INSTRUCTIONS: ARKANSAS PATERNITY ACKNOWLEDGMENT SUPPLY ORDER FORM

For a hospital to obtain forms from the Paternity Acknowledgment Program operated by the Child Support Enforcement department of the Arkansas Department of Finance and Administration, use the document discussed in this form. This document can be obtained from the website operated by the Arkansas Department of Finance and Administration.

Arkansas Paternity Acknowledgment Supply Order Form Step 1: On the first blank line, enter the date.

Arkansas Paternity Acknowledgment Supply Order Form Step 2: On the second blank line, enter your name.

Arkansas Paternity Acknowledgment Supply Order Form Step 3: On the third blank line, enter the name of the hospital where birth was given.

Arkansas Paternity Acknowledgment Supply Order Form Step 4: On the fourth blank line, enter the hospital's street address.

Arkansas Paternity Acknowledgment Supply Order Form Step 5: On the fifth blank line, enter the hospital's city, state and zip code.

Arkansas Paternity Acknowledgment Supply Order Form Step 6: On the sixth blank line, enter the hospital's phone number.

Arkansas Paternity Acknowledgment Supply Order Form Step 7: On the seventh blank line, enter the hospital's fax number.

Arkansas Paternity Acknowledgment Supply Order Form Step 8: On the eighth blank line, enter the hospital's email address.

Arkansas Paternity Acknowledgment Supply Order Form Step 9: If requesting paternity acknowledgment brochures in English, enter the quantity needed on the ninth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 10: If requesting paternity acknowledgment brochures in Spanish, enter the quantity needed on the tenth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 11: If requesting paternity affidavits in English, enter the quantity needed on the tenth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 12: In requesting paternity affidavits Spanish translation flyers, enter the quantity needed on the eleventh blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 13: If requesting a video in English, enter the quantity needed on the twelfth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 14: If requesting a video in Spanish, enter the quantity needed on the thirteenth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 15: If requesting a staff training video, enter the quantity needed on the fourteenth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 16: Enter any miscellaneous comments where indicated.

INSTRUCTIONS: ARIZONA APPLICATION FOR CHILD CARE ASSISTANCE (Form CC-001)

To apply for child care assistance provided by the Arizona child care administration, a form CC-001 should be filed. This document can be obtained from the website maintained by the Arizona Department of Economic Security.

Arizona Application For Child Care Assistance CC-001 Step 1: Indicate with a check mark whether this is an initial application or a reapplication.

Arizona Application For Child Care Assistance CC-001 Step 2: Indicate with a check mark why you and your spouse are seeking assistance. You may voluntarily indicate whether or not you are a member of an American Indian tribe with a check mark.

Arizona Application For Child Care Assistance CC-001 Step 3: Provide all information requested about you and your spouse on lines 1 and 2.

Arizona Application For Child Care Assistance CC-001 Step 4: Lines 3 through 9 require documentation about all persons living in your household.

Arizona Application For Child Care Assistance CC-001 Step 5: At the top of the second page, answer all questions by checking "yes" or "no" as applicable.

Arizona Application For Child Care Assistance CC-001 Step 6: Document all unearned income in the table provided.

Arizona Application For Child Care Assistance CC-001 Step 7: The next section requires you to document all work activity.

Arizona Application For Child Care Assistance CC-001 Step 8: If attending school, provide all information required about it in the section where indicated.

Arizona Application For Child Care Assistance CC-001 Step 9: In the next section, provide all information requested about the work activity of your spouse or another parent of children who lives with you.

Arizona Application For Child Care Assistance CC-001 Step 10: The fourth page contains a tax claimant questionnaire.

Arizona Application For Child Care Assistance CC-001 Step 11: The bottom of page four requires documentation of any relative who will claim you or your family members as a dependent.

Arizona Application For Child Care Assistance CC-001 Step 12: On the fifth page, indicate all efforts you have made towards achieving self-sufficiency by checking the appropriate statements.

Arizona Application For Child Care Assistance CC-001 Step 13: On the sixth page, print and sign your name and enter the date.

Arizona Application For Child Care Assistance CC-001 Step 14: Submit the form and maintain a copy for your records.