Get Az Faa-1004a 2018

Filling out the AZ FAA-1004A form is an essential process for designating an alternate card holder for your EBT benefits. This guide offers comprehensive, step-by-step instructions to assist you in completing this form accurately and efficiently online.

Follow the steps to complete the AZ FAA-1004A form online.

1. Click ‘Get Form’ button to access the AZ FAA-1004A form and open it in your online editor.
2. In the first section, enter the case name by filling in the last name, first name, and middle initial of the account holder.
3. Provide the name of the eligible individual (EI) in the section labeled 'EI's Name.'
4. Fill out the case address, ensuring to include the street number and name, city, state, and ZIP code.
5. Input the case number in the designated field to identify your application.
6. Check the box to certify that you wish to designate the person listed below as your EBT Alternate Card Holder to access your benefits in your absence.
7. If applicable, check the box to remove any existing EBT Alternate Card Holder and specify their name.
8. Print the name of the EBT Alternate Card Holder, including the last name, first name, and middle initial.
9. Enter the birthdate of the EBT Alternate Card Holder.
10. As the primary informant, provide your signature to confirm the information entered.
11. Include the date of signing to finalize your certification.
12. For case worker use only, additional sections are available for case worker signatures and documentation, which should be filled out as relevant.
13. After completing all required fields, review the form for accuracy. You can then save changes, download, print, or share the completed form.

Complete your AZ FAA-1004A form online today to ensure timely processing of your benefits.