TCA Request Form

Request For Full Report

Please note that all fields on this form are required:


Title:	A value is required for title.
First Name:	A value is required for first name.
Last Name:	A value is required for last name.
Phone Number:	A value is required for phone.
Email:	A value is required for email.Invalid email format.
Agency/Organization:	A value is required for agency/Org.
Address:	A value is required fir address.
City:	A value is required for city.
State:
Zip:	A value is required for the zip.
Requesting Report:	Please Select a Valid Report Name. Please select an item.

YES I ACCEPT. In Order to Submit the Report Request You Need to Accept the FOUO Acceptance Statement. I have read and will abide by the AZDOHS FOUO Policy and Procedures that are relating to the TCA document (both CD and hard copies). Please print a copy of the AZDOHS FOUO Policy and Procedures for your future reference.

Your regional planner will review your request. All requests are subject to AZDOHS approval. These reports are for official use only (FOUO) and must be handled in accordance with AZDOHS’s FOUO Policy. Requests are limited to one per agency.