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Copy Request Form. 3/10

Copy Request Form. 3/10

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Petition for Deceased Employee Benefits

Petition for Deceased Employee Benefits

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Petition-Appeal – IC Status


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Oklahoma Workers’ Compensation Notice and Instruction to Employers and Employees

  Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees

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Respondent’s Response to Claimant’s Form A Application For Change of Physician

Respondent's Response to Claimant's Form A Application For Change of Physician

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Claimant’s Application for Change of Physician and Request for Hearing

Claimant's Application for Change of Physician and Request for Hearing

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Form Instructions for W2 and W3

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SNA-1000A Rights and Responsibilities

SNA-1000A Rights and Responsibilities

 

INSTRUCTIONS: ARIZONA RIGHTS AND RESPONSIBILITIES (Form SNA-1000A)

 

 

When enrolling in the Arizona Supplemental Nutrition Assistance Employment and Training program, a form SNA-1000A must be computed. This form outlines the rights and responsibilities of both the person enrolling and of the program. This document can be obtained from the website maintained by the Arizona Department of Economic Security.

 

Arizona Rights And Responsibilities SNA-1000A Step 1: In the first blank box, enter your last name, first name and middle initial.

 

Arizona Rights And Responsibilities SNA-1000A Step 2: In the second blank box, enter your case number.

 

Arizona Rights And Responsibilities SNA-1000A Step 3: In the third blank box, enter your JAS identification number.

 

Arizona Rights And Responsibilities SNA-1000A Step 4: The next 13 numbered lines outline your rights and responsibilities. Line 1 concerns your responsibility to obtain employment as soon as possible.

 

Arizona Rights And Responsibilities SNA-1000A Step 5: Line 2 concerns your responsibility to attend scheduled appointments as part of the program.

 

Arizona Rights And Responsibilities SNA-1000A Step 6: Line 3 concerns your responsibility to complete required assessments.

 

Arizona Rights And Responsibilities SNA-1000A Step 7: Line 4 concerns your responsibility to be involved in developing an Employment and Career Development Plan.

 

Arizona Rights And Responsibilities SNA-1000A Step 8: Line 5 concerns your responsibility to participate in activities identified in your Employment and Career Development Plan.

 

Arizona Rights And Responsibilities SNA-1000A Step 9: Line 6 concerns your responsibility to tell program staff about any problems which may complicate your participation in the program.

 

Arizona Rights And Responsibilities SNA-1000A Step 10: Line 7 concerns your responsibility to notify staff if you will be absent from meetings or activities identified in your Employment and Career Development Plan.

 

Arizona Rights And Responsibilities SNA-1000A Step 11: Lines 8 through 13 outline the remainder of your responsibilities.

 

Arizona Rights And Responsibilities SNA-1000A Step 12: Lines 1 through 6 in the next section outline the rights and responsibilities of the program.

 

Arizona Rights And Responsibilities SNA-1000A Step 13: Enter your signature in the first blank box.

 

Arizona Rights And Responsibilities SNA-1000A Step 14: Enter the date in the second blank box.

 

Arizona Rights And Responsibilities SNA-1000A Step 15: Your supervising specialist should enter their signature in the third blank box and the date in the fourth blank box to confirm that they have discussed your rights and responsibilities with you.

 

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Master Mediator Application

Master Mediator Application

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Request for Payment of Charges for Medical or Rehabilitation Services/ Notice of Appeal of Administr

Request for Payment of Charges for Medical or Rehabilitation Services/ Notice of Appeal of Administr

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