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.
To qualify for Emergency NA benefits, you must have valid identification and meet any of the following:
Your monthly gross income, cash, and bank accounts are less than your monthly housing and utility expenses
Your monthly gross income is less than $150 and your cash and bank accounts are $100 or less
At least one person in your household is a migrant or seasonal farm worker and your cash and bank accounts are $100 or less
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.
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.