Arizona Department of Economic Security Forms

This Form is used for obtaining authorization to disclose health information to RSA - Arizona.

This form is used for authorizing the release of RSA records, including HIPAA covered records in the state of Arizona.

This type of document is a RSA-1313A FORSPA authorization form used in Arizona. It is used for granting permission to disclose RSA records, including those covered by HIPAA.

This form is used for filing a quarterly report on employment support aide services in Arizona.

This document is used for submitting a six-month report for those transitioning to employment in the state of Arizona.

This form is used for a quality assurance review in the transition to employment process in Arizona.

This Form is used for requesting a verbal fair hearing in Arizona.

This form is used for the Arizona Disaster Nutrition Assistance Program (DNAP). It includes forms and desk aids specific to the program.

This form is used for verifying the unfitness for work for adults in Arizona.

This form is used for obtaining consent to share early intervention referral and initial IFSP (Individualized Family Service Plan) date in Arizona.

This form is used for applying for Disaster Nutrition Assistance in Arizona.

This Form is used for applying for benefits in Arizona. The form is specifically designed for individuals who are seeking financial assistance.

This form is used for notifying individuals in Arizona that their DNA test request has been denied by the Federal Aviation Administration (FAA).

This form is used for notifying individuals in Arizona about their participation and referral status for the ABLE-BODIED ADULT WITHOUT DEPENDENTS (ABAWD) program.

This form is used for keeping track of income and expenses for self-employed individuals in Arizona. It helps in budgeting and financial planning for self-employment.

This document is the CC-228-S Budgetary Employment Registry form for self-employed individuals in Arizona. It is used to register employment information for budgeting purposes.

This document is used for employment and wage verification in the state of Arizona. It is typically required when applying for certain benefits or loans.

This document is used for verifying salary and employment in Arizona.

This document is a guide for support coordinators in Arizona on how to make referrals for AAC (Augmentative and Alternative Communication) evaluations. It provides instructions and information on the process.

This form is used for reporting monthly legal services assistance in Arizona.

This form is used for authorizing the release of information in Arizona. It is available in both English and Spanish.

This form is used for referring individuals to the Temporary Assistance for Needy Families (TANF) program in the San Carlos Apache Tribe in Arizona.

This Form is used for verifying employment history in the state of Arizona.

This form is used for verifying living arrangements and residential address in Arizona.

This form is used for outlining the rights and responsibilities of individuals receiving child care assistance in Arizona.

This Form is used for requesting information and creating an agreement to provide pending information in the state of Arizona.

This form is used for understanding and outlining the rights and responsibilities of individuals under the Arizona Department of Public Safety.

This form is used for referring tribal Native Americans in Arizona to the Native Employment Works program.

This Form is used for declaring the physical custody of a minor or minors by a caregiver in Arizona.

This Form is used for outlining the rights and responsibilities of child care assistance in Arizona.

This form is used for requesting verification of a godparent or specified relative in the state of Arizona.