Homepage Fill Out Your Guardianship Subsidy Application Form
Article Structure

The Guardianship Subsidy Application form, specifically designated as ACY-1009AFORNA, plays a pivotal role in supporting those who assume the vital responsibility of becoming a permanent guardian for children adjudicated as dependent through the juvenile court system. This application is intended for use by individuals appointed as guardians and serves as a gateway to monthly financial support designed to alleviate the costs associated with raising these children. To qualify for this subsidy, potential guardians must first seek any available state and federal benefits on behalf of the child, as these amounts will influence the final subsidy payment. The application requires detailed information about both the guardian and the child, including personal identifiers, relationships, and financial data related to any government assistance received. It is also important to note that each child must be listed individually on the form unless they are siblings, ensuring that the subsidy accurately reflects the needs of each child. Additionally, the application includes queries about other benefits, enabling an assessment of overall income from various sources. By carefully compiling the necessary information and submitting this application, guardians can take significant steps toward securing the financial assistance needed to provide a stable and supportive environment for the children in their care.

Guardianship Subsidy Application Example

ACY-1009AFORNA (5-11)

ARIZONA DEPARTMENT OF ECONOMIC SECURITY

Administration for Children, Youth and Families

GUARDIANSHIP SUBSIDY APPLICATION

(Use separate form if children are NOT siblings)

Guardianship subsidy is available in a monthly amount to a person appointed permanent guardian through the juvenile court for a child who was adjudicated dependent. It is necessary that the guardian apply for any state and federal program benefits on behalf of the child prior to submitting this application. State and federal program benefits and any other assets which the child is receiving or eligible to receive are deducted from the guardianship subsidy rate to determine the guardianship subsidy payment.

Office Use Only

Date received: _____________________

Rate while in care: __________________

Subsidy amount: ___________________

DES Rep.: ________________________

APPLICATION DATE

 

CASE MANAGER’S NAME

 

 

 

AREA CODE AND PHONE NO.

COUNTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROSPECTIVE PERMANENT GUARDIAN’S NAME (Last, First, M.I.)

 

 

 

 

 

AREA CODE AND PHONE NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (No., Street, Apt No., City, State, ZIP)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE

 

 

SOC. SEC. NO.

 

ETHNICITY

 

 

 

RELATIONSHIP

 

 

 

 

 

 

 

 

 

 

 

 

1. NAME OF CHILD (Last, First, M.I.)

 

 

BIRTHDATE

 

 

SOC. SEC. NO.

 

 

 

 

 

 

 

 

 

 

ETHNICITY

SEX

DATE ADJUDICATED DEPENDENT

DATE PLACED WITH GUARDIAN

CHILDS ID NO.

 

DATE GUARDIANSHIP GRANTED

 

 

 

 

 

 

 

 

 

 

 

2. NAME OF CHILD (Last, First, M.I.)

 

 

BIRTHDATE

 

 

SOC.SEC. NO.

 

 

 

 

 

 

 

 

 

 

ETHNICITY

SEX

DATE ADJUDICATED DEPENDENT

DATE PLACED WITH GUARDIAN

CHILDS ID NO.

 

DATE GUARDIANSHIP GRANTED

 

 

 

 

 

 

 

 

 

 

 

3. NAME OF CHILD (Last, First, M.I.)

 

 

BIRTHDATE

 

 

SOC. SEC. NO.

 

 

 

 

 

 

 

 

 

 

ETHNICITY

SEX

DATE ADJUDICATED DEPENDENT

DATE PLACED WITH GUARDIAN

CHILDS ID NO.

 

DATE GUARDIANSHIP GRANTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.Have you applied for TANF (FAA) benefits on behalf of each child? No Yes Currently receiving $____________

5.Indicate other state/federal programs to which you have applied on behalf of the child?

