hs-3476 SSBG SSBG Social Assessment and Service Plan - instructions HIPAA Authorization for Release of Medical/Health Information (Somali) (HS-2557s) - Instructions Applicants are notified by mail (within 45 days of the application date for Families First and 30 days of the application date for SNAP) of the eligibility decision. Instructions Monthly Racial and Ethnic Data, Home TN-ELDS Documentation Form hs-3115 SSBG Service Proposal - instructions Once approved, SNAP replacement benefits are issued on the current recipient’s EBT card.
PROMISe™ is a HIPAA-compliant claim processing and management information system. With the app you can look up your benefits, review information, check the status of applications, upload documents, and report changes. If you need assistance filing out the Online Application, please call 1-855-626-2050.
myCOMPASS PA is a mobile app for people living in Pennsylvania who have applied for or receive state benefits. Infant Meal Menu/Meal Count Record for 6 through 11 months (HS-3296) - Instructions Residency Questionnaire for Families Experiencing Homelessness (Arabic) (HS-3351a) - Instructions HIPAA Authorization for Release of Medical/Health Information to a 3rd Party (Somali) (HS-2939s) - Instructions Home and Community Services Information System (HCSIS) is a web-based application that serves as the operating system for all Department of Human Services program offices that support the home and community-based services programs and Medicaid waivers. Parent/Guardian Authorization For The Tennessee Department Of Education Or Local Education Agency To Release School Attendance Records - (Spanish) Child Support Online Application
Transmittal Authorization Form (Open with Chrome or Internet Explorer)
DHS Online Services COMPASS. Civil Rights Complaint Appeal Application for Child Care Payment Assistance /SMART STEPS(Spanish) (HS-3408sp) - Instructions FA Online Human Services. Subscribe to receive email updates from the Department of Human Services program offices.
hs-SSBG Monthly Services Report Form - instructions, HS-3071 Claim for Reimbursement hs-3475 SSBG Authorized Signatories - instructions
Summer Food Service Program Income Excess Funds, Career Counseling and Information and Referral Services Verification (HS-3289) - Instructions English / Spanish / Arabic / Somali, Consolidated Appeal Request (HS-3058) - Instructions Screening Small assessment to find out if you are eligible for food benefits or SoonerCare(Medicaid).
Appeal From FInding (Arabic) English Application (HS-0169) - English Addendum - English Instructions - English Instructions Addendum Withdrawal of Civil Rights Complaint (Spanish) hs-3134 SSBG Risk Factor Matrix (APS Assessment) - instructions In order to determine eligibility for the program, DHS caseworkers may ask for documentation like birth certificates, social security cards, check stubs, bank statements, utility bills, rent receipts, tax returns, and insurance policies. Submit your application online or print and sign the application and fax, mail, or bring it to a DHS county office for us to process. DHS is implementing COVID-19 precautions for all visitors entering office lobbies across the state. Pre-Employment Transitions Services Permission (HS-3288) - Instructions, Supplemental Nutrition Assistance Program (SNAP), Deaf, Deaf-Blind and Hard of Hearing Services, Community Tennessee Rehabilitation Centers, Family Assistance Live Chat, Direct Email, Child Care Payment Assistance Online Application, Arabic Application and Addendum (HS-0169), Somali Application and Addendum (HS-0169), Verification Checklist in Spanish (HS-2771), Affidavit Request for SNAP Replacement Due to Power Outage (HS-3003), Affidavit Request for SNAP Replacement Due to Power Outage (HS-3003) Spanish, Families First Program Waiver of Hearing and Disqualification Consent Agreement (HS-3113), Families First Program Waiver of Hearing and Disqualification Consent Agreement (Spanish) (HS-3113SP), Family Assistance Self-Employment Calendar, Family Assistance Fax Cover Sheet (English) (HS-3457), Family Assistance Fax Cover Sheet (Spanish) (HS-3457sp), Family Assistance Fax Cover Sheet (Arabic) (HS-3457a), Family Assistance Fax Cover Sheet (Somali) (HS-3457s), APS Confidentiality and Nondisclosure Agreement Letter, hs-3468 APS Confidentiality and Nondisclosure Agreement Letter, Consolidated Appeal Request in Spanish (HS-3058SP), Withdrawal of Appeal for Fair Hearing (HS-2908), Adult Day Care Criminal/Juvenile History & State Registry Review Disclosure (HS-2680), Application to Renew a License To Operate A Child Care Agency (HS-2012), Application to Renew a License To Operate A Child Care Agency (Spanish) (HS-2012SP), Criminal Background Check Transfer (HS-3299), Personal Safety Curriculum Notification (HS-2984), Personal Safety Curriculum Notification (Spanish) (HS-2984SP), Personal Safety Curriculum Notification for Drop-in Centers (HS-2994), Personal Safety Curriculum Notification for Drop-in Centers (Spanish) (HS-2994SP), HS-3069 Claim for Reimbursement Child and Adult Care Food Program, HS-3083 Claim for Reimbursement Child and Adult Care Food Program (Homes Only), Instructions Monthly Racial and Ethnic Data, Child Care Fingerprint Applicant Information & Criminal/Juvenile History Disclosure Form, Application for Child Care Payment Assistance/ SMART STEPS (HS-3408), Application for Child Care Payment Assistance /SMART STEPS(Spanish) (HS-3408sp), Application for Child Care Payment Assistance/ SMART STEPS (Arabic) (HS-3408a), Application for Child Care Payment Assistance/ SMART STEPS (Somali) (HS-3408s), Residency Questionnaire for Families Experiencing Homelessness (HS-3351), Residency Questionnaire for Families Experiencing Homelessness (Arabic) (HS-3351a), Residency Questionnaire for Families Experiencing Homelessness (Somali) (HS-3351s), Residency Questionnaire for Families Experiencing Homelessness (Spanish) (HS-3351sp), Complaint Under Civil Rights Act of 1964 (Arabic), Complaint Under Civil Rights Act of 1964 (Somali), Complaint Under Civil Rights Act of 1964 (Spanish), Withdrawal of Civil Rights Complaint (Arabic), Withdrawal of Civil Rights Complaint (Somali), Withdrawal of Civil Rights Complaint (Spanish), Infant Meal Menu/Meal Count Record for 0 through 6 months (HS-3295), Infant Meal Menu/Meal Count Record for 6 through 11 months (HS-3296), Public Release for Summer Food Service Program Open Sites (HS-3266), Summer Food Service Program (SFSP) and Child and Adult Care Food Program (CACFP) Bond Waiver Request (HS-3267), HIPAA Authorization for Release of Medical/Health Information (HS-2557), HIPAA Authorization for Release of Medical/Health Information (Arabic) (HS-2557a), HIPAA Authorization for Release of Medical/Health Information (Somali) (HS-2557s), HIPAA Authorization for Release of Medical/Health Information (Spanish) (HS-2557sp), HIPAA Authorization for Release of Medical/Health Information (Large Print) (HS-2557LP), HIPAA Authorization for Release of Medical/Health Information to a 3rd Party (HS-2939), HIPAA Authorization for Release of Medical/Health Information to a 3rd Party (Arabic) (HS-2939a), HIPAA Authorization for Release of Medical/Health Information to a 3rd Party (Somali) (HS-2939s), HIPAA Authorization for Release of Medical/Health Information to a 3rd Party (Spanish) (HS-2939sp), 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), 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), hs-3116 SSBG Social Assesment and Service Plan, hs-3117 Application for Social Services Block Grant (SSBG) Services, hs-3134 SSBG Risk Factor Matrix (APS Assessment), hs-3470 Specific Assistance to Individuals Only, hs-3476 SSBG SSBG Social Assessment and Service Plan, Summer Food Service Program Income Excess Funds, Career Counseling and Information and Referral Services Verification (HS-3289), FLSA Section 14c Subminimum Wage Employee Referral (HS-3287), Pre-Employment Transitions Services Permission (HS-3288). If you are applying for SNAP (food stamp) benefits, the documents listed below may be needed to complete the application process. With the app you can look up your benefits, review information, check the status of applications, upload documents, and report changes. Consolidated Appeal Request in Spanish (HS-3058SP) - Spanish Instructions, Withdrawal of Appeal for Fair Hearing (HS-2908) - Form Instructions, Adult Day Care Criminal/Juvenile History & State Registry Review Disclosure (HS-2680) - Instructions HIPAA Authorization for Release of Medical/Health Information to a 3rd Party (Arabic) (HS-2939a) - Instructions ... Department of Human Services.
These centers coordinate care for people with Medicaid. 1-866-311-4287 (Toll free). Your eligibility counselor will explain what information is needed, how to get it and help you if you need assistance. You may be asked to provide more information during your interview. Please tell us if you need assistance with this site because you have a disability or don’t speak English. Somali Application and Addendum (HS-0169) - Somali Instructions - Somali Addendum-instructions, Verification Checklist (HS-2772) - Instructions hs-3116 SSBG Social Assesment and Service Plan - instructions Application for Child Care Payment Assistance/ SMART STEPS (Arabic) (HS-3408a) - Instructions To apply for Health Care, go to the online DHS benefits portal or download the paper DHS Application (Spanish).To discuss another person’s case, please download the Authorization to Obtain or Release Health Care Information form and send the completed form to Imaging Center 4, PO Box 2027 Cedar Rapids, IA 52406 or fax to 515-564-4017.For information on how to apply for Nursing Facility Medicaid visit the Long Term Care page. Parent/Guardian Authorization For The Tennessee Department Of Education Or Local Education Agency To Release School Attendance Records Verification Checklist in Spanish (HS-2771) - Instructions, Affidavit Request for SNAP Replacement Due to Power Outage (HS-3003) - Instructions HIPAA Authorization for Release of Medical/Health Information (Large Print) (HS-2557LP) - Instructions Application for Child Care Payment Assistance/ SMART STEPS (Somali) (HS-3408s) - Instructions, Residency Questionnaire for Families Experiencing Homelessness (HS-3351) - Instructions Find a facility near you. Criminal Background Check Transfer (HS-3299) - Instructions Family Assistance Fax Cover Sheet (Somali) (HS-3457s) - Instructions, APS Confidentiality and Nondisclosure Agreement Letter