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Individual and Family



Select Programs

ALTCS
What benefits do you want ?
 
Medical Assistance from AHCCCS or the Tax Credit to help pay for health insurance
Help with Medicare Costs Only
Nutrition Assistance
 
Cash Assistance
Arizona Long Term Care Services
What is the best day and time for you to complete the interview?
Do you need an interpreter?
   
Please review that the programs selected are the same you are renewing. If the programs are not selected or you wish to apply for additional programs, please ensure your selections are correct before continuing.
   
CONTINUE
 
Please review the dates entered.



The Application Received Date entered is more than 6 months in the past for one or more programs selected.



Only users with the special permission “Date Manage” can complete this action.

Please contact management.
 
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The application has been pre-filled with some of the information we have. Please review each page of the application and enter or change your information as needed.

It is important to complete and submit the application for it to be processed

Click “Continue” to begin your application.

Click “Return to Home Page” to cancel this application and return to the Home Page.

 
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Our records show that you are receiving
 
As a result, this application will be treated as a Change Report for
 
  OK

Cash Assistance Program Requirements

 

To be eligible for the Cash Assistance Program, your income cannot be over a maximum level. You must be responsible for a dependent child, and the applicant cannot have received 12 months of Cash Assistance benefits in Arizona or received 60 months of Cash Assistance benefits from anywhere in the U.S. We count the number of months in which Cash Assistance benefits were received by the applicant since October 01, 2002.



Effective August 09, 2017, a household may get an extension of 12 additional months when all of the following apply:

• The household requests an extension.

• No adult has a sanction for noncompliance with the Jobs Administration during the household's final month of benefits. The final month of benefits must be October 2017 or later.

• Children ages 6 - 15 years old are attending school, unless the child was excused.

 
You must also do all of the following:
 
  • Complete an application

  • Complete an interview

  • Give all information and proof needed to make a decision on your application

  • Keep children’s shots up to date

  • Be sure that all children ages 6 through 15 attend school

  • Apply for other benefits that you might be eligible for (unemployment, Social Security survivors, etc.)

  • Apply for, or give your Social Security number

  • Sign over child support, spousal support, and medical support to the State of Arizona

  • Follow the laws that prohibit illegal drug use (this may require you to do mandatory drug testing)

  • Give the Division of Child Support Services information and proof to get child and medical support from any parent who is not in the home

  • Complete Jobs Administration requirements, which may include preparing for and accepting a job

  • Cooperate with federal and state reviews and audits of your eligibility

  • Report changes to information you provided in your application for the Cash Assistance Program

  •  

    Highest monthly amount of Cash Assistance

     

    Number of people
    receiving assistance

     

    If you have a Shelter Expense

     

    If you don’t have a Shelter Expense

    1

     

    $164

     

    $103

    2

     

    $220

     

    $139

    3

     

    $278

     

    $175

    4

     

    $335

     

    $211

    5

     

    $392

     

    $247

    6

     

    $449

     

    $283



    NOTE: Tribal TANF Cash Assistance policies may be different.

     
    I do not want to apply for Cash Assistance   Continue my application for Cash Assistance

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    Help and Hints

       
    Select Program
    About this page
    This page is for you to tell us what programs you want to apply for. You can select one or more programs. If you need more information, you can click on the program name.

    How to complete this page
    Check the box next to each program that you want to apply for.
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    Select ProgramAbout this page
    This page is for you to tell us what programs you want to apply for. You can select one or more programs. If you need more information, you can click on the program name.

    How to complete this page
    Check the box next to each program that you want to apply for.
    You are saving and closing the application, you can come back later.
       
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  • {0} is NOT eligible for HPE – Received HPE in last 24 months
  • {0} is NOT eligible for HPE – Age 65 or older and no minor children
  • {0} is NOT eligible for HPE – Receiving Medicare and no minor children
  • Presumptive Eligibility Alert!

    Warning!

       

    If you switch to the Hospital Presumptive Eligibility (HPE) at this point, you will NOT be able to use this application to submit as a full AHCCCS application. You will need to ensure that a full AHCCCS application is submitted later, if the HPE application is approved.


    Select ‘Return to Full Application’ to continue the full AHCCCS application. You will have an opportunity to also submit a HPE application at the end of the full application process.


    Select ‘Continue with HPE’ to apply ONLY for Hospital Presumptive Eligibility.


       
    Return To Full Application Continue to HPE

    Stop

       

    This application includes Nutrition Assistance and/or Cash Assistance. You will not be able to help your customer apply for these programs on this application if you choose to go to the Hospital Presumptive Eligibility (HPE) application.


    Select ‘Return to Full Application” to continue applying for all programs.


    Select ‘Continue with HPE’ to apply for ONLY Hospital Presumptive Eligibility. You will need to create another application if your customer wants to apply for Nutrition Assistance or Cash Assistance.


       
    Return To Full Application Continue to HPE

    Warning:Some persons cannot qualify for Hospital Presumptive Eligibility

       

    Warning:No one in this application can qualify for Hospital Presumptive Eligibility

       

    HPE is only available to persons who have not had HPE in the past 24 months.



    Hospital Presumptive Eligibility (HPE) is not available to persons who are age 65 or older when there are no minor children in the household.



    Hospital Presumptive Eligibility (HPE) is not available to persons who are receiving Medicare unless there are minor children in the household.



       

    To continue this application for all persons in this application, click on the “Return to Full Application” button.


    To continue applying for HPE for the other persons in this application, click on the “Continue HPE for Other Persons” button.


    Click “OK” to return to the full application.


       
    Return To Full Application Continue HPE for other persons
    Ok
       
       
    Yes
    No