Child 1: SSI

SSA

VA Child Support

Child 2: SSI

SSA

VA

Child Support

Child 3: SSI

SSA

VA

Child Support

6.The monthly amount received for the child from the sources identified in question 5? Child 1: $ ____________; Child 2: $ ____________; Child 3: $ ____________

7.Additional income the child receives and the source?

Child 1: $ ____________ from ________________________________________

Child 2: $ ____________ from ________________________________________

Child 3: $ ____________ from ________________________________________

APPLICANT’S SIGNATURE

DATE

Please attach a date stamped copy of the Petition for Guardianship that was filed with the court.

Distribution: Original – Subsidy Program Specialist; Copy – Applicant

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 la oficina local.

Form Characteristics

Fact Name Details
Form Identification The form is known as ACY-1009AFORNA and is published by the Arizona Department of Economic Security.
Purpose of Application The Guardianship Subsidy Application is designed for appointed permanent guardians seeking a monthly subsidy for children adjudicated dependent.
Eligibility Requirement Guardians must apply for any state and federal benefits for the child prior to submitting the application.
Deduction of Benefits Any state and federal benefits, as well as other assets, are deducted from the subsidy rate to determine the final payment amount.
Document Submission A date-stamped copy of the Petition for Guardianship must be attached to the application.
Discrimination Policy The form adheres to civil rights laws ensuring nondiscrimination in services based on various factors including race, disability, and age.
Language Assistance Free language assistance for Department of Economic Security services is available upon request.
Access Accommodations The Department must make reasonable accommodations for individuals with disabilities to participate in programs and services.
Application Processing Applications should be reviewed by a subsidy program specialist, and it includes sections for various pertinent details about the child.

Guidelines on Utilizing Guardianship Subsidy Application

After completing the Guardianship Subsidy Application form, you will submit it to the appropriate authorities. This application is crucial for determining your eligibility for financial assistance as a permanent guardian of a dependent child. Be sure to gather any required documentation to support your application before submitting it.

  1. Begin by providing your personal information in the designated fields, including your name, phone number, address, birthdate, and Social Security number.
  2. List the names of each child for whom you are applying for the guardianship subsidy. Include each child's birthdate, Social Security number, ethnicity, sex, and other relevant details as outlined in the form.
  3. Indicate whether you have applied for Temporary Assistance for Needy Families (TANF) benefits on behalf of each child. Mark 'Yes' or 'No' and fill in the amount you are currently receiving if applicable.
  4. Identify other state or federal programs you have applied for on behalf of each child. Check the appropriate boxes for programs such as SSI, SSA, VA, or Child Support.
  5. Enter the monthly amounts received from the sources identified in the previous step for each child.
  6. Provide details about any additional income each child receives, including the amount and the source of that income.
  7. Sign and date the application at the bottom to confirm that all provided information is accurate and complete.
  8. Finally, attach a date-stamped copy of the Petition for Guardianship that was filed with the court before submission.

What You Should Know About This Form

What is the Guardianship Subsidy Application form?

The Guardianship Subsidy Application form is a document used to apply for financial assistance for guardians who have been appointed as permanent guardians through the juvenile court for children who were adjudicated dependent. It helps determine the monthly subsidy amount based on other benefits the child may be receiving.

Who is eligible to apply for the guardianship subsidy?

A person appointed as a permanent guardian through the juvenile court for a child who was adjudicated dependent is eligible to apply. It's required that the guardian also applies for any state and federal program benefits on behalf of the child before submitting this application.

What benefits must be applied for before submitting the application?

The guardian must apply for state and federal program benefits on behalf of the child. These can include Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), Social Security Administration (SSA) benefits, Veterans Affairs (VA) benefits, and child support. These benefits are considered when calculating the subsidy amount.

How does the guardianship subsidy amount get determined?

The guardianship subsidy amount is calculated by deducting any state and federal program benefits and other assets the child is receiving or is eligible to receive from the standard subsidy rate. The resulting figure determines the monthly payment to the guardian.

What happens if I am currently receiving benefits for the child?

