How to Complete and Submit the Tennessee Declaration of Citizenship Form

The Tennessee Declaration of Citizenship Form is a one-page sworn statement that adults must sign and submit when applying for a state-issued professional license, permit, or public benefit in Tennessee. You attest to being a U.S. citizen, a qualified alien, or an eligible nonimmigrant, and you back the attestation with identification documents the agency reviews before approving your application.¹ The form itself is short. The supporting documents are where applications get held up.

Who Has to File One

Anyone 18 or older applying for a federal, state, or local public benefit through a Tennessee state agency or local health department must complete the declaration.¹ In practice, that covers professional and commercial licenses, alcoholic beverage permits, housing assistance, unemployment, health programs, food assistance, and state- or locally-funded postsecondary education.²

The Department of Health requires it for every initial license and reinstatement in the health professions it regulates, from medical and nursing to dental.³ The Alcoholic Beverage Commission uses it for permit applications.⁴ Boards under Commerce and Insurance, the Board for Licensing Contractors, and agencies administering housing or social services use their own versions of the same form.

Applicants under 18 are exempt. Benefits where federal law prohibits states from verifying immigration status are also outside the requirement.¹

Where to Get the Right Form

There is no single statewide version. Each agency publishes its own, matched to the benefit it administers. The Department of Health’s version is a downloadable PDF on TN.gov that asks for your healthcare profession and Tennessee license number.³ The Alcoholic Beverage Commission posts its version, along with its documentation requirements, on its Declaration of Citizenship Information page.⁴

Start on the website of the specific agency or board you are applying to and look in the application packet. If you cannot find it, call the agency. They are required by statute to include it in their application materials.

What Goes on the Form

Agency versions vary slightly, but every one of them collects the same core information:

Full legal name, including maiden name if applicable, exactly as it appears on the ID you plan to submit. Name mismatches are a common reason applications stall.
Current mailing address.
Profession and existing Tennessee license number, on agency forms that ask for it. Leave the license number blank for a first-time application.
A Yes or No answer to whether you are a United States citizen.
If you answered No, your status category: qualified alien, or nonimmigrant whose visa relates to employment in the United States.³
Your signature under penalty of perjury. The form itself states that false statements are subject to perjury penalties.¹

Notarization is not required. Your signature under penalty of perjury satisfies the statute.

Supporting Documents by Status

Signing the declaration is not enough on its own. You also have to produce identification proving the status you claimed. What qualifies depends on your category.

U.S. Citizens

Under T.C.A. § 4-58-103(c), citizens can satisfy the requirement with any one of the following:¹

Tennessee driver license or photo ID issued by the Department of Safety.
A driver license from another state whose issuance requirements are at least as strict as Tennessee’s, as determined by the Department of Safety.
Official birth certificate from any U.S. state or territory. Puerto Rican birth certificates issued before July 1, 2010 are not accepted.
Federal birth certificate issued by the U.S. government.
Valid, unexpired U.S. passport.
Certificate of birth abroad (DS-1350 or FS-545).
Report of birth abroad (FS-240).
Certificate of citizenship (N-560 or N-561).
Certificate of naturalization (N-550, N-570, or N-578).
U.S. Citizen ID card (I-197 or I-179).
Social Security number the agency can verify with the Social Security Administration.

The statute requires one document from this list, but some agencies ask for two. The Alcoholic Beverage Commission, for instance, requires two forms of proof from U.S. citizens.⁴ Check your agency’s instructions before you file so you are not sent back for a second document.

Qualified Aliens

“Qualified alien” is a federal category that includes lawful permanent residents, refugees, asylees, parolees admitted for at least one year, individuals whose deportation has been withheld, Cuban and Haitian entrants, residents under a Compact of Free Association, and certain battered immigrants with approved or pending petitions.⁵

You must present two documents proving identity and immigration status, both of a type the U.S. Department of Homeland Security accepts for verification through its SAVE program.¹ Common examples are a Permanent Resident Card (I-551), Employment Authorization Card (I-766), Reentry Permit (I-327), Refugee Travel Document (I-571), Arrival/Departure Record (I-94), and an unexpired foreign passport.⁴

If you can only produce one qualifying document, the agency has to verify it through the federal SAVE system before processing your application.¹ Plan for extra time if that is your situation.

