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Form CCA-1164A Affidavit of Immunization Exemption for Children in Care - Arizona
What Is Form CCA-1164A?
This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form CCA-1164A?A: Form CCA-1164A is the Affidavit of Immunization Exemption for Children in Care in Arizona.
Q: Who is this form for?A: This form is for children in care in Arizona who are seeking an exemption from immunization requirements.
Q: What is the purpose of this form?A: The purpose of this form is to provide documentation of an exemption from immunization requirements for children in care.
Q: What information is required on this form?A: This form requires information about the child in care, the exemption category, and the signature of the person responsible for the child's care.
Form Details:
- Released on May 1, 2023;
- The latest edition provided by the Arizona Department of Economic Security;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form CCA-1164A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.
