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Tre Hargett
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Safe At Home Forms

The forms below may be used to update your contact information with the program, to request assistance verifying your eligibility for public benefits enrollment, or for other purposes.

Image
Form
Forms for Applicants
Notice of Change (PDF, 274.9KB)
SS-9435
Notice of Name Change (PDF, 248.6KB)
SS-9438
Petition for Review (PDF, 247.6KB)
SS-9431
Eligibility Verification Request (PDF, 253.4KB)
SS-9437
Release of School Records (PDF, 247.1KB)
SS-9441
Withdrawal Form (PDF, 253.8KB)
SS-9439
Forms for Application Assistants
Certified Application Assistant Application (PDF, 250.8KB)
SS-9434
Forms for Agencies & Law Enforcement
Administrative Request for Disclosure (PDF, 250.2KB)
SS-9436
Law Enforcement Request for Disclosure (PDF, 251.2KB)
SS-9432

Related Links

What is the Notice of Change form?
What is the Notice of Name Change form?
What is the Petition for Review form?
What is the Eligibility Verification Request form?
What is the Release of School Records form?
What is the Law Enforcement Request for Disclosure form?
What is the Administrative Request for Disclosure form?
What is the Withdrawal Form?
What is the Certified Application Assistant Application form?

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Safe at Home Documents
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Our mission is to exceed the expectations of our customers, the taxpayers, by operating at the highest levels of accuracy, cost-effectiveness, and accountability in a customer-centered environment.

 

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Secretary of State Tre Hargett

Tre Hargett was elected by the Tennessee General Assembly to serve as Tennessee’s 37th secretary of state in 2009 and re-elected in 2013, 2017, and 2021. Secretary Hargett is the chief executive officer of the Department of State with oversight of more than 300 employees. He also serves on 16 boards and commissions, on two of which he is the presiding member. The services and oversight found in the Secretary of State's office reach every department and agency in state government.

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