Nonimmigrants

If you are a nonimmigrant applying for a professional or commercial license tied to your visa-authorized employment, provide a copy of your machine-readable visa.⁴ Federal law allows this narrow route so nonimmigrants on work-related visas can obtain the state licenses their jobs require.²

How to Submit and What Happens Next

You file the completed declaration and your supporting documents with the agency handling your application. No central office handles these forms statewide. Most boards accept uploads through their online licensing portals in PDF; you can also mail the originals or copies, or deliver them in person at a regional service center. Confirm each agency’s preferred method before you send anything.

Scan or photocopy every document before you submit it, and verify that nothing is expired. Outdated materials are rejected.

For U.S. citizens with valid ID, review is usually fast. The agency compares your document against the statutory list and clears you to continue. For qualified aliens and nonimmigrants, the agency runs your information through the federal SAVE system, which U.S. Citizenship and Immigration Services administers.⁶ Most queries come back within seconds, but cases that need additional review take several federal workdays, and complex ones can run longer.⁷ The agency may contact you for extra documentation during that process.

Penalties for a False Declaration

You are signing under penalty of perjury, and Tennessee enforces that language at both state and federal levels.

Perjury in Tennessee is a Class A misdemeanor punishable by up to 11 months and 29 days in jail, a fine of up to $2,500, or both.⁸ Separately, T.C.A. § 4-58-104 makes anyone who knowingly files a false declaration liable under the Tennessee Medicaid False Claims Act or the state False Claims Act, with the agency filing a complaint through the Attorney General and any recovery going into a fund dedicated to enforcing the verification law.⁹

At the federal level, falsely claiming U.S. citizenship is its own crime under 18 U.S.C. § 911, punishable by up to three years in federal prison, a fine, or both.¹⁰ Non-citizens convicted of the offense may also face deportation or bars on re-entry. If you are unsure which status category applies to you, talk to an immigration attorney before signing anything.

Common Reasons Applications Get Held Up

Most trouble comes from the documents rather than the form itself. A few things to check before you file:

Confirm expiration dates. An expired passport or lapsed driver license will be rejected, and renewal processing can add weeks.
Make the name on your ID match the name on the form. If you changed your name through marriage or court order, bring the legal name-change paperwork.
Read the specific agency’s instructions on how many documents it wants. The statute lets citizens produce one; the Alcoholic Beverage Commission asks for two. Do not assume the baseline is universal.
If your only birth certificate is a Puerto Rican one issued before July 1, 2010, obtain a replacement issued after that date or use a different document from the citizen list.¹
Qualified aliens producing a single document should expect SAVE verification to add days or weeks to processing.

1
Justia. Tennessee Code 4-58-103 – Verification of Citizenship of Applicants for Benefits
2
Office of the Law Revision Counsel. 8 USC 1621 – Aliens Who Are Not Qualified Aliens or Nonimmigrants Ineligible for State and Local Public Benefits
3
Tennessee Department of Health. Tennessee Declaration of Citizenship Form
4
State of Tennessee. Tennessee Alcoholic Beverage Commission – Declaration of Citizenship Information
5
Office of the Law Revision Counsel. 8 USC 1641 – Definitions
6
U.S. Citizenship and Immigration Services. SAVE
7
U.S. Citizenship and Immigration Services. Guide to Understanding SAVE Verification Responses
8
Justia. Tennessee Code 39-16-702 – Perjury
9
Justia. Tennessee Code 4-58-104 – Liability for False, Fictitious or Fraudulent Statements
10
Office of the Law Revision Counsel. 18 USC 911 – False Claim of Citizenship