The Tennessee DHS Family Assistance Application form is a crucial document designed to help individuals and families access various support services offered by the Department of Human Services. By completing this form, applicants can seek assistance with essential needs such as food, housing, and healthcare. Understanding the application process can significantly impact the well-being of those in need.
The Tennessee Department of Human Services (DHS) offers a Family Assistance Application form designed to help individuals and families access various support services. This form is essential for those seeking assistance with food, cash, and medical benefits. Applicants will find that the form requires personal information, including details about household members, income sources, and expenses. It also includes sections for reporting any disabilities or special needs, which can impact eligibility for certain programs. Completing the application accurately is crucial, as it determines the level of assistance a household may receive. The form can be submitted online or in person, and applicants should be prepared to provide documentation to support their claims. Understanding the application process and the information required can significantly streamline the experience for those in need of assistance.
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When filling out the Tennessee DHS Family Assistance Application form, it's important to approach the task with care. Here are seven things you should and shouldn't do:
Following these guidelines can help ensure a smoother application process.
The Supplemental Nutrition Assistance Program (SNAP) application is similar to the Tennessee DHS Family Assistance Application form in its purpose of providing assistance to individuals and families in need. Both documents require personal information, income details, and household composition to determine eligibility for food assistance. The SNAP application also includes sections for reporting expenses and resources, making it comprehensive in assessing an applicant's financial situation.
The Temporary Assistance for Needy Families (TANF) application shares similarities with the Family Assistance Application form as it aims to provide financial support to low-income families. Both applications require information about the applicant's income, assets, and family structure. Additionally, both forms often include questions about employment status and barriers to work, ensuring that the assistance provided aligns with the needs of the applicants.
The Medicaid application is another document that parallels the Tennessee DHS Family Assistance Application form. Both forms gather extensive personal and financial information to evaluate eligibility for assistance programs. Medicaid applications also require details about household members and income, similar to the Family Assistance Application. This information helps determine whether an individual qualifies for health coverage under state and federal guidelines.
The Women, Infants, and Children (WIC) application is akin to the Family Assistance Application in that it provides nutritional support to specific populations. Both documents require applicants to disclose their income and household size. The WIC application focuses on the nutritional needs of pregnant women, new mothers, and young children, while the Family Assistance Application covers a broader range of assistance programs, but both aim to support vulnerable populations in maintaining health and well-being.
The Low-Income Home Energy Assistance Program (LIHEAP) application is also comparable to the Tennessee DHS Family Assistance Application form. Both applications assess the financial situation of applicants to determine eligibility for assistance. LIHEAP focuses specifically on helping low-income households with energy costs, while the Family Assistance Application encompasses various forms of aid. Each application requires detailed income information and household composition, ensuring that assistance is directed to those who need it most.
Filling out the Tennessee DHS Family Assistance Application form is an important step toward accessing the benefits you may need. Once you have completed the form, you will submit it to the appropriate office for review. The following steps will guide you through the process of filling out the application accurately and efficiently.
After submitting your application, you will receive a notification regarding the next steps in the process. Be prepared to provide any additional information if requested, and keep an eye on your mail or email for updates.
When filling out the Tennessee DHS Family Assistance Application form, accuracy is crucial. One common mistake is leaving sections blank. Each part of the application is designed to gather specific information. Omitting details can lead to delays or even denial of assistance. Always ensure that every applicable section is completed.
Another frequent error is providing incorrect personal information. This includes names, addresses, and Social Security numbers. Mismatched or incorrect data can complicate the verification process. Double-check all personal details before submitting the application to avoid unnecessary setbacks.
People often overlook the importance of supporting documentation. The application may require proof of income, residency, or other relevant information. Failing to include these documents can result in a rejection of the application. Be sure to attach all necessary paperwork to ensure a smooth review process.
Some applicants misinterpret the income reporting requirements. It’s essential to report all sources of income accurately. This includes wages, benefits, and any other financial support. Underreporting income, whether intentionally or accidentally, can lead to serious consequences, including repayment of benefits.
Another mistake is not signing the application. A signature is a critical component that confirms the information provided is true and complete. Applications submitted without a signature will be considered incomplete. Always remember to sign and date the application before submission.
