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State of Tennessee Health Services and Development Agency Andrew Jackson Building, 9th Floor, 502 Frederick Street, Nashville, TN 37243 www.tn.gov/hsda Phone: 6157412364RELOCATION EXEMPTION STAFF

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This is a form required for reporting certain information to the State of Tennessee regarding open arms care in Chattanooga.

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Any organization or entity involved in providing open arms care services in Chattanooga is required to file this form.

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The purpose of this form is to ensure transparency and accountability in the provision of open arms care services in Chattanooga.

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The form requires information such as the name of the organization, services provided, number of beneficiaries, funding sources, and other relevant details.

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