Tennessee Department of Human Services Forms
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Form HS-3463 "Tennessee Ssbg Contract Budget Revision" - Tennessee
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34 votes
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Form HS-2978 "Transmittal Authorization" - Tennessee
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11 votes
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98 KB
2 pages
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Form HS-0169 "Family Assistance Application" - Tennessee
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(4.8 / 5)
10 votes
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242 KB
2 pages
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Tennessee Snap/TANF Application Form
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Form HS-3408 "Application for Child Care Payment Assistance/Smart Steps" - Tennessee
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(4.4 / 5)
12 votes
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1 MB
6 pages
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Form HS-2997 "Request for Administrative Hearing" - Tennessee
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63 votes
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61 KB
4 pages
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Form HS-2755 "Client Complaint" - Tennessee
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84 votes
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1 MB
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Form HS-3003 "Affidavit Request for Snap Replacements Due to Household Misfortune and Power Outage" - Tennessee
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(4.7 / 5)
6 votes
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28 KB
1 page
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Formulario HS-3003 "Declaracion Jurada De Solicitud De Restitucion De Snap Debido a Una Adversidad E Interrupcion Del Servicio Electrico Del Nucleo Familiar" - Tennessee (Spanish)
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(4.5 / 5)
24 votes
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1 MB
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Form HS-2939 "Hipaa Authorization for Release of Medical/Health Information to 3rd Party" - Tennessee
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104 votes
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1 MB
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Form HS-3082 "External Data Request" - Tennessee
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50 votes
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196 KB
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Form HS-2633 "Withdrawal of Civil Rights Complaint" - Tennessee (Arabic)
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(4.4 / 5)
39 votes
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246 KB
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Form HS-2938 "General Authorization for Release of Information by the Tennessee Department of Human Services to a 3rd Party" - Tennessee
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10 votes
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254 KB
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Form HS-3194 "Summer Food Service Program Income Excess Funds Form" - Tennessee
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(4.5 / 5)
8 votes
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155 KB
2 pages
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Form HS-3069 "Claim for Reimbursement Child and Adult Care Food Program" - Tennessee
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18 votes
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349 KB
2 pages
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Form HS-3083 "Claim for Reimbursement Child and Adult Care Food Program (Homes Only)" - Tennessee
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23 votes
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341 KB
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Form HS-3071 "Claim for Reimbursement" - Tennessee
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22 votes
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254 KB
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Form HS-2937 "Parent/Guardian Authorization for the Tennessee Department of Education or Local Education Agency to Release School Attendance Records" - Tennessee
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35 votes
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22 KB
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Form HS-2940 "General Authorization for Release of Information to the Tennessee Department of Human Services" - Tennessee