Lastly, many applicants fail to keep a copy of their submitted application. This step is vital for tracking the progress of the application and for future reference. Having a copy allows individuals to follow up effectively if there are questions or issues. Make sure to retain a copy for your records.
RECORD OF EMERGENCY DATA
PRIVACY ACT STATEMENT
AUTHORITY: 5 USC 552, 10 USC 655, 1475 to 1480 and 2771, 38 USC 1970, 44 USC 3101, and EO 9397 (SSN).
PRINCIPAL PURPOSES: This form is used by military personnel and Department of Defense civilian and contractor personnel, collectively referred to as civilians, when applicable. For military personnel, it is used to designate beneficiaries for certain benefits in the event of the Service member's death. It is also a guide for disposition of that member's pay and allowances if captured, missing or interned. It also shows names and addresses of the person(s) the Service member desires to be notified in case of emergency or death. For civilian personnel, it is used to expedite the notification process in the event of an emergency and/or the death of the member. The purpose of soliciting the SSN is to provide positive identification. All items may not be applicable.
ROUTINE USES: None.
DISCLOSURE: Voluntary; however, failure to provide accurate personal identifier information and other solicited information will delay notification and the processing of benefits to designated beneficiaries if applicable.
INSTRUCTIONS TO SERVICE MEMBER
This extremely important form is to be used by you to show the names and addresses of your spouse, children, parents, and any other person(s) you would like notified if you become a casualty (other family members or fiance), and, to designate beneficiaries for certain benefits if you die. IT IS YOUR RESPONSIBILITY to keep your Record of Emergency Data up to date to show your desires as to beneficiaries to receive certain death payments, and to show changes in your family or other personnel listed, for example, as a result of marriage, civil court action, death, or address change.
INSTRUCTIONS TO CIVILIANS
This extremely important form is to be used by you to show the names and addresses of your spouse, children, parents, and any other person(s) you would like notified if you become a casualty.
Not every item on this form is applicable to you. This form is used by the Department of Defense (DoD) to expedite notification in the case of emergencies or death. It does not have a legal impact on other forms you may have completed with the DoD or your employer.
IMPORTANT: This form is divided into two sections: Section 1 - Emergency Contact Information and Section 2 - Benefits Related Information. READ THE INSTRUCTIONS ON PAGES 3 AND 4 BEFORE COMPLETING THIS FORM.
SECTION 1 - EMERGENCY CONTACT INFORMATION
1. NAME (Last, First, Middle Initial)
2. SSN
3a. SERVICE/CIVILIAN CATEGORY
ARMY
NAVY
MARINE CORPS
AIR FORCE
DoD
CIVILIAN
CONTRACTOR
b. REPORTING UNIT CODE/DUTY STATION
4a. SPOUSE NAME (If applicable) (Last, First, Middle Initial)
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
SINGLE
DIVORCED
WIDOWED
5. CHILDREN
b. RELATIONSHIP
c. DATE OF BIRTH
d. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
a. NAME (Last, First, Middle Initial)
(YYYYMMDD)
6a. FATHER NAME (Last, First, Middle Initial)
7a. MOTHER NAME (Last, First, Middle Initial)
8a. DO NOT NOTIFY DUE TO ILL HEALTH
b. NOTIFY INSTEAD
9a. DESIGNATED PERSON(S) (Military only)
10. CONTRACTING AGENCY AND TELEPHONE NUMBER (Contractors only)
DD FORM 93, JAN 2008
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X
SECTION 2 - BENEFITS RELATED INFORMATION
11a. BENEFICIARY(IES) FOR DEATH GRATUITY
c. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
d. PERCENTAGE
(Military only)
12a. BENEFICIARY(IES) FOR UNPAID PAY/ALLOWANCES
c. PERCENTAGE
(Military only) NAME AND RELATIONSHIP
13a. PERSON AUTHORIZED TO DIRECT DISPOSITION (PADD)
14. CONTINUATION/REMARKS
15.SIGNATURE OF SERVICE MEMBER/CIVILIAN (Include rank, rate, or grade if applicable)
16.SIGNATURE OF WITNESS (Include rank, rate, or grade as appropriate)
17.DATE SIGNED
DD FORM 93 (BACK), JAN 2008
INSTRUCTIONS FOR PREPARING DD FORM 93
(See appropriate Service Directives for supplemental instructions for completion of this form at other than MEPS)
All entries explained below are for electronic or typewriter completion, except those specifically noted. If a computer or typewriter is not available, print in black or blue-black ink insuring a legible image on all copies. Include "Jr.," "Sr.," "III" or similar designation for each name, if applicable. When an address is entered, include the appropriate ZIP Code. If the member cannot provide a current address, indicate "unknown" in the appropriate item. Addresses shown as P.O. Box Numbers or RFD numbers should indicate in Item 14, "Continuations/Remarks", a street address or general guidance to reach the place of residence. In addition, the notation "See Item 14" should be included in the item pertaining to the particular next of kin or when the space for a particular item is insufficient. If the address for the person in the item has been shown in a preceding item, it is unnecessary to repeat the address; however, the name must be entered. Those items that are considered not applicable to civilians will be left blank.
