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A person or the person’s representative may ask for an application to be withdrawn.
NOTE When a legal representative turned in the application, only the legal representative (or their authorized representative) can ask to withdraw the application.
An application may be withdrawn in writing or verbally.
A written, signed request for withdrawal may be accepted in one of the following formats:
· Voluntary Withdrawal of Application or Benefits (DE-130) form;
· Voluntary withdrawal option in Health-e-Arizona Plus (HEAplus); or
· A signed, written request to withdraw the application.
When a verbal request to voluntarily withdraw is made, the application is denied based on the verbal request. A denial letter is sent to notify the person that the application has been denied.
When a person or the person’s representative contacts the office to take back the voluntary withdrawal request within 35 days of the denial letter, the case is reopened. When more than 35 days have passed, a new application is required.
Term |
Definition |
Legal representative |
A person authorized by law to represent the customer. This includes: · A person appointed by a Court of Law to represent an individual; · The natural or adoptive custodial parent of a minor child; or · An agency appointed by a Court of Law as guardian of the customer, such as a tribal social services (foster care) agency. |
Authorized Representative |
A person, or an organization, appointed by the customer to act on their behalf for the application process, renewing eligibility, or other communications. |
A person may voluntarily withdraw an application at any time prior to the date an eligibility decision is made.
Program |
Legal Authorities |
All Programs |
CFR 42 431.213 AAC R9-22-313, R9-28-401 |