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(4.3 / 5)
24 votes
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81 KB
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Form HS-3006 "Child Care Family or Group Home Documentation: Use of Developmental Learning Standards" - Tennessee
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6 votes
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49 KB
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Instructions for Form HS-3456 "Specific Assistance Request" - Tennessee
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24 votes
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12 KB
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Instructions for Form HS-3003 "Request for Food Stamp Replacement Due to Household Misfortune" - Tennessee
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20 votes
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103 KB
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Instructions for Form HS-3117 "Application for Social Services Block Grant (Ssbg) Services" - Tennessee
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(4.6 / 5)
12 votes
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10 KB
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Form HS-2939A "Hipaa Authorization for Release of Medical/Health Information to a 3rd Party" - Tennessee (Arabic)
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(4.4 / 5)
36 votes
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176 KB
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Formulario HS-2634S "Formulario Para Apelacion De Queja De Derechos Civiles" - Tennessee (Spanish)
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86 votes
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24 KB
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Formulario HS-2937S "Autorizacion Del Padre, La Madre O El Tutor Para Que El Departamento De Educacion De Tennessee O La Institucion Educativa Local Divulgue Registros De Asistencia Escolar" - Tennessee (Spanish)
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84 votes
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25 KB
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Formulario HS-2940S "Autorizacion General Para Divulgacion De Informacion Al Departamento De Servicios Humanos De Tennessee" - Tennessee (Spanish)
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58 votes
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83 KB
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Formulario HS-2938S "Autorizacion General Otorgada Al Departamento De Servicios Humanos De Tennessee Para Divulgacion De Informacion a Terceros" - Tennessee (Spanish)
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74 votes
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84 KB
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Formulario HS-0169SP "Solicitud De Asistencia Familiar" - Tennessee (Spanish)
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(4.7 / 5)
20 votes
Size:
251 KB
2 pages
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Tennessee Snap/TANF Application Form
TANF Application Form
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Formulario HS-3408SP "Solicitud Para Asistencia De Pago De Cuidado Infantil/Smart Steps" - Tennessee (Spanish)
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(4.5 / 5)
13 votes
Size:
1 MB
6 pages
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Formulario HS-3310SP "Informe De Incidente De Lesion Grave Para El Proveedor De Cuidado Infantil" - Tennessee (Spanish)
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67 votes
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1 MB
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Formulario HS-2939SP "Autorizacion Hipaa Divulgacion De Informacion Medica O De Salud a Terceros" - Tennessee (Spanish)
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70 votes
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210 KB
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Formulario HS-2633SP "Retiro De Queja De Derechos Civiles" - Tennessee (Spanish)
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63 votes
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175 KB
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"Application for Health Coverage & Help Paying Costs" - Tennessee
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(4.6 / 5)
19 votes
Size:
469 KB
16 pages
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"Solicitud De Cobertura De Seguro Medico Y Ayuda Para Pagar Los Costos" - Tennessee (Spanish)
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(4.7 / 5)
14 votes
Size:
370 KB
16 pages
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"Work Readiness Assessment Form" - Tennessee
