NOTICE OF SUBSTANTIVE POLICY STATEMENT
A.R.S. § 41-1013(B)(9)
AGENCY NAME
1.	Statement title and policy number:
Title and number:
2.	Is this a new policy or revision:
New or revision:		
3.	Date issued and effective date (if different from the date issued):
Date issued:
Effective date:
4.	Policy summary:
Summary of contents:
5.	Authority (include the federal or state constitutional provision or statute, administrative rule, or regulation; or final court judgment):
Add provision, statute, rule or regulation, or court judgment
6.	Agency contact information:
Name:	First and Last name
Title:	Title	
Division:	Agency division	
Address:	Street address, city, state, and zip code
Telephone:	Include area code, (xxx) xxx-xxxx
Fax:	(if applicable), include area code, (xxx) xxx-xxxx 
Email:	Email address
Website:	Website address
7.	An electronic copy of the complete policy can be viewed at:
Website:	Be specific
8.	A paper copy of complete policy can be obtained at:
Physical Address:
Copy or other fees: