Form Aaa-1222a Lthpd - Telephone Assistance Program Client Instruction Sheet printable pdf download

AAA-1222A LTHPD (3-15)

Douglas A. Ducey

Timothy Jeffries

Governor

Director

TELEPHONE ASSISTANCE PROGRAM

CLIENT INSTRUCTION SHEET



Attached is the Telephone Assistant Program (TAP) Checksheet

(THIS FORM IS NOT AN APPLICATION)



Have your doctor complete the “Doctor’s Office Only” and “Confirmation of Medical Need” sections



Call

to set up an appointment with your local Family Service

Center or Community Action Program (CAP) to have an application completed for Telephone Assistance

Program and get a list of items that you need to bring with you to the appointment

•

At the time of your appointment:

Have your Telephone Assistance Program (TAP) Checksheet with the Confirmation of Medical Need

section completed by your doctor and all other materials listed by your case worker ready.

•

Your caseworker will complete the “Family Service Center or CAP Use Only” section of the Telephone

Assistant Program (TAP) Checksheet.

•

After you have completed the above instructions, your application will be sent to the Department of

Economic Security, Division of Aging and Adult Services (DES – AAA) for processing. You will be

notified of your eligibility by mail.

•

Processing takes 30 to 45 days from the application date.

If you need further assistance or more information, please call

602-542-4446 or Toll Free 1-800-582-5706

Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the

Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act

of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits

discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national

origin, age, disability, genetics and retaliation. The Department must make a reasonable accommodation to allow a person

with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must

provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It

also means that the Department will take any other reasonable action that allows you to take part in and understand a program

or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take

part in a program or activity because of your disability, please let us know of your disability needs in advance if at all

possible. To request this document in alternative format or for further information about this policy, contact your local office;

TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. • Disponible en español en

línea o en la oficina local.

_______________________________________________________________________________________________________________________________________________________________________

1789 W. Jefferson, S/C 950A, Phoenix, AZ 85007  P.O. Box 6123, Phoenix, AZ 85005

Telephone (602) 542-4446  Fax (602) 542-6655 

Form Aaa-1222a Lthpd - Telephone Assistance Program Client Instruction Sheet

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