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42 votes
Size:
45 KB
3 pages
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"Application for Csbg Services" - Tennessee
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41 votes
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"Employee Letter of Resignation Form" - Tennessee
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9 votes
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148 KB
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Employee Resignation Form
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"New Hire Reporting Form" - Tennessee
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36 votes
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330 KB
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"Tennessee Child Care Provider Annual Professional Development Plan" - Tennessee
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23 votes
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![Form HS-3463 "Tennessee Ssbg Contract Budget Revision" - Tennessee](https://data.templateroller.com/pdf_docs_html/2069/20696/2069653/form-hs-3463-tennessee-ssbg-contract-budget-revision-tennessee.png "Form HS-3463 "Tennessee Ssbg Contract Budget Revision" - Tennessee")
![Form HS-2978 "Transmittal Authorization" - Tennessee](https://data.templateroller.com/pdf_docs_html/2036/20368/2036899/form-hs-2978-transmittal-authorization-tennessee.png "Form HS-2978 "Transmittal Authorization" - Tennessee")
![Form HS-0169 "Family Assistance Application" - Tennessee](https://data.templateroller.com/pdf_docs_html/2049/20494/2049408/form-hs-0169-family-assistance-application-tennessee.png "Form HS-0169 "Family Assistance Application" - Tennessee")
![Form HS-3408 "Application for Child Care Payment Assistance/Smart Steps" - Tennessee](https://data.templateroller.com/pdf_docs_html/2049/20496/2049614/form-hs-3408-application-for-child-care-payment-assistance-smart-steps-tennessee.png "Form HS-3408 "Application for Child Care Payment Assistance/Smart Steps" - Tennessee")
![Form HS-2997 "Request for Administrative Hearing" - Tennessee](https://data.templateroller.com/pdf_docs_html/1919/19190/1919002/form-hs-2997-request-administrative-hearing-tennessee.png "Form HS-2997 "Request for Administrative Hearing" - Tennessee")
![Form HS-2755 "Client Complaint" - Tennessee](https://data.templateroller.com/pdf_docs_html/1919/19190/1919005/form-hs-2755-client-complaint-tennessee.png "Form HS-2755 "Client Complaint" - Tennessee")
![Form HS-3003 "Affidavit Request for Snap Replacements Due to Household Misfortune and Power Outage" - Tennessee](https://data.templateroller.com/pdf_docs_html/2069/20696/2069648/form-hs-3003-affidavit-request-for-snap-replacements-due-to-household-misfortune-and-power-outage-tennessee.png "Form HS-3003 "Affidavit Request for Snap Replacements Due to Household Misfortune and Power Outage" - Tennessee")
![Formulario HS-3003 "Declaracion Jurada De Solicitud De Restitucion De Snap Debido a Una Adversidad E Interrupcion Del Servicio Electrico Del Nucleo Familiar" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/2069/20696/2069649/formulario-hs-3003-declaracion-jurada-de-solicitud-de-restitucion-de-snap-debido-a-una-adversidad-e-interrupcion-del-servicio-electrico-del-nucleo-familiar-tennessee-spanish.png "Formulario HS-3003 "Declaracion Jurada De Solicitud De Restitucion De Snap Debido a Una Adversidad E Interrupcion Del Servicio Electrico Del Nucleo Familiar" - Tennessee (Spanish)")
![Form HS-2939 "Hipaa Authorization for Release of Medical/Health Information to 3rd Party" - Tennessee](https://data.templateroller.com/pdf_docs_html/1919/19190/1919009/form-hs-2939-hipaa-authorization-release-medical-health-information-to-3rd-party-tennessee.png "Form HS-2939 "Hipaa Authorization for Release of Medical/Health Information to 3rd Party" - Tennessee")
![Form HS-3082 "External Data Request" - Tennessee](https://data.templateroller.com/pdf_docs_html/1919/19190/1919004/form-hs-3082-external-data-request-tennessee.png "Form HS-3082 "External Data Request" - Tennessee")
![Form HS-2633 "Withdrawal of Civil Rights Complaint" - Tennessee (Arabic)](https://data.templateroller.com/pdf_docs_html/1919/19190/1919006/form-hs-2633-withdrawal-civil-rights-complaint-tennessee.png "Form HS-2633 "Withdrawal of Civil Rights Complaint" - Tennessee (Arabic)")
![Form HS-2938 "General Authorization for Release of Information by the Tennessee Department of Human Services to a 3rd Party" - Tennessee](https://data.templateroller.com/pdf_docs_html/1913/19132/1913212/form-hs-2938-general-authorization-for-release-of-information-by-the-tennessee-department-of-human-services-to-a-3rd-party-tennessee.png "Form HS-2938 "General Authorization for Release of Information by the Tennessee Department of Human Services to a 3rd Party" - Tennessee")
