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Form NumberForm NameEffective DatePDFWord
FA-001 Application for Benefits 08/01/2015 430 KB
FA-001-S Aplicación de Beneficios 08/01/2015 525 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 05/01/2015 80 KB
FA-053-FF Verification of Employment History 05/01/2015 213 KB
FA-057-FF Land Operations Office Information Request 10/01/2005 527KBS
FA-058-FF Verification of Insurance Value 05/01/2015 80 KB
FA-059-FF Authority to Release Information 05/01/2015 59 KB
FA-060-FF Authority to Release Student Information 05/01/2015 79 KB
FA-065-FF Verification of Living Arrangements/Residential Address 05/01/2015 78 KB
FA-065-FFS Verificación de Arreglos de Vivienda/Dirección Residencial 05/01/2015 74 KB
FA-075-FF Verification of School Attendance 05/01/2015 58 KB
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 / Fair Hearing Rights 04/01/2015 36 KB
FA-100-S Petición para una Audiencia Imparcial 04/01/2015 36 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) 02/01/2015 166 KB
FA-412-FFS Informe de Cambios 02/01/2015 182 KB
FA-501 Hearing Request Record 05/01/2015 111 KB
FA-574-FF Withdrawal or Stop Benefits/Fair Hearing Request 05/01/2015 58 KB
FA-574-FFS Petición para Retirar o Terminar Beneficios/Audiencia Parcial 05/01/2015 64 KB
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) 05/01/2015 68 KB
FAA-1055A Spread the Word 05/01/2015 233 KB
FAA-1097A Young Adult Transitional Insurance (YATI) Referral 08/01/2015 125 KB
FAA-1208A Language Notification Flyer 11/01/2014 912 KB
FAA-1221A Verification of Cooperation with the Division of Child Support Services (DCSS) 06/01/2015 86 KB
FAA-1221A-S Verificación de Cooperación con la División de Sustento para Menores (DCSE) 06/01/2015 86 KB
FAA-1249A Verification of Disability 05/01/2015 70 KB
FAA-1320A Pascua Yaqui TANF Personal Responsibility Agreement (PY-PRA) 04/01/2007 168 KB
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 05/01/2015 95 KB
FAA-1436AS Verificación de Gastos Médicos 05/01/2015 103 KB
FAA-1439A Self-Employment Income Statement 05/01/2015 232 KB
FAA-1439AS Estado de Resultados de Trabajo por Cuenta Propia 05/01/2015 242 KB
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 09/01/2015 114 KB
FAA-1506A Customer Statement of No Income 05/01/2015 36 KB
FAA-1506A-S Declaración del Cliente de Qu No Tiene Ingresos 05/01/2015 36 KB
FAA-1515A Statement of Expenses for Nutrition Assistance 07/01/2015 44 KB

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