Nutrition Assistance (NA) Application
You have the right to file your application immediately by providing your Name, Address and Signature.
The NA benefit Start Date will begin the day your application is considered to be received.
Your application will be screened for Emergency NA benefits and, if eligible, your household will receive NA benefits within 7 days of the application received date.
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.
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
Have your fingerprints imaged by the Department of Economic Security
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
NOTE: Tribal TANF Cash Assistance policies may be different.
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.
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.
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.