![Form HS-3194 "Summer Food Service Program Income Excess Funds Form" - Tennessee](https://data.templateroller.com/pdf_docs_html/1913/19132/1913215/form-hs-3194-summer-food-service-program-income-excess-funds-form-tennessee.png "Form HS-3194 "Summer Food Service Program Income Excess Funds Form" - Tennessee")
![Form HS-3069 "Claim for Reimbursement Child and Adult Care Food Program" - Tennessee](https://data.templateroller.com/pdf_docs_html/1913/19132/1913217/form-hs-3069-claim-for-reimbursement-child-and-adult-care-food-program-tennessee.png "Form HS-3069 "Claim for Reimbursement Child and Adult Care Food Program" - Tennessee")
![Form HS-3083 "Claim for Reimbursement Child and Adult Care Food Program (Homes Only)" - Tennessee](https://data.templateroller.com/pdf_docs_html/1913/19132/1913218/form-hs-3083-claim-for-reimbursement-child-and-adult-care-food-program-homes-only-tennessee.png "Form HS-3083 "Claim for Reimbursement Child and Adult Care Food Program (Homes Only)" - Tennessee")
![Form HS-3071 "Claim for Reimbursement" - Tennessee](https://data.templateroller.com/pdf_docs_html/1913/19132/1913214/form-hs-3071-claim-for-reimbursement-tennessee.png "Form HS-3071 "Claim for Reimbursement" - Tennessee")
![Form HS-2937 "Parent/Guardian Authorization for the Tennessee Department of Education or Local Education Agency to Release School Attendance Records" - Tennessee](https://data.templateroller.com/pdf_docs_html/1913/19132/1913211/form-hs-2937-parent-guardian-authorization-for-the-tennessee-department-of-education-or-local-education-agency-to-release-school-attendance-records-tennessee.png "Form HS-2937 "Parent/Guardian Authorization for the Tennessee Department of Education or Local Education Agency to Release School Attendance Records" - Tennessee")
![Form HS-2940 "General Authorization for Release of Information to the Tennessee Department of Human Services" - Tennessee](https://data.templateroller.com/pdf_docs_html/1913/19132/1913213/form-hs-2940-general-authorization-for-release-of-information-to-the-tennessee-department-of-human-services-tennessee.png "Form HS-2940 "General Authorization for Release of Information to the Tennessee Department of Human Services" - Tennessee")
![Form HS-3006 "Child Care Family or Group Home Documentation: Use of Developmental Learning Standards" - Tennessee](https://data.templateroller.com/pdf_docs_html/1913/19131/1913175/form-hs-3006-child-care-family-or-group-home-documentation-use-of-developmental-learning-standards-tennessee.png "Form HS-3006 "Child Care Family or Group Home Documentation: Use of Developmental Learning Standards" - Tennessee")
![Instructions for Form HS-3456 "Specific Assistance Request" - Tennessee](https://data.templateroller.com/pdf_docs_html/2069/20696/2069652/instructions-for-form-hs-3456-specific-assistance-request-tennessee.png "Instructions for Form HS-3456 "Specific Assistance Request" - Tennessee")
![Instructions for Form HS-3003 "Request for Food Stamp Replacement Due to Household Misfortune" - Tennessee](https://data.templateroller.com/pdf_docs_html/1918/19189/1918991/request-food-stamp-replacement-due-to-household-misfortune.png "Instructions for Form HS-3003 "Request for Food Stamp Replacement Due to Household Misfortune" - Tennessee")
![Instructions for Form HS-3117 "Application for Social Services Block Grant (Ssbg) Services" - Tennessee](https://data.templateroller.com/pdf_docs_html/2069/20696/2069651/instructions-for-form-hs-3117-application-for-social-services-block-grant-ssbg-services-tennessee.png "Instructions for Form HS-3117 "Application for Social Services Block Grant (Ssbg) Services" - Tennessee")
![Form HS-2939A "Hipaa Authorization for Release of Medical/Health Information to a 3rd Party" - Tennessee (Arabic)](https://data.templateroller.com/pdf_docs_html/1919/19190/1919016/form-hs-2939a-hipaa-authorization-release-medical-health-information-to-a-3rd-party-tennessee.png "Form HS-2939A "Hipaa Authorization for Release of Medical/Health Information to a 3rd Party" - Tennessee (Arabic)")
![Formulario HS-2634S "Formulario Para Apelacion De Queja De Derechos Civiles" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/1918/19189/1918993/form-hs-2634s-formulario-para-apelacion-de-queja-de-derechos-civiles-tennessee.png "Formulario HS-2634S "Formulario Para Apelacion De Queja De Derechos Civiles" - Tennessee (Spanish)")
![Formulario HS-2937S "Autorizacion Del Padre, La Madre O El Tutor Para Que El Departamento De Educacion De Tennessee O La Institucion Educativa Local Divulgue Registros De Asistencia Escolar" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/1919/19190/1919011/form-hs-2937s-autorizacion-del-padre-la-madre-o-el-tutor-para-que-el-departamento-de-educacion-de-tennessee-o-la-institucion-educativa-local-divulgue-registros-de-asistencia-escolar-tennessee.png "Formulario HS-2937S "Autorizacion Del Padre, La Madre O El Tutor Para Que El Departamento De Educacion De Tennessee O La Institucion Educativa Local Divulgue Registros De Asistencia Escolar" - Tennessee (Spanish)")
