Arizona Department of Economic Security Forms

This Form is used for sending a special message to your child care specialist in Arizona.

This Form is used for cancelling the direct deposit for Arizona residents. It is written in Spanish.

This form is used for canceling direct deposit for Arizona residents receiving unemployment benefits from the Federal-State Extended Duration program.

This document is an application packet for individuals who want to become instructors for Article 9 of the Arizona Firefighters and Fire Marshals Personnel Retirement Fund (FORFF).

This form is used for applying for IV-D services and genetic testing agreement in Arizona.

This document authorizes the disclosure of protected health information in Arizona.

This Form is used for documenting the work focus requirement for Able-Bodied Adults Without Dependents (ABAWD) in Arizona. It helps individuals applying for assistance benefits to demonstrate their compliance with the work requirements.

This form is used for reporting work activity for individuals receiving benefits under the SNAP Employment and Training (E&T) program in the state of Arizona.

This form is used for referring individuals who may benefit from Augmentative Alternative Communication (AAC) in the state of Arizona. The AAC referral packet includes necessary documentation for assessment and intervention.

This form is used for monitoring training providers in Arizona. It is a tool that helps in the evaluation and oversight of training programs.

This Form is used for applying and agreeing to transfer severable portion experience rating in Arizona.

This form is used for registering and documenting employment history for individuals who provide DES certified services in Arizona.

This Form is used for calculating and recording unpaid co-payments for healthcare services in the state of Arizona.

This form is used for an agreement for direct deposit in Arizona.

This form is used for withdrawing a combined-wage claim in Arizona.

This form is used in Arizona to request a reconsideration or appeal regarding a specific issue.

This form is used for pre-pass screening for children between the ages of 6 and 11 in Arizona.

This form is used for pre-pass screening for children who are at least 2 years and 10 months old, but less than 6 years old in Arizona.

This form is used for pre-pass screening of members who are at least 12 years old in Arizona.

This form is used for the pre-pas screening of children between the ages of 0 and 2 years 10 months old in Arizona.

This Form is used for requesting a waiver for the Forest Fire Commercial Use Authorization (Cobv) in Arizona.

This document is a confidential financial statement form specifically used in Arizona. It is used to provide financial information and details for official purposes.

This is an Arizona legal document needed to verify that you were unemployed during the report week and are eligible to receive Arizona Unemployment Insurance or AZUI.

This form is used for collecting performance measures related to domestic violence housing intervention in Arizona. It helps to track and analyze the effectiveness of interventions in addressing domestic violence situations.

This document is used for the FORFF Training Program Credential Checklist in Arizona.

This document is used as a cover sheet for monthly invoices in Arizona.

This form is used for filing an adjustment report in Arizona. It is typically used to report any changes or updates to your unemployment claim.

This Form is used for authorizing the disclosure of protected health information in the state of Arizona. It is necessary when sharing medical information with third parties.

This form is used for creating a backup provider agreement for family child care homes in Arizona. It covers aspects such as backup care, discipline, and transportation.

This form is used for health self-disclosure in the state of Arizona. It requires individuals to provide information about their health status.

This form is used for requesting a withdrawal or stop of benefits and filing a fair hearing request in Arizona.

This document is for recertifying instructors in Arizona who provide prevention and support for fire and forest emergencies.