ITEM 1. Enter full last name, first name, and middle initial.
ITEM 2. Enter social security number (SSN).
ITEM 3a. Service. Military: Mark X in appropriate block.
Civilian: Mark two blocks as appropriate. Examples: an Army civilian would mark Army and either Civilian or Contractor; a DoD civilian, without affiliation to one of the Military Services, would mark DoD and then either Civilian or Contractor as appropriate.
ITEM 3b. Reporting Unit Code/Duty Station. See Service Directives.
ITEM 4a. Spouse Name. Enter last name (if different from Item 1), first name and middle initial on the line provided. If single, divorced, or widowed, mark appropriate block.
ITEM 4b. Address and Telephone Number. Enter the "actual" address and telephone number, not the mailing address. Include civilian title or military rank and service if applicable. If one of the blocks in 4a is marked, leave blank.
ITEM 5a-d. Children. Enter last name (only if different from Item 1) first name and middle initial, relationship, and date of birth of all children. If none, so state. Include illegitimate children if acknowledged by member or paternity/maternity has been judicially decreed. Relationship examples: son, daughter, stepson or daughter, adopted son or daughter or ward. Date of birth example: 19950704. For children not living with the member's current spouse, include address and name and relationship of person with whom residing in item 5d.
ITEM 6a. Father Name. Last name, first name and middle initial.
ITEM 6b. Address and Telephone Number of Father. If unknown or deceased, so state. Include civilian title or military rank and service if applicable. If other than natural father is listed, indicate relationship.
ITEM 7a. Mother Name. Last name, first name and middle initial.
ITEM 7b. Address and Telephone Number of Mother. If unknown or deceased, so state. Include civilian title or military rank and service if applicable. If other than natural mother is listed, indicate relationship.
ITEM 8. Persons Not to be Notified Due to Ill Health.
a.List relationship, e.g., "Mother," of person(s) listed in Items 4, 5, 6, or 7 who are not to be notified of a casualty due to ill health. If more than one child, specify, e.g., "daughter Susan." Otherwise, enter "None".
b.List relationship, e.g., "Father" or name and address of person(s) to be notified in lieu of person(s) listed in item 8a. If "None" is entered in Item 8a, leave blank.
ITEM 9a. This item will be used to record the name of the person or persons, if any, other than the member's primary next of kin or immediate family, to whom information on the whereabouts and status of the member shall be provided if the member is placed in a missing status. Reference 10 USC, Section 655. NOT APPLICABLE to civilians.
ITEM 9b. Address and telephone number of Designated Person(s). NOT APPLICABLE to civilians.
ITEM 10. Contracting Agency and Telephone Number
(Contractors only). NOT APPLICABLE to military personnel. Civilian contractors will provide the name of their contracting agency and its telephone number. Example: XYZ Electric, (703) 555-5689. The telephone number should be to the company or corporation's personnel or human resources office.
