A Signing the Application
 
(01/01/17 - 12/31/17)
In order to complete the eligibility determination for any program, an official application MUST be signed and dated by the PI, participant or representative, UNDER PENALTY OF PERJURY. This must be completed on the application signature page.
 
A signed application is required for any of the following:
 
When submitting a new or renewal application. (See Identifiable Applications)
When requesting additional program benefits at the time of interview.
 
A signature is a name or mark representing the name of the person or authorized representative. The signature is personally added to authenticate a particular person as the source or approval of the information.
 
A signature is unique to the person signing the document.
 
The following are acceptable methods to sign a document:
 
Written Signature
A hand written signature or mark of a person’s name on paper documents as a proof of identity. The purpose of the signature is also to indicate the person’s agreement with the information on the document.
When the person signs the application with a mark, the signing must be witnessed by the EI or supervisor. The witness MUST sign the application in the space designated for the witness.
When the person is not able to read or write, or is physically unable to do so, their representative may sign the paper application. Document the case file with the reason that the person is unable to sign the application.
Electronic Signature
When an account is created in Health-e-Arizona Plus (HEAplus), a person can electronically sign their application and other documents using the electronic signature option.
The person enters their name and checks the box at the end of their application or other electronically available documents. This becomes their legal signature and is treated the same as a written signature on paper.
Telephonic Signature
A telephonic signature, or voice signature, is a voice recording intended to capture the voice authorization of the person acknowledging they gave the information, answered the questions, understood and agreed to the information in the document that is being signed.
After recording a summary of the household’s details, the person is asked for specific information that equals the voice signature. Responses provided by the person are recorded by designated staff.
When a person agrees to use a telephonic signature, it becomes their legal signature and is the same as if they signed their name on paper. Identity is verified prior to the telephonic signature by requesting the person provide confidential case information.
 
NOTE Designated staff includes HEAplus Customer Support (Conduent), AHCCCS staff and community assistors. When a memorandum of understanding (MOU) is needed, the MOU must require that the recordings are readily accessible to the Family Assistance Administration.
 
Deny the application with the NS (No Signature) Denial or Closure Reason Code when a required participant does not sign the application.