FAA1.D Application Requirements : 02 Official Applications - Overview : B Official Applications - AHCCCS Applications
B Official Applications - AHCCCS Applications
 
(10/01/10 –12/31/10)
FAA accepts the following applications as OFFICIAL applications for ALL AHCCCS Title XIX programs:
 
Application for AHCCCS Health Insurance (AH‑001)
Application for AHCCCS Health Insurance (FAA-0001‑H)
Application for AHCCCS Health Insurance and Medicare Savings Programs (DE-103)
Application for Arizona Long Term Care System (ALTCS) (DE‑101, 102, and 104)
Health-e-Arizona Plus online application
KidsCare (KC‑108)
Any other DES/FAA approved application form used for FAA pilot programs or projects
 
NOTE ALL FAA site codes must stock the FAA-0001‑H.
 
When an application for assistance or benefits is received that is NOT listed as an official AHCCCS application, see Acceptable Applications.