Step Iii - Appeal Form - Tennessee Department Of Human Resources
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3Step III Appeal Form
Board of Appeals
Department of Human Resources
James K. Polk Building, 505 Deaderick Street, 1st Floor, Nashville, TN 37243
Phone: (615) 741-3827
Fax: (615) 401-6848
Email: DOHR.Step3Appeals@tn.gov
To file an appeal and commence Step III of the appeals process, the employee or agency shall submit a fully
completed Step III appeal form or otherwise notify the Step III Administrator and any relevant documentation to
the Board of Appeals. Relevant documentation includes, but is not limited to, any disciplinary letter from the
agency, the Step II decision letter and the written decision letter from the appointing authority in Step I (if
issued). The submission may be made either electronically, by hand delivery, or by U.S. mail (preferably certified)
to the address listed above. Submission of this information must be made no later than fourteen (14) days of
receipt of decision letter by the Commissioner of Human Resources at Step II. If an employee submits a Step II
appeal via U.S. mail, the appeal is deemed timely as long as it is postmarked within the fourteen (14) day
timeframe. It is the responsibility of the appealing party to ensure the Step III appeal form and
documentation has been received by the Board of Appeals. Confirmation of receipt can be made by
contacting the Board of Appeals administrator at DOHR.Step3Appeals@tn.gov or by dialing (615) 741-3827.
Confirmation of receipt by the Board of Appeals administrator will be made by email unless the employee or
agency designates another preferred method of communication below.
To be completed by the employee (if appealing party):
When completing this section, it is very important to include reliable contact information in which the Board may
use to contact you throughout the entire Step III appeals process.
What is your preferred method of communication/correspondence for Step III appeal purposes? Please note
that communication/correspondence will also be sent electronically is an email address is provided, even if not
selected as preferred communication method. For purpose of receipt, notice shall be deemed received as of the
date of the email.
Email
Mail
Please note that should your contact information change during the appeal process, it is your responsibility
to notify appropriate parties and update contact information.
Employee’s name:
Mailing address:
Preferred phone number:
Personal email ad-
PR - 0468
RDA Pending
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