FAA2.A The Application : 03 Application Requirements
Application Requirements
Information on this page refers to the Nutrition Assistance program Information on this page refers to the Cash Assistance program
Persons applying for benefits in the state of Arizona are required to use an official Family Assistance Administration (FAA) application. The official FAA application is used during the application process when determining eligibility.
Policy
How to Apply – Official Applications and Where to Find Them
Benefits can only be requested using an official application. It is required that the official application is an identifiable application in order to be accepted for processing.
An identifiable application includes all of the following:
Name of the applicant
Residential or mailing address
Signature of the Primary Informant(g), responsible adult participant, or the Authorized Representative
NOTE When FAA receives an official application that is missing one or more of the requirements listed above, the application is not accepted for processing and the date of application is not saved.
FAA accepts all of the following official FAA applications for the Nutrition Assistance (NA) and Cash Assistance (CA) programs:
Health-e-Arizona Plus (HEAplus) online application at http://www.healthearizonaplus.gov/
Application for Benefits (FAA-0001A)
Application for Benefits – Large Print (FAA-0001A-LP)
Application for Benefits – Extra Large Print (FAA-0001A-XLP)
Solicitud de Beneficios (FAA-0001A-S) Spanish version
Elderly Simplified Application Project (ESAP) Nutrition Assistance Application (FAA-1821A) form
Solicitud de Asistencia Nutricional Proyecto de Solicitud Simplificada Para Personas de Tercera Edad (FAA-1821S)
NOTE The FAA-1821A and FAA-1821S are used for NA only.
Any other DES/FAA approved application form used for FAA pilot programs or projects
Photocopies or print outs of any of the previously listed official applications
Forms may be downloaded and printed from the DES Document Center.
Applications are available in English and Spanish. FAA provides an application to anyone who asks for one. When applicants are unable to come to FAA to get an application, they can complete any of the following:
Online HEAplus application at http://www.healthearizonaplus.gov/.
Paper application downloaded from the DES Documents Center or MyFamilyBenefits (MFB) at https://myfamilybenefits.azdes.gov/Home.aspx.
Request an application be mailed. The application can be requested by calling the Customer Care Center for HEAplus, AHCCCS, and FAA at (855) HEA-PLUS or (855) 432-7587, or any DES local office. FAA staff places an application in the outgoing mail on the same day it is requested.
Complete a telephonic application over the phone by calling the centralized Customer Care Center for HEAplus, AHCCCS and FAA at (855) HEA-PLUS or (855) 432-7587.
Official applications can also be obtained from any of the following sources:
Hospitals
Community organizations
Organizations involved in outreach efforts
Download or print the application from the DES Document Center. To locate the application form complete the following steps from the DES Documents Center webpage:
Click on the Forms tab.
Type FAA-0001A in the Search by Name, Number or Keyword field.
A PDF application form is available to download.
NOTE Official applications that are faxed, photocopied, or downloaded and printed from a website are acceptable.
Who Can Apply
Anyone can apply for benefits for any of the following:
For themselves
For someone in their household
On behalf of a different budgetary unit (For more information on who can apply, see Authorized Representatives.)
When the PI is incompetent(g) or incapacitated(g), the application and interview may be completed by someone acting responsibly on behalf of the applicant.
How to Submit an Application
Applications and information may be turned in using any of the following methods:
In person at any FAA office
By mailing to DES FAA P.O. Box 19009 Phoenix, AZ 85005-9009
By Fax at (844) 680-9840
Online through HEAplus at http://www.healthearizonaplus.gov/ or by calling (855) 432-7587
Over the phone by calling the centralized Customer Care Center for HEAplus, AHCCCS and FAA at (855) 432-7587.
NOTE Public Resource Computers (kiosks) are available in some FAA lobbies to assist applicants in applying online through HEAplus.
When an applicant visits an FAA office, the applicant is allowed to submit the application and complete the interview regardless of where the applicant lives.
All applications that meet the identifiable application requirements must be registered by FAA within one workday(g).
Participants may voluntarily withdraw their application at any time. Their request may be verbal or written.
Effective Date of the Application
The effective date of an identifiable application is as follows:
When a paper application is turned in, the effective date of the application is the date the identifiable application is received.
For NA and CA applications turned in online in HEAplus during business hours(g), the effective date of the identifiable application is the date the signature was obtained.
When the HEAplus application is turned in outside of business hours and the interview is not completed the same day, the effective date of the application is the next workday(g).
When the HEAplus application is turned in outside of business hours and the interview is completed on the same day, the effective date of the application is that same date.
The date of application for a telephonic application is the date the participant completes the voice signature process. When the participant begins the application during business hours, then completes the application and voice signature after business hours, the date of the application is that same date. When no signature is obtained, the effective date of the application is the date the signature is obtained.
NOTE When an identifiable application is received from a source other than FAA, the effective date of the application is the date the application is received by FAA.
All questions on the application that pertain to the programs that are being applied for, need to be answered before an eligibility determination can be made. The Primary Informant(g) (PI) or authorized representative is required to provide information needed for the requested programs and is subject to criminal penalties when providing false statements.
When a participant decides to apply for additional programs during the interview, the interview date is used as the application date for the additional programs.
Any applicant may apply for benefits at any time. When an applicant is incarcerated at the time of application submission, the effective date of application cannot begin before their release date.
When an applicant is incarcerated at one of the following correctional facilities, see Inmate Pre-release NA Applications:
Lewis State Prison
Perryville State Prison
Tucson State Prison
Verification
The participant has the primary responsibility for providing verification. (See Participant Responsibilities – Providing Verification for additional policy.)
When an NA application is expedited, all verification except for the identity of the PI can be postponed.
Legal Authorities
last revised 08/01/2022