The Arizona DES form FAA-1701A, Verification of Terminated Employment, is a one-page document your former employer completes to confirm when you stopped working and what your final wages were. The Department of Economic Security uses it to verify income when you apply for or renew Nutrition Assistance (SNAP) or Cash Assistance. You fill in the identifying information at the top, your former employer fills in the employment dates and final pay, and you return the signed form to DES before the deadline on your Request for Information notice.
Where to Download the Form
The FAA-1701A is a free PDF on the DES website. The most direct source is the digital library page for the Verification of Terminated Employment, which always links to the current version.1Arizona Department of Economic Security. Verification of Terminated Employment (English) Paper copies are also available at any local DES office; the office locator at des.az.gov will point you to one nearby.2Arizona Department of Economic Security. DES Office Locator If a caseworker sent you a Request for Information notice, the form number FAA-1701A will be listed on it.
What You Fill In, What the Employer Fills In
The form has three parts: identifying information at the top, employment and wage details in the middle, and an employer signature block at the bottom. Most of it is for the employer to complete, but you have to supply a few things first and sign an authorization before handing it off.
Case and Employee Information
At the top, write your case name exactly as it appears on your benefits paperwork, the date, and your HEAplus Application ID if you have one. Enter the employed household member’s full legal name (last, first, middle initial) and Social Security number.3Arizona Department of Economic Security. FAA-1701A Verification of Terminated Employment Sign the authorization statement that lets the employer release your employment information to DES.
Employment Dates and Final Wages
Your former employer fills in the hire date, the date of your first paycheck, your last day of work, and the date your final check was or will be issued.3Arizona Department of Economic Security. FAA-1701A Verification of Terminated Employment DES uses these dates to figure out whether any paychecks overlap with the period you’re claiming reduced or no income.
Underneath, the employer breaks down the final pay: month and year, pay period ending date, date the check was actually paid, gross earnings, hours worked, and tips.3Arizona Department of Economic Security. FAA-1701A Verification of Terminated Employment Ask the employer to fill in every column. Blank wage fields are one of the most common reasons caseworkers send the form back.
Employer Signature and Company Information
The person completing the form prints their name, signs, and writes their job title, then adds the company name, address, phone, and fax number.3Arizona Department of Economic Security. FAA-1701A Verification of Terminated Employment DES policy requires both a date and the signature of the employer or a qualified source for the verification to be accepted.4Arizona Department of Economic Security. FAA4.I Sources of Earned Income Verification A form returned without a signature or title will almost certainly be rejected on first review.
If Your Former Employer Won’t Complete It
Sometimes the company has closed, the manager has moved on, or the employer simply ignores the request. Federal SNAP regulations require the state agency to help you find another way to verify termination when the employer fails to cooperate and other documentation is unavailable.5eCFR. 7 CFR 273.2 Contact your caseworker before the verification deadline passes and explain what’s happening. DES can accept several alternatives:
- Documents you already have, such as final pay stubs, a termination letter, a severance agreement, or direct-deposit records showing when paychecks stopped.5eCFR. 7 CFR 273.2
- A collateral contact, meaning someone outside your household (a former coworker, a staffing agency supervisor, or a neighbor) whom the caseworker can call to confirm the termination verbally.5eCFR. 7 CFR 273.2
- A home visit, used only when no documents or contacts are available.
How to Submit the Completed Form
DES accepts the FAA-1701A through several channels. Use whichever gets the form in before your deadline.
- Online: log into MyFamilyBenefits at myfamilybenefits.azdes.gov and use the upload documents feature, or upload through Health-e-Arizona Plus at healthearizonaplus.gov.6Arizona Department of Economic Security. MyFamilyBenefits7Arizona Department of Economic Security. FAA-0412A
- Fax: (602) 257-7031 from a 602, 480, or 623 area code; 1-844-680-9840 from any other area code.7Arizona Department of Economic Security. FAA-0412A
- Mail: Department of Economic Security, P.O. Box 19009, Phoenix, AZ 85005-9009.7Arizona Department of Economic Security. FAA-0412A
- In person: deliver it to your local DES office during business hours and ask the front desk to stamp your copy as proof of delivery.2Arizona Department of Economic Security. DES Office Locator
Keep a copy. If you fax, print the confirmation page. If you mail, consider certified mail or at least a photo of the signed form before it goes in the envelope.
Meeting the Deadline on Your Notice
When DES sends a Request for Information notice asking for the FAA-1701A, the notice gives you a specific response deadline. Missing it can result in your application being denied or your benefits being reduced for lack of evidence. Federal regulations give households at least ten days to provide requested verification, but your notice may give you longer, so read the date carefully.5eCFR. 7 CFR 273.2 After the form arrives, a caseworker reviews the dates and wages and may contact the employer directly to cross-check the numbers. If something doesn’t match, expect a follow-up request or a phone interview to clear it up.
If DES Denies or Reduces Your Benefits
If DES denies your application or lowers your benefits based on the employment verification (or lack of it), you can appeal. The deadline is 90 days from the date on the decision notice for Nutrition Assistance, and 30 days for Cash Assistance. Filing within ten days of the notice date lets you keep receiving your current benefit amount while the appeal is pending; after that window, benefits may stop or decrease during the process. You can file online through Health-e-Arizona Plus, by fax to the Appeals Processing Unit at (602) 257-7058, by mail to Department of Economic Security – Appeals, P.O. Box 19009, Phoenix, AZ 85005-9009, or by phone at (602) 774-9279 or 1-877-525-9990.8Arizona Department of Economic Security. FAA-0098A