ITEM 11a. Beneficiary(ies) for Death Gratuity (Military only). Enter first name(s), middle initial, and last name(s) of the person(s) to receive death gratuity pay. A member may designate one or more persons to receive all or a portion of the death gratuity pay. The designation of a person to receive a portion of the amount shall indicate the percentage of the amount, to be specified only in 10 percent increments, that the person may receive. If the member does not wish to designate a beneficiary for the payment of death gratuity, enter "None," or if the full amount is not designated, the payment or balance will be paid as follows:
(1)To the surviving spouse of the person, if any;
(2)To any surviving children of the person and the descendants of any deceased children by representation;
(3)To the surviving parents or the survivor of them;
(4)To the duly appointed executor or administrator of the estate of the person;
(5)If there are none of the above, to other next of kin of the person entitled under the laws of domicile of the person at the time of the person's death.
The member should make specific designations, as it expedites payment.
DD FORM 93 (INSTRUCTIONS), JAN 2008
(Continued)
ITEM 11a. (Continued) Seek legal advice if naming a minor child as a beneficiary. If a member has a spouse but designates a person other than the spouse to receive all or a portion of the death gratuity pay, the Service concerned is required to provide notice of the designation to the spouse.
NOT APPLICABLE to civilians.
Item 11b. Relationship. NOT APPLICABLE to civilians.
ITEM 11c. Enter beneficiary(ies) full mailing address and telephone number to include the ZIP Code. NOT
APPLICABLE to civilians.
ITEM 11d. Show the percentage to be paid to each person. Enter 10%, 20%, 30%, up to 100% as appropriate. The sum shares must equal 100 percent. If no percent is indicated and more than one person is named, the money is paid in equal shares to the persons named. NOT APPLICABLE to
civilians.
ITEM 12a. Beneficiary(ies) for Unpaid Pay/Allowance (Military only). Enter first name(s), middle initial, last name(s) and relationship of person to receive unpaid pay and allowances at the time of death. The member may indicate anyone to receive this payment. If the member designated two or more beneficiaries, state the percentage to be paid each in item 10c. If the member does not wish to designate a beneficiary, enter "By Law." The member is urged to designate a beneficiary for unpaid pay and allowances as payment will be made to the person in order of precedence by law (10 USC 2771) in the absence of a designation. Seek legal advice if naming a minor child as beneficiary. NOT APPLICABLE to civilians.
ITEM 12b. Enter beneficiary(ies) full mailing address and telephone number to include the ZIP Code. NOT
ITEM 12c. If the member designated two or more beneficiaries, state the percentage to be paid each in this section. The sum shares must equal 100 percent. NOT
ITEM 13a. Enter the name and relationship of the Person Authorized to Direct Disposition (PADD) of your remains should you become a casualty. Only the following persons may be named as a PADD: surviving spouse, blood relative of legal age, or adoptive relatives of the decedent. If neither of these three can be found, a person standing in loco parentis may be named. NOT APPLICABLE to civilians.
ITEM 13b. Address and telephone number of PADD. NOT
ITEM 14. Continuations/Remarks. Use this item for remarks or continuation of other items, if necessary. Prefix entry with the number of the item being continued; for example, 5/John J./son/ 19851220/321 Pecan Drive, Schertz TX 78151. Also use this item to list name, address, and relationship of other persons the member desires to be notified. Other dependents may also be listed. This block offers the greatest amount of flexibility for the member to record other important information not otherwise requested but considered extremely useful in the casualty notification and assistance process. Besides continuing information from other blocks on this form, the member may desire to include additional information such as: NOK language barriers, location or existence of a Will, additional private insurance information, other family member contact numbers, etc. If additional space is required, attach a supplemental sheet of standard bond paper with the information.
ITEM 15. Signature of Service Member/Civilian. Check and verify all entries and sign all copies in ink as follows: First name, middle initial, last name. Include rank, rate, or grade if applicable. May be electronically signed (see DoD Instruction 1300.18 for guidelines).
ITEM 16. Signature of Witness. Have a witness (disinterested person) sign all copies in ink as follows: First name, middle initial, last name. Include rank, rate, or grade as appropriate. A witness signature is not required for electronic versions of the DD Form 93 (see DoD Instruction 1300.18).
ITEM 17. Date the member or civilian signs the form. This item is an ink entry and must be completed on all copies.
DD FORM 93 (INSTRUCTIONS) (BACK), JAN 2008