dhs online application

To start a new online application or to continue working on a saved application, you will need to login to your DHS Account. General Authorization for Release of Information to the TDHS to a 3rd Party - (Spanish) 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. 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).

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