Form CCA-1164A Affidavit of Immunization Exemption for Children in Care - Arizona

Form CCA-1164A Affidavit of Immunization Exemption for Children in Care - Arizona

What Is Form CCA-1164A?

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 CCA-1164A?
A: Form CCA-1164A is the Affidavit of Immunization Exemption for Children in Care in Arizona.

Q: Who is this form for?
A: This form is for children in care in Arizona who are seeking an exemption from immunization requirements.

Q: What is the purpose of this form?
A: The purpose of this form is to provide documentation of an exemption from immunization requirements for children in care.

Q: What information is required on this form?
A: This form requires information about the child in care, the exemption category, and the signature of the person responsible for the child's care.

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Form Details:

  • Released on May 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 CCA-1164A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.

Download Form CCA-1164A Affidavit of Immunization Exemption for Children in Care - Arizona

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  • Form CCA-1164A Affidavit of Immunization Exemption for Children in Care - Arizona, Page 1
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