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The Tennessee Department of Human Services (DHS) offers a Family Assistance Application form designed to help individuals and families access a range of critical services. This application plays a fundamental role in determining eligibility for various assistance programs such as Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), and child care support. Through this form, applicants are required to provide detailed information, including household income, employment status, and dependent information, which are vital for assessing financial need. The application covers essential areas like citizenship status and residency, ensuring that services reach those most in need. Confusion often arises around the required documentation, but the form typically outlines what applicants must submit to support their claims. By providing clear sections and detailed instructions, the Family Assistance Application aims to streamline the process, making it easier for families to navigate the complexities of social service programs in Tennessee. Understanding this application is a vital step in securing the assistance that can lead to improved well-being and stability for countless families across the state.
Tennessee DHS Family Assistance Application Example
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.
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SECTION 1 - EMERGENCY CONTACT INFORMATION |
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1. NAME (Last, First, Middle Initial) |
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2. SSN |
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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 |
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SINGLE |
DIVORCED |
WIDOWED |
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5. CHILDREN |
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b. RELATIONSHIP |
c. DATE OF BIRTH |
d. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER |
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a. NAME (Last, First, Middle Initial) |
(YYYYMMDD) |
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6a. FATHER NAME (Last, First, Middle Initial) |
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER |
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7a. MOTHER NAME (Last, First, Middle Initial) |
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER |
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8a. DO NOT NOTIFY DUE TO ILL HEALTH |
b. NOTIFY INSTEAD |
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9a. DESIGNATED PERSON(S) (Military only) |
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b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER |
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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 |
b. RELATIONSHIP |
c. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER |
d. PERCENTAGE |
(Military only) |
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12a. BENEFICIARY(IES) FOR UNPAID PAY/ALLOWANCES |
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER |
c. PERCENTAGE |
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(Military only) NAME AND RELATIONSHIP |
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13a. PERSON AUTHORIZED TO DIRECT DISPOSITION (PADD) |
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER |
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(Military only) NAME AND RELATIONSHIP |
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14. CONTINUATION/REMARKS |
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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
(YYYYMMDD)
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
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
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)
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
INSTRUCTIONS FOR PREPARING DD FORM 93
(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
APPLICABLE to civilians.
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
APPLICABLE to civilians.
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
APPLICABLE to civilians.
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
File Breakdown
| Fact Name | Description |
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| Purpose of the Form | The Tennessee DHS Family Assistance Application form is used to apply for financial assistance and benefits. |
| Eligibility Criteria | Applicants must meet specific income, resource, and residency requirements set by the state. |
| Governing Laws | The application process is governed by Title 71 of the Tennessee Code Annotated. |
| Types of Benefits | This form covers various benefits, including Families First, Food Stamps, and TennCare. |
| Application Process | Applications can be submitted online, by mail, or in person at local DHS offices. |
| Required Information | Applicants must provide personal identification, income information, and family details. |
| Processing Time | The average processing time is usually within 30 days from the date of application submission. |
| Renewal Requirements | Participants must renew their benefits periodically and submit updated information as required. |
| Assistance Resources | Applicants can access assistance through local DHS offices or online resources for help. |
| Appeal Process | Individuals have the right to appeal decisions regarding their benefits under state guidelines. |
Guide to Using Tennessee DHS Family Assistance Application
Completing the Tennessee DHS Family Assistance Application form is an important step for anyone seeking assistance. Once you have the form ready, follow the steps outlined below carefully to ensure accurate submission.
- Start by downloading or obtaining the Family Assistance Application form from the Tennessee DHS website or your local office.
- Read through the instructions provided on the first page of the form, as they will guide you in filling it out correctly.
- Provide your personal information, including your full name, date of birth, and contact details. Make sure to double-check the accuracy of your input.
- Fill in details regarding your household. Include information for each family member, such as their names, ages, and relationship to you.
- Indicate your income sources. Clearly state all forms of income earned by you and other household members, including employment, benefits, or any other financial support.
- List your monthly expenses. This includes rent or mortgage payments, utilities, food, and any other regular costs associated with your household.
- Provide information about any assets you own, such as savings accounts, vehicles, or property. Make sure to provide accurate values.
- Review the completed application for any errors or missing information. Corrections at this stage can prevent delays.
- Sign and date the application at the designated area. Be aware that an unsigned form may not be processed.
- Submit your application. You can do this online through the DHS portal or deliver it in person at your local DHS office.
Get Answers on Tennessee DHS Family Assistance Application
What is the Tennessee DHS Family Assistance Application form?
