Forms and Brochures

FORMS

TENNESSEE DEPARTMENT OF HUMAN SERVICES APPLICATION/REVIEW OF ELIGIBILITY FOR FAMILIES FIRST, FOOD STAMPS, MEDICAID/TENNCARE STANDARD

DEPARTAMENTO DE SERVICIOS HUMANOS DE TENNESSEE
SOLICITUD/REVISIÓN DE ELEGIBILIDAD PARA FAMILIES
FIRST, FOOD STAMPS, MEDICAID/TENNCARE STANDARD

APPEAL FORM - Families First, Food Stamps, Medicaid\TennCare
English
Spanish

CHILD SUPPORT FORMS

• CHILD SUPPORT APPEAL FORM
• CHILD SUPPORT APPLICATION
• CLIENT COMPLAINT

• Direct Deposit Enrollment Form For Child Support Payments

CIVIL RIGHTS FORMS

• Civil Rights Complaint
• Civil Rights Complaint - Spanish
• Withdrawal of Civil Rights Complaint
• Withdrawal of Civil Rights Complaint - Spanish
• Civil Rights Complaint Appeal
• Civil Rights Complaint Appeal - Spanish
• COMPLAINT UNDER CIVIL RIGHTS ACT OF 1964
• WITHDRAWAL OF COMPLAINT OR APPEAL FOR FAIR HEARING

• APPEAL FROM FINDING

HIPAA RELEASE FORMS

• HIPAA Authorization for Release of Information
• HIPAA Authorization for Release of Information - (Spanish)
• Parent/Guardian Authorization For The Tennessee Department Of Education Or Local Education Agency To Release School Attendance Records
• Parent/Guardian Authorization For The Tennessee Department Of Education Or Local Education Agency To Release School Attendance Records - (Spanish)
• HIPAA General Authorization for Release of Information to the TDHS to a 3rd Party
• HIPAA General Authorization for Release of Information to the TDHS to a 3rd Party - (Spanish)
• Tennessee Department Of Human Services HIPAA Authorization For Release Of Medical/Health Information To 3rd Party
• Tennessee Department Of Human Services HIPAA Authorization For Release Of Medical/Health Information To 3rd Party - (Spanish)
• General Authorization For Release Of Information To The Tennessee Department Of Human Services

• General Authorization For Release Of Information To The Tennessee Department Of Human Services - (Spanish)

VOCATIONAL REHABILITATION FORMS

• VR APPEAL FORM
• YOUR RIGHTS AS AN APPLICANT

BROCHURES

Providing Documentation of Citizenship for TennCare/Medicaid

STOPPING ABUSE OF THE ELDERLY AND PERSONS WHO HAVE DISABILITIES MAY START WITH YOU

Fraud, The LAW and YOU

HIPAA Privacy Notice - English
HIPAA Privacy Notice - Trifold brochure
HIPAA Privacy Notice - Spanish

Title VI Brochure

Important Notice To All Who Apply for Families First, Food Stamps, or Medicaid

Aviso Importante Para Los Solicitantes

Disability Etiquette (courtesy of Tennessee Disability Coalition)

Talking About Disability (courtesy of Tennessee Disability (Coalition)

Tennessee Technology Access Project (TTAP) Brochure

Mission Statement To improve the well-being of economically disadvantaged, disabled or vulnerable Tennesseans through a network of financial, employment, rehabilitative and protective services.