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Form JOB-1117A Authorization to Release Ahcccs Health Insurance Eligibility Information to the Jobs Program Private Contractor - Arizona
What Is Form JOB-1117A?
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 the JOB-1117A form?
A: The JOB-1117A form is an authorization form.
Q: What does the JOB-1117A form authorize?
A: It authorizes the release of Ahcccs health insurance eligibility information.
Q: Who is the recipient of the Ahcccs health insurance eligibility information?
A: The recipient is the Jobs Program Private Contractor in Arizona.
Form Details:
- Released on January 1, 2023;
- 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 JOB-1117A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.