![Formulario HS-2940S "Autorizacion General Para Divulgacion De Informacion Al Departamento De Servicios Humanos De Tennessee" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/1919/19190/1919021/form-hs-2940s-autorizacion-general-para-divulgacion-de-informacion-al-departamento-de-servicios-humanos-de-tennessee-tennessee.png "Formulario HS-2940S "Autorizacion General Para Divulgacion De Informacion Al Departamento De Servicios Humanos De Tennessee" - Tennessee (Spanish)")
![Formulario HS-2938S "Autorizacion General Otorgada Al Departamento De Servicios Humanos De Tennessee Para Divulgacion De Informacion a Terceros" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/1919/19190/1919014/form-hs-2938s-autorizacion-general-otorgada-al-departamento-de-servicios-humanos-de-tennessee-para-divulgacion-de-informacion-a-terceros-tennessee.png "Formulario HS-2938S "Autorizacion General Otorgada Al Departamento De Servicios Humanos De Tennessee Para Divulgacion De Informacion a Terceros" - Tennessee (Spanish)")
![Formulario HS-0169SP "Solicitud De Asistencia Familiar" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/2049/20494/2049407/formulario-hs-0169sp-solicitud-de-asistencia-familiar-tennessee-spanish.png "Formulario HS-0169SP "Solicitud De Asistencia Familiar" - Tennessee (Spanish)")
![Formulario HS-3408SP "Solicitud Para Asistencia De Pago De Cuidado Infantil/Smart Steps" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/2049/20496/2049615/formulario-hs-3408sp-solicitud-para-asistencia-de-pago-de-cuidado-infantil-smart-steps-tennessee-spanish.png "Formulario HS-3408SP "Solicitud Para Asistencia De Pago De Cuidado Infantil/Smart Steps" - Tennessee (Spanish)")
![Formulario HS-3310SP "Informe De Incidente De Lesion Grave Para El Proveedor De Cuidado Infantil" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/1918/19189/1918999/form-hs-3310sp-informe-de-incidente-de-lesion-grave-para-el-proveedor-de-cuidado-infantil-tennessee.png "Formulario HS-3310SP "Informe De Incidente De Lesion Grave Para El Proveedor De Cuidado Infantil" - Tennessee (Spanish)")
![Formulario HS-2939SP "Autorizacion Hipaa Divulgacion De Informacion Medica O De Salud a Terceros" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/1919/19190/1919013/form-hs-2939sp-autorizacion-hipaa-divulgacion-de-informacion-medica-o-de-salud-a-terceros-tennessee.png "Formulario HS-2939SP "Autorizacion Hipaa Divulgacion De Informacion Medica O De Salud a Terceros" - Tennessee (Spanish)")
![Formulario HS-2633SP "Retiro De Queja De Derechos Civiles" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/1919/19190/1919003/form-hs-2633sp-retiro-de-queja-de-derechos-civiles-tennessee.png "Formulario HS-2633SP "Retiro De Queja De Derechos Civiles" - Tennessee (Spanish)")
!["Application for Health Coverage & Help Paying Costs" - Tennessee](https://data.templateroller.com/pdf_docs_html/2049/20495/2049548/application-for-health-coverage-help-paying-costs-tennessee.png ""Application for Health Coverage & Help Paying Costs" - Tennessee")
!["Solicitud De Cobertura De Seguro Medico Y Ayuda Para Pagar Los Costos" - Tennessee (Spanish)](https://data.templateroller.com/pdf_docs_html/2049/20495/2049549/solicitud-de-cobertura-de-seguro-medico-y-ayuda-para-pagar-los-costos-tennessee-spanish.png ""Solicitud De Cobertura De Seguro Medico Y Ayuda Para Pagar Los Costos" - Tennessee (Spanish)")
!["Work Readiness Assessment Form" - Tennessee](https://data.templateroller.com/pdf_docs_html/571/5712/571284/work-readiness-assessment-form-tennessee.png ""Work Readiness Assessment Form" - Tennessee")
!["Application for Csbg Services" - Tennessee](https://data.templateroller.com/pdf_docs_html/1919/19190/1919098/application-csbg-services-tennessee.png ""Application for Csbg Services" - Tennessee")
!["Employee Letter of Resignation Form" - Tennessee](https://data.templateroller.com/pdf_docs_html/7/78/7897/employee-letter-resignation-form-tennessee.png ""Employee Letter of Resignation Form" - Tennessee")
!["New Hire Reporting Form" - Tennessee](https://data.templateroller.com/pdf_docs_html/1729/17292/1729215/new-hire-reporting-form-tennessee.png ""New Hire Reporting Form" - Tennessee")
!["Tennessee Child Care Provider Annual Professional Development Plan" - Tennessee](https://data.templateroller.com/pdf_docs_html/333/3333/333301/tennessee-child-care-provider-annual-professional-development-plan-tennessee.png ""Tennessee Child Care Provider Annual Professional Development Plan" - Tennessee")
