Get Az Faa-1004a 2021-2025

The AZ FAA-1004A form is designed for users who wish to appoint an EBT alternate card holder for accessing Nutrition Assistance or Cash Assistance benefits. This guide provides a step-by-step approach to completing the form online, ensuring clarity and ease of use.

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

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your case name by filling in the fields for last name, first name, and middle initial. Ensure that the details are accurate to avoid processing delays.
3. Input the EI’s name, followed by the case address, including street number and name. Fill in the city, state, and ZIP code accordingly.
4. Locate your case number and enter it in the designated section. This information is crucial for identifying your application.
5. Check the box indicating your intention to designate a person as your EBT alternate card holder. This authorizes them to access your benefits when you are unable to.
6. If you wish to remove an existing EBT alternate card holder, check the corresponding box and provide their name.
7. Print the name of the EBT alternate card holder, including their last name, first name, and middle initial.
8. Input the birthdate of the alternate card holder to complete their designation.
9. The primary informant must sign the form in the designated signature box, followed by entering the date of signing.
10. Make sure to check the 'For case worker use only' section if it’s applicable to your situation, and follow any additional instructions provided there.
11. Once all sections are filled out correctly, you can save changes, download the completed form, print it, or share it via the available options in the online editor.

Complete your AZ FAA-1004A form online today for efficient processing of your benefits.