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This version of the form is not currently in use and is provided for reference only. Download this version of
Form FAA-1004A
for the current year.
Form FAA-1004A Designation of Ebt Alternate Card Holder - Arizona
What Is Form FAA-1004A?
This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form FAA-1004A?
A: Form FAA-1004A is the Designation of EBT Alternate Card Holder form for Arizona.
Q: What is the purpose of Form FAA-1004A?
A: The purpose of Form FAA-1004A is to designate an alternate cardholder for Electronic Benefit Transfer (EBT) in Arizona.
Q: Who needs to fill out Form FAA-1004A?
A: Any individual who wishes to designate an alternate cardholder for their EBT benefits in Arizona needs to fill out Form FAA-1004A.
Q: Is there a fee for submitting Form FAA-1004A?
A: No, there is no fee for submitting Form FAA-1004A.
Q: Can I designate more than one alternate cardholder?
A: Yes, you can designate multiple alternate cardholders on Form FAA-1004A.
Q: What information do I need to provide on Form FAA-1004A?
A: You will need to provide your name, address, phone number, EBT card number, and the name and information of the alternate cardholders you wish to designate.
Q: What happens after I submit Form FAA-1004A?
A: After you submit Form FAA-1004A, the Arizona Department of Economic Security will process your request and update your EBT account accordingly.
Form Details:
- Released on August 1, 2021;
- The latest edition provided by the Arizona Department of Economic Security;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form FAA-1004A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.