The Tennessee DHS Family Assistance Application form is used to apply for various assistance programs offered by the Department of Human Services in Tennessee. These programs may include food assistance, cash assistance, and other necessary services aimed at helping families in need.
Who is eligible to apply for assistance?
Eligibility for the Family Assistance programs generally depends on several factors, including income, family size, and residency. Typically, families with limited financial resources may qualify. It's essential to review specific eligibility requirements based on the type of assistance being sought, as these can vary by program.
How can I access the Family Assistance Application form?
The form is available online through the Tennessee Department of Human Services website. You can also request a paper application by visiting your local DHS office. The availability of online submission may help streamline the application process.
What information do I need to provide on the application?
When completing the application, applicants should expect to provide personal information such as:
- Full name and address
- Social Security numbers for all household members
- Income details
- Employment information
- Assets and resources
It’s crucial to provide accurate and complete information to avoid delays in processing.
Can I apply for multiple assistance programs using the same form?
Yes, the Family Assistance Application form allows applicants to request assistance for multiple programs simultaneously. This comprehensive approach helps streamline the process and ensures that individuals receive the benefits they may qualify for without the need to fill out multiple applications.
What happens after I submit my application?
After submitting your application, it will undergo a review process. The DHS may contact you for additional information or clarification if needed. Once reviewed, you will receive a determination of eligibility by mail. Expect a timeline for this decision, generally within 30 days, though it may vary based on the volume of applications received.
Is there an appeal process if my application is denied?
If your application is denied, you have the right to appeal the decision. The denial notice will include instructions on how to initiate an appeal. This typically involves submitting a written request for a hearing, where you will have the opportunity to present your case.
Can I update my application after submission?
Yes, applicants can usually update their information after submission if circumstances change. For instance, if your income changes or if there are changes in household composition, these updates should be reported promptly to the DHS. Contact your local office or use the online portal, if available, to make the necessary adjustments.
Where can I find additional assistance if I have questions about my application?
If you have questions or need assistance regarding your application, consider reaching out to the Tennessee Department of Human Services directly. You may also visit local community organizations that often provide support and guidance throughout the application process.
Common mistakes
When filling out the Tennessee DHS Family Assistance Application form, many people inadvertently make mistakes that can delay processing or lead to denial of assistance. It is crucial to take the time to complete the application accurately to ensure that families receive the support they need.
One common mistake is failing to provide complete personal information. Missing details such as names, addresses, or Social Security numbers can lead to complications. Ensure that all required fields are filled out fully and correctly.
Many applicants overlook the necessity of providing income documentation. Failing to include recent pay stubs or tax returns can result in a delay in processing. Properly documenting income helps the Department assess your eligibility for assistance.
Another frequent error is not updating household information. Life changes, such as the addition or removal of a family member, must be reported promptly. Neglecting to do so can affect the amount of assistance received.
Inaccurate answers to questions can also derail an application. Answering truthfully and carefully can prevent misinterpretations that lead to a denial. Each question serves a purpose and needs to be approached with diligence.
It's essential to understand the required documents that need to be submitted. Missing documentation can halt the process. Applicants should review the checklist provided and ensure all necessary paperwork is attached.
Some applicants submit the form without signing it. A signature is a confirmation of the truthfulness of the information provided and is legally required. Double-check that your signature is included at the end of the application.
Ignoring deadlines is another common oversight. Applications must be submitted within certain timeframes to be considered. Mark your calendar and set reminders to avoid missing these important dates.
When filling out the form, providing the wrong contact information can lead to missed communications. Ensure that the contact details provided are accurate and up-to-date, allowing for efficient correspondence.
Lastly, not seeking help when needed can contribute to errors. Applicants should feel empowered to reach out to local assistance programs or community organizations for guidance. Getting support can make the process more manageable and increase the chances of a successful application.
Documents used along the form
When applying for assistance through the Tennessee Department of Human Services (DHS), there are various forms and documents that you may need to submit alongside the Family Assistance Application form. These documents help provide additional information that may be required to process your application efficiently. Below is a list of commonly used documents:
- Proof of Identification: This may include a government-issued photo ID, such as a driver's license or passport. Providing valid identification helps verify your identity and establishes eligibility.
- Income Documentation: Pay stubs, tax returns, or employment verification letters are examples of income documents. These materials are essential to assess your financial situation accurately.
- Residency Verification: This could be a lease agreement, utility bills, or any official correspondence that confirms your address. Proof of residency is important for determining eligibility based on your location.
- Social Security Numbers: As part of your application, you will need to provide Social Security numbers for all household members. This information is crucial for tracking and verifying assistance eligibility.