If you are currently receiving benefits for the child, you must enter the total amount you receive on the application form. This information is critical, as it will influence the determination of the guardianship subsidy amount.

Do I need to provide additional documentation with my application?

Yes, you must attach a date-stamped copy of the Petition for Guardianship that you filed with the court. This documentation is essential for processing your application.

What should I do if I have multiple children in my guardianship application?

If you are applying for a guardianship subsidy for multiple children, you must use separate forms if they are not siblings. Ensure that all relevant details for each child are accurately filled out in their respective sections.

Where do I submit the completed application?

Submit the completed application to the Subsidy Program Specialist in your local Department of Economic Security office. Keep a copy for your records in case you need to reference it later.

What assistance is available if I have a disability?

The Department offers reasonable accommodations for individuals with disabilities. If you need assistance or require the application in an alternative format, contact your local office ahead of time. TTY/TDD services are also available at 7-1-1.

Can I get help in languages other than English?

Yes, free language assistance services are available upon request. If you need help in another language, let your local office know, and arrangements can be made.

Common mistakes

Completing the Guardianship Subsidy Application form can be a nuanced process. It’s essential to pay close attention to details to avoid common mistakes. One frequent error is omitting necessary documents. For example, applicants often forget to attach a date-stamped copy of the Petition for Guardianship that was filed with the court. This document is crucial, and without it, the application may be delayed or denied.

Another mistake occurs when guardians fail to list all relevant state and federal programs. Some individuals only note a few benefits, neglecting others like SSI or VA benefits. Each child's potential benefits must be fully disclosed to accurately calculate the subsidy amount. Incomplete information can lead to incorrect subsidy assessments, affecting the financial support for the child.

It's also common for applicants to miscalculate income from various sources. When reporting additional income received by the child, the amounts should be confirmed before submission. A misreported figure can alter the subsidy rate, and discrepancies may cause unnecessary complications. Clear and accurate reporting is critical for a smooth application process.

Another oversight is failing to answer all questions thoroughly. For example, question 4 asks if you have applied for TANF (FAA) benefits. Indicating "No" without additional clarification can lead to misunderstandings. Each question must be addressed comprehensively, ensuring all relevant details are provided.

Finally, some guardians overlook the importance of signing and dating the application. An unsigned document is incomplete and cannot be processed. It is vital to ensure that all sections, including the signature field, are filled out before submission. Addressing these common mistakes can significantly enhance the chances of approval for the Guardianship Subsidy.

Documents used along the form

When applying for a Guardianship Subsidy, several other forms and documents may be required to support the application process. Each of these documents plays a crucial role in ensuring that all necessary information is provided for a comprehensive review. Below is an overview of some of the essential forms that are typically used alongside the Guardianship Subsidy Application form.

  • Petition for Guardianship: This is a formal request filed with the court that initiates the guardianship process. It outlines the reasons for seeking guardianship and includes pertinent details about the child and the proposed guardian. A stamped copy of this petition must be attached to the subsidy application.
  • Income Verification Documents: These documents provide proof of the guardian's income and financial status. They can include pay stubs, tax returns, or bank statements. This information is vital to determine the appropriate subsidy amount.
  • Verification of State or Federal Benefits: Guardians must document any benefits that the child is currently receiving or is eligible to receive. This could include forms or letters confirming eligibility for programs such as TANF (Temporary Assistance for Needy Families) or SSI (Supplemental Security Income).
  • Child’s Medical Documentation: This includes any relevant medical records or letters from health professionals related to the child’s health and well-being. Such documentation might be important for assessing the child's needs and any potential additional support required from the guardian.

Submitting these associated documents is vital. Their presence not only ensures compliance with the application requirements but also facilitates a smoother review process. Applicants should remember to keep copies of all submitted documents for their own records and follow any additional guidelines provided by the respective authority.

