Arizona Department of Economic Security Forms

This form is used for requesting a fair hearing in Arizona.

This document is a Spanish-language form used in Arizona to file a complaint for customer discrimination.

This Form is used for designating a substitute cardholder for an Electronic Benefits Transfer (EBT) card in Arizona. It is written in Spanish.

This form is used for filing a discrimination complaint against a client in Arizona. It allows individuals to report any instances of discrimination they may have experienced in their interactions with a client.

This Form is used for designating an alternate cardholder for Electronic Benefit Transfer (EBT) in the state of Arizona.

This form is used for requesting the withdrawal or termination of the Arizona FORFF program.

This document is used for the verification of housing arrangements/residential address in Arizona.

This type of document is used for creating a personalized service plan for families in Arizona. It is designed to help support and address the unique needs of the family.

This form is used for the disposition of the Program Review Committee (PRC) in Arizona.

This document is a transfer file checklist form for individuals in Arizona. It helps ensure that all necessary documents are included when transferring files.

This Form is used for creating a staffing schedule for habilitation IDLA staff in Arizona.

This form is used for summarizing child indicators in the state of Arizona.

This document is a Spanish form used for creating a trust for customer services in Arizona.

This document is a Spanish form used in Arizona for the agreement of a treatment plan for behavior.

This form is used for public education agencies in Arizona to notify or refer students for any specific education-related purposes.

This form is used for requesting a complaint in Arizona.

This Form is used for submitting a claim request in Arizona. It is in Spanish.

This Form is used for requesting approval of incentives for adult and dislocated workers under the Workforce Innovation and Opportunity Act (WIOA) Title I-B program in Arizona.

This Form is used for claimants in Arizona to provide information about their federal civilian service, wages, and reason for separation when applying for unemployment benefits under the UCFE program.

This form is used for providing acceptable proof of good cause in the state of Arizona.

This form is used for disclosing transportation-related expenses and the disclaimer for Arizona.

This document is a Spanish form used in Arizona to request an exemption for transportation expenses.

This Form is used for referring a patient to a healthcare provider in Arizona.