- Child Support Documentation: If applicable, provide records of child support payments or agreements. This information may impact your eligibility for certain forms of assistance.
Gathering these documents ahead of time can streamline the application process and help ensure that you provide the necessary information to facilitate a timely decision. Doing so increases the likelihood of a smooth experience with the Tennessee DHS.
Similar forms
Medicaid Application Form: Similar to the Family Assistance Application, the Medicaid Application collects personal and financial information to determine eligibility for medical assistance. Both forms require details about household income and size.
Supplemental Nutrition Assistance Program (SNAP) Application: Like the Family Assistance Application, the SNAP Application assesses financial circumstances to provide food assistance. They both request similar income and asset information.
Temporary Assistance for Needy Families (TANF) Application: The TANF Application is focused on providing financial aid to families in need, similar to how the Family Assistance Application addresses various family support needs.
Welfare-to-Work Program Application: This application aims to assist individuals in securing employment. It shares the same goal of promoting self-sufficiency as the Family Assistance Application.
Child Care Assistance Application: For families seeking financial help with child care costs, this application requires similar personal and income information as the Family Assistance Application.
Low-Income Home Energy Assistance Program (LIHEAP) Application: This document assesses a household's energy needs, focusing on financial qualifications, much like the Family Assistance Application does for various assistance programs.
Housing Assistance Application: For those seeking financial help with housing, the Housing Assistance Application collects comparable data about income and family size, similar to the Family Assistance Application.
Veterans Affairs Assistance Application: This document is designed for veterans seeking financial aid, requiring personal information and service history, much like the information gathered in the Family Assistance Application.
Social Security Disability Insurance (SSDI) Application: Similar in its aim to provide support to those unable to work, this application gathers personal and medical information akin to what is required in the Family Assistance Application.
Unemployment Benefits Application: This application seeks to provide temporary financial aid to those without work, requesting financial and work history information similar to the Family Assistance Application.
Dos and Don'ts
When completing the Tennessee DHS Family Assistance Application form, it is essential to follow certain guidelines to ensure that your application is processed smoothly. Below is a list of things to do and avoid.
- Do read all instructions carefully.
- Do provide accurate and complete information.
- Do double-check your application before submission.
- Do keep a copy of your completed application for your records.
- Do ask for help if you have questions about the form.
- Don't leave any sections blank unless specified.
- Don't submit the application if you're unsure about the information provided.
By adhering to these guidelines, you can enhance the chances of a successful application process.
Misconceptions
The Tennessee Department of Human Services (DHS) Family Assistance Application form serves as a vital tool for individuals and families seeking various forms of financial aid and assistance. However, several misconceptions surround this application process, leading to confusion among potential applicants. Below is a list of five common misconceptions, along with clarifications.
- Misconception 1: The application is only for low-income families.
- Misconception 2: The application takes an excessively long time to process.
- Misconception 3: All applicants must provide the same documentation.
- Misconception 4: Submitting an application guarantees assistance.
- Misconception 5: Help is only available for families with children.
This application is often perceived as only suitable for families living in extreme poverty. In reality, it encompasses a broader range of financial situations, including middle-income households facing temporary financial difficulties.
Many applicants believe that submitting the form will lead to long waiting periods before they receive any assistance. While processing times can vary, Tennessee DHS strives to process applications promptly and effectively, often within a few weeks.
Another common belief is that each applicant needs to submit a rigid set of documents. In fact, requirements may vary based on individual circumstances, allowing for some flexibility in the documentation needed.
Some individuals think that by simply submitting the application, they will automatically receive the aid they are looking for. However, eligibility is determined through a thorough review process, and not every application will qualify for assistance.
It is a common belief that only families with children can receive support through this application. However, several programs exist to assist individuals without children, including those who are experiencing hardship or other qualifying situations.
Key takeaways
The Tennessee DHS Family Assistance Application form is a crucial document for individuals seeking various assistance programs. Here are some key takeaways to keep in mind when filling out and using this form:
- Gather necessary documents beforehand. Having information like Social Security numbers, income details, and residency proof will streamline the application process.
- Complete all sections thoroughly. Incomplete applications can lead to delays or rejections. Take the time to ensure every question is answered accurately.
- Review the application before submission. Check for errors or omissions to strengthen your submission and reduce the chances of needing to resubmit.
- Follow up after submission. After sending in your application, inquire about its status to ensure it’s being processed and understand any next steps you need to take.
Understanding these aspects can significantly enhance your experience with the application process and improve your chances of receiving assistance in a timely manner.