Request 10/01/2006 176KBS
FA-063-FF Verification of Loan 04/01/2007 194KBS
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-070 Verification of Child Support Income 07/01/2007 20KBS
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-PD Fair Hearing Request 06/01/2013 24 KB 64 KB
FA-100-PDS Petición para una Audiencia imparcial 06/01/2013 27 KB 69 KB
FA-155-1-FF Recent Employment/Training Background (Part 1) 11/01/2008 71KBS
FA-155-2-FF Recent Employment/Training Background (Part 2) 01/01/2006 36KBS
FA-157-FF Personal Responsibility Agreement (PRA) 09/01/2007 45KBS
FA-157-FFS Acuerdo de Responsabilidad Personal (PRA) 09/01/2007 49KBS
FA-191-FF Employability Data 06/01/2009 86kbs
FA-257 Individual Development Account Agreement 03/01/2010 51kbs
FA-259-FF Unwed Minor Parent Abuse/Neglect Claim 05/01/2011 72kbs
FA-259-FFS Reclamo de Abuso o Negligencia de Un Padre/Madre Soltero/A Que es Menor de Edad 05/01/2011 80kbs
FA-260-FF Claim of Sexual Assault 01/01/2005 59KBS
FA-260-FFS Reclamo de Asalto Sexual 01/01/2005 68KBS
FA-264-PD Personal Responsibility Agreement (PRA) 10/01/2006 26KBS
FA-264-PDS Acuerdo de Responsabilidad Personal (PRA) 10/01/2006 31KBS
FA-412-FF Change Report (English) 12/01/2012 153 KB
FA-412-FFS Informe de Cambios 12/01/2012 168 KB
FA-501 Hearing Request Record 05/01/2011 113kbs
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 03/01/2013 862 KB
FAA-1221A Verification of Cooperation with the Division of Child Support Enforcement (DCSE) 04/01/2008 265KBS
FAA-1221A Verificación de Cooperación con la División de Sustento para Menores (DCSE) 04/01/2008 95KBS
FAA-1249A Verification of Disability 03/01/2010 178kbs
FAA-1260A Participant's Statement - No Change in Shelter Cost/Utility Allowance (Eng/Span) 03/01/2010 198kbs
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-1344A LIBL Extension Request 06/01/2007 47KBS
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-1415A Illegal Drug Use Statement 02/01/2010 115kbs
FAA-1415AS Declaración Sobre el Uso de Drogas Ilegales 02/01/2010 115kbs
FAA-1433A Information Exchange (FAA/CCA/NEW) 10/01/2010 87kbs
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-1440A STBL Extension Request 04/01/2011 34kbs
FAA-1440AS Solicitud de Extensión del Límite de Beneficios Estatales (STBL por sus siglas en inglés) 04/01/2011 38kbs
FAA-1475A Verification of Out-Of-State Benefits 04/01/2014 99 KB
PAF-588 Don't Take a Chance...Report a Change 04/01/2014 143 KB
PAF-588-S No se arriesgue...¡Informe los cambios! 04/01/2014 161 KB


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