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LESS and MAP Page 1 of 8 Tenner USE ONLY Date Received: caseworker: Application for Individuals Needing Long Term Services and Supports or a Medicare Savings Program (like CMB or SLAB) Who should

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How to Fill Out this Form - Tennessee:

1. Start by carefully reading the instructions provided on the form. Make sure you understand the purpose of the form and what information is required.
2. Provide accurate and up-to-date personal information. This may include your full name, address, date of birth, and Social Security number.
3. If the form requires you to select options or checkboxes, make sure to accurately mark your choices. Double-check your selections to avoid any mistakes.
4. Fill out the form legibly and neatly. If your handwriting is difficult to read, consider typing the information instead.
5. If any sections of the form are not applicable to you, indicate this by writing "N/A" or crossing out those sections.
6. Attach any required supporting documents, such as identification or proof of address. Ensure that these documents are valid and current.
7. Once you have completed the form, review it carefully to make sure all the information is correct. Look for any errors or omissions before submitting it.
8. If you have any questions or concerns while filling out the form, don't hesitate to seek assistance from the appropriate authorities or an expert in the field.

Who Needs this Form - Tennessee?

1. Tennessee residents: This form is specifically designed for individuals who reside in the state of Tennessee. It may be required for various purposes such as tax filing, voter registration, or applying for state-specific benefits.
2. Organizations and businesses operating in Tennessee: Certain forms may be necessary for entities operating within the state of Tennessee to comply with state laws and regulations. These forms may include business registration forms, permits, or licensing applications.
3. Individuals or entities involved in legal proceedings in Tennessee: If you are involved in a legal case or require legal documentation related to matters in Tennessee, you may need to fill out specific forms that are recognized by Tennessee courts or legal authorities.

Remember, it is always important to check with the relevant government agencies, organizations, or legal professionals to determine the specific forms needed in your individual circumstances.

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