HIPAA Authorization for Release of Medical/Health Information to a 3rd Party (Spanish) (HS-2939sp) - Instructions Parent/Guardian Authorization For The Tennessee Department Of Education Or Local Education Agency To Release School Attendance Records - (Spanish) hs-3134 SSBG Risk Factor Matrix (APS Assessment) - instructions DHS Online Services COMPASS. To start a new online application or to continue working on a saved application, you will need to login to your DHS Account. SNAP recipients must request replacement benefits within 10 (ten) calendar days of experiencing food loss. Infant Meal Menu/Meal Count Record for 6 through 11 months (HS-3296) - Instructions Application for Child Care Payment Assistance/ SMART STEPS (Somali) (HS-3408s) - Instructions, Residency Questionnaire for Families Experiencing Homelessness (HS-3351) - Instructions The Tennessee Department of Human Services is prepared to provide replacement Supplemental Nutrition Assistance Program benefits to families who suffered losses due to severe weather which may have caused power outages. These rules will impact customers coming into state offices for scheduled in-person appointments beginning Monday, June 1, 2020. hs-3480 SSBG Missed Appointment Log - instructions You may be trying to access this site from a secured browser on the server. HIPAA Authorization for Release of Medical/Health Information (Arabic) (HS-2557a) - Instructions Application for Child Care Payment Assistance /SMART STEPS(Spanish) (HS-3408sp) - Instructions 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. 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. 615-743-2000 (Nashville area) Withdrawal of Civil Rights Complaint (Arabic) Complaint Under Civil Rights Act of 1964 (Arabic) Solicitud en Español (HS-0169) - Apéndice en Español - Instrucciones en Español - Apéndice de Instrucciones en Español Personal Safety Curriculum Notification (Spanish) (HS-2984SP) - Instructions hs-3460 SSBG Corrective Action Plan - instructions If you need assistance filing out the Online Application, please call 1-855-626-2050. Application for Child Care Payment Assistance/ SMART STEPS (Arabic) (HS-3408a) - Instructions Change Report (Spanish) (HS-2302sp) - Instructions Complaint Under Civil Rights Act of 1964 (Spanish) Accessibility | Privacy | Security | Acceptable Use | Privacy | Security | Acceptable Use Office Hours Monday to Friday, 8:15 am to 4:45 pm Connect With Us 64 New York Avenue, NE, 6th Floor, Washington, DC 20002 Phone: (202) 671-4200 Fax: (202) 671-4326 DHS Home | DHS Services | DHS UAG Portal. Your eligibility counselor will explain what information is needed, how to get it and help you if you need assistance. FA Online Human Services. After the recorded message, you will reach an operator who can provide you with an interpreter. Apply for benefits To apply for benefits follow this link Create User ID Create a user ID for doing reviews/renewals and saving eligibility assessments. English / Spanish / Arabic / Somali PROMISe™ is a HIPAA-compliant claim processing and management information system. ... Department of Human Services. hs-3109 SSBG Change in Circumstances - instructions General Authorization for Release of Information to the TDHS to a 3rd Party DHS is implementing COVID-19 precautions for all visitors entering office lobbies across the state. Somali Application and Addendum (HS-0169) - Somali Instructions - Somali Addendum-instructions, Verification Checklist (HS-2772) - Instructions General Authorization for Release of Information to the TDHS to a 3rd Party - (Spanish) hs-3470 Specific Assistance to Individuals Only - instructions HIPAA Authorization for Release of Medical/Health Information (Spanish) (HS-2557sp) - Instructions If you do not already have a TDHS account, you will need to create one to access services (e.g. Client Complaint, Complaint Under Civil Rights Act of 1964 Appeal From FInding (Arabic) Apply for Families First and/or SNAP online, Tennessee Department of Human Services Application/Review of Eligibility For Families First, Supplemental Nutrition Assistance Program (SNAP): Please Select a Link to Continue. Customers filing initial applications and recertifications are not required to visit an office provided their identity has been verified and all other mandatory verifications have been completed. Personal Safety Curriculum Notification for Drop-in Centers (HS-2994) - Instructions Affidavit Request for SNAP Replacement Due to Power Outage (HS-3003) Spanish - Instructions, Change Report (English) (HS-2302) - Instructions Provider Reimbursement and Operations Management Information System (PROMISe) is a web-based application for registered providers. hs-3131 SSBG Annual Program Evaluation - instructions hs-3465 SSBG Invoice for Reimbursement - instructions Change Report (Somali) HS-2302s) - Instructions, Families First Program Waiver of Hearing and Disqualification Consent Agreement (HS-3113) - Instructions Personal Safety Curriculum Notification for Drop-in Centers (Spanish) (HS-2994SP) - Instructions, HS-3069 Claim for Reimbursement Child and Adult Care Food Program Complaint Under Civil Rights Act of 1964 (Somali) FLSA Section 14c Subminimum Wage Employee Referral (HS-3287) - Instructions hs-3116 SSBG Social Assesment and Service Plan - instructions Proudly founded in 1681 as a place of tolerance and freedom. Appeal From Finding (Somali), Infant Meal Menu/Meal Count Record for 0 through 6 months (HS-3295) - Instructions Request for Removal from Abuse Registry Arriving alone to drop-off or pick-up documents or take part in scheduled in-person appointments. People may apply for Supplemental Nutrition Assistance Program (SNAP) benefits at their local Department of Human Services county office or by applying online using the Family Assistance (FA) Online application. hs-3475 SSBG Authorized Signatories - instructions Answering COVID-19 health screening questions and passing a temperature check. Please tell us if you need assistance with this site because you have a disability or don’t speak English. myCOMPASS PA is a mobile app for people living in Pennsylvania who have applied for or receive state benefits. Current SNAP recipients can find information on their case with CaseConnect. SNAP benefits are issued and accessed electronically using a Benefit Security Card or EBT Card. hs-3115 SSBG Service Proposal - instructions Criminal Background Check Transfer (HS-3299) - Instructions العربية التعليمات ملحق - العربي الملحق - ية العرب الطلب ستمارة – (If applying for SNAP only, an incomplete application can be accepted as long as it contains your name, address, and signature). 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. Child Support Application Transmittal Authorization Form (Open with Chrome or Internet Explorer) Residency Questionnaire for Families Experiencing Homelessness (Spanish) (HS-3351sp) - Instructions, Self Employment Reporting and Verification, Child Support Appeal Form English Application (HS-0169) - English Addendum - English Instructions - English Instructions Addendum Application to Renew a License To Operate A Child Care Agency (HS-2012) - Instructions Find a facility near you. hs-3476 SSBG SSBG Social Assessment and Service Plan - instructions Application to Renew a License To Operate A Child Care Agency (Spanish) (HS-2012SP) - Instructions Applications are available in: Verification Checklist in Spanish (HS-2771) - Instructions, Affidavit Request for SNAP Replacement Due to Power Outage (HS-3003) - Instructions Withdrawal of Civil Rights Complaint (Spanish) HS-3083 Claim for Reimbursement Child and Adult Care Food Program (Homes Only) Change Report (Arabic) (HS-2302a) - Instructions hs-3456 Specific Assistance Request - instructions Appeal From Finding Arji Soomaali - Tilmaamaha Soomaali - Tilmaamaha Wax lagu daray Soomaali. 1-866-311-4287 (Toll free). Free assistance is available. Summer Food Service Program (SFSP) and Child and Adult Care Food Program (CACFP) Bond Waiver Request (HS-3267) - Instructions, COMMUNITY SERVICES BLOCK GRANT APPLICATION, HIPAA Authorization for Release of Medical/Health Information (HS-2557) - Instructions
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