Similar forms

Here are five documents similar to the Guardianship Subsidy Application form, each serving a unique purpose but sharing common characteristics in their intent and structure:

  • Foster Care Subsidy Application: This document assists foster parents in applying for financial support while caring for foster children. Like the guardianship application, it requires information about the child and the applicant's relationship to the child.
  • Child Support Application: This form is used to request financial assistance from a non-custodial parent for child support. It also collects details about the child as well as the applicant's financial circumstances, similar to how the guardianship application addresses monthly income and benefits.
  • Medicaid Application: Individuals use this form to apply for Medicaid services, which also involves reporting household income and dependent details. Both forms aim to ensure that families receive the necessary assistance to support their dependents.
  • Temporary Assistance for Needy Families (TANF) Application: This form helps families apply for financial aid to meet basic needs. It shares the requirement to report other income sources and benefits that might impact the amount of aid received, much like the guardianship subsidy.
  • Special Education Services Application: Parents complete this form to request special services for children needing additional educational support. It parallels the guardianship application by requiring detailed information about the child and their specific needs to qualify for assistance.

Dos and Don'ts

When filling out the Guardianship Subsidy Application form, it is important to follow certain guidelines to ensure a smooth application process.

  • Do ensure all sections of the form are completed accurately.
  • Do attach a date-stamped copy of the Petition for Guardianship filed with the court.
  • Do apply for all relevant state and federal benefits before submitting the application.
  • Do provide clear and accurate information regarding the child's income and other benefits.
  • Do keep copies of the submitted application for your records.
  • Don't leave any required fields blank; this could delay the process.
  • Don't forget to include the social security numbers where applicable.
  • Don't submit the application without double-checking for any errors or missing information.
  • Don't neglect to provide contact information for follow-up questions.
  • Don't assume that previous applications or documentation are acceptable; all documents should be current and relevant.

Misconceptions

Misconceptions about the Guardianship Subsidy Application form:

  • It is not necessary to apply for other benefits before applying for the subsidy. Many believe they can directly apply for the guardianship subsidy without first seeking other state and federal program benefits. However, applying for these benefits is a required step that can affect the overall subsidy amount you receive.
  • The subsidy amount remains constant regardless of other income. Some applicants assume that the guardianship subsidy amount will stay the same. In reality, this payment is adjusted based on any additional income the child receives, such as benefits from SSI, SSA, or other sources.
  • The application is only for children who are not siblings. There is a common misunderstanding that a separate form is necessary if you are applying for siblings. The application can be completed for siblings on the same form, but clear documentation for each child is essential.
  • Guardian’s income or assets do not matter in determining the subsidy. Some guardians think their financial situation will not be considered for the subsidy. While the guardian’s income is not directly evaluated, the child's eligibility for other benefits is crucial. This can impact the final subsidy amount awarded.

Key takeaways

Filling out the Guardianship Subsidy Application form can be a critical step in securing financial support for children placed under your care. To ensure a smooth application process, consider these key takeaways:

  • Understand Eligibility: Only individuals who have been appointed as permanent guardians through the juvenile court can apply for the subsidy.
  • Document Requirements: A date-stamped copy of the Petition for Guardianship submitted to the court must accompany your application.
  • Benefits Application: Before applying for the Guardianship Subsidy, the guardian is required to apply for state and federal program benefits on the child’s behalf.
  • Income Assessment: Any state or federal benefits received by the child will be deducted from the subsidy amount. It is vital to accurately report these benefits.
  • Multiple Children: If you are applying for multiple children, ensure to fill out separate forms only if the children are not siblings.
  • Accurate Information: Provide complete and precise details regarding each child’s SOC. SEC. NO., birth date, and other personal information in the application.
  • Stay Informed: Be aware of how the subsidy amount is calculated, including the impact of other income sources on the final subsidy payment.
  • Follow Up: After submitting your application, maintain open communication with your case manager to address any potential issues or additional documentation requests.

By carefully navigating this process, guardians can help ensure that the needs of the children in their care are adequately met.