Department of Human Services
Dr. Raquel Hatter, Commissioner

Family Assistance Application

Tennessee Department of Human Services Application/Review of Eligibility For Families First, Food Stamps, Medicaid/Tenncare Standard - Spanish - Arabic - Somali

 

APPEAL FORM

Civil Rights Complaint
English / Spanish
Civil Rights Complaint Appeal
English / Spanish
Appeal form (Families First, Food Stamps, Medicaid/TennCare)
English / Spanish

 

Request for Administrative Hearing

CHILD CARE

• Home TN-ELDS Documentation Form
• Center TN-ELDS Documentation Form

• Summary of Family Home Licensing Requirements
• Summary of Group Home Licensing Requirements
• Summary of Center Licensing Requirements
• Personal Safety Notification Form
• Sample Influenza Information Notification Form
• Child Care Fingerprint Applicant Information & Criminal/Juvenile History Disclosure Form
• Transmittal Authorization Form
• Sample Professional Development Plan

CHILD SUPPORT FORMS

• Child Support Appeal Form
• Child Support Application
• Child Support Application Spanish
• Client Complaint

CIVIL RIGHTS FORMS

• Complaint Under Civil Rights Act of 1964
• Complaint Under Civil Rights Act of 1964 (Spanish)
• Withdrawal of Civil Rights Complaint
• Withdrawal of Civil Rights Complaint (Spanish)
• Appeal From Finding
• Appeal From Finding (Spanish)

CUSTOMER SERVICE FORMS

• Customer Feedback Form

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)
• General Authorization for Release of Information to the TDHS to a 3rd Party
• 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