Family Update/Change Form

This form allows you to provide information in writing to the housing authority. You may report changes in income, changes in household composition, change in mailing address, or any other information you need to provide the housing authority.

Form Date Field*

Which Housing Authority services your account?*

Select

Are you currently waiting to receive housing assistance*

Select

Are you a currently receiving housing assistance?*

Select

What is the head of household's first name*

What is the head of household's last name*

What is your complete mailing address?*

What state do you receive your mail in?*

What is your mailing address zip code?*

Phone number with area code and email address*

Are you reporting an increase or decrease in income*

Select

Did you have a change in Employment?

For job loss: provide a letter from your employer with end date. For new job: provide a letter from your employer with start date, rate of pay, and hours worked per week. For an increase/decrease in wages; provide three current and consecutive pay stubs.

Select

Are you receiving unemployment

Provide a screenshot or award letter of your unemployment benefits including start date and weekly amount: https://unemployment.cmt.ohio.gov/cmtview/loginc.jsp

Select or enter value

Change in TANF/OWF/Cash Assistance

Provide a letter from the Department of Job and Family Services with the start/end date and monthly benefit amount, if applicable.

Select

Change in Social Security

Provide a letter from Social Security with the start/end date and monthly benefit amount.

Select or enter value

Change in Child Support

Provide a 12 month print out from Child Support Enforcement Agency's website: https://jfs.ohio.gov/Ocs/CustServWebPortalWelcome2.stm

Select or enter value

What is the change to your child support?

Are you seeking to report something else

Please provide information in writing or upload documentation in regards to your change.

Does this change mean that you or an adult member of your household will now have zero income

If you are now at zero income you will receive forms from the housing authority that will need completed and returned the housing authority.PLEASE PROVIDE THE FULL NAME OF THE INDIVIDUAL REPORTING ZERO INCOME.

Do you need to add or remove someone from your household

If you are looking to add or remove household members please provide the full name of the person you are looking to add or remove from your household.

Select or enter value

File Upload

Please upload documentation supporting your requested income change. Examples: Paystubs, Layoff Notification, Benefit change letter. Please note, changes cannot be completed without proper supporting documentation. Failure to submit proper documentation may delay the income change.

Drag and drop files here or

NOTICE

IF YOU DO NOT SUPPLY DOCUMENTATION NOW THE HOUSING AUTHORITY WILL NOT BE ABLE TO PROCESS YOUR CHANGE UNTIL IT IS RECEIVED.

ELECTRONIC SIGNATURE - TYPE YOUR FULL NAME*

By entering your name in the box below you are electronically signing this form and certifying that the information given above is accurate and complete to the best of your knowledge and belief. You understand that providing false information is punishable under Federal and State law is is grounds for termination of your housing assistance.

Please review the Electronic Signature line above. Does your FULL NAME show?*

If no, please re-type your name on the Electronic Signature Line.

Housing Change / Update Form

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