PUBLIC HOUSING CHANGE FORM

The following information constitutes all changes and additions to my application as of the date of my signature below.

If “Yes” pick up a child care verification and return to our office within 5 days or bring in 4 consecutive receipts.

Change of Address:

Change of Household Composition:
Please circle whether you are ADDING or REMOVING this person to your lease.

If you are adding a household member, a valid birth certificate, social security card, and INS must be submitted. Anyone 18 or older must submit a valid police background check and all income verification along with the information stated above.

Change in Benefits

$ per week
$ per month
per month
$ per month
per month

If you are no longer employed, you will not be reworked until verification of NEW income is received. You must show income by AFDC, unemployment, child support, contributions, etc. When you receive verification from AFDC, unemployment, food stamp office, or contributions, you are responsible for reporting this information written to this office so you can be reworked as soon as possible. If written verification is received after the 20th of the month you may not be reworked for the next month; however, we will make every effort to rework you as quickly as possible.

You are responsible for your portion of the rent until you receive a Notice of Change to Lease and Contract. This will be mailed to you with the effective date of change.