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	How do I report changes to income, family composition, or wait list preferences changes? You now can report income and family changes using our online form! A Housing Specialist will review your request and contact you. All changes must be approved and will need to have all required information to process.

	Example of Reasons to complete Change Report: Loss of Income A member has been added through birth, adoption or court awarded custody. A household member is leaving or has left the family unit. Family break-up.

Please fill out all required information.*

Name
Social Security Number
Phone Number
Address on File
Head of Household's Email

Please select one:*

	I am a waiting list applicant
	I am a participant

Please select the housing program:*

	Housing Choice Voucher (A.K.A. Section 8)
	Public Housing
	TBRA

	Please ONLY fill out the section for which you are requesting a change.

FAMILY CHANGE - ADD
In order to add someone you must bring the following four items: 1) Orig. birth certificate 2) Orig. social security card 3) Picture identification 4) Proof of income and assets (i.e., checking, savings etc.)

		Name of the Person		Date of Birth		Relationship to you
ADD a member to the household				01/01/1900-12/31/2100

FAMILY CHANGE - REMOVE
You must submit evidence of the former family member’s new address.

		Name of the person		Relationship to you		Move out date		New address for this person
REMOVE a member from my household						01/01/1900-12/31/2100

EMPLOYMENT INCOME CHANGE - INCREASE

		Who in the family has an income change?		Phone number		Fax number		Employment start date		Name of employer		Hours worked per week		Hourly rate $$
Increase in income:								01/01/1900-12/31/2100

EMPLOYMENT INCOME CHANGE - DECREASE
To be effective next month, all documentation must be received by the 20th calendar day of the month to allow adequate time for processing.

		Who in the family has an income change?		Name of the employer		Termination date		Phone number		Fax number
Termination						01/01/1900-12/31/2100

		What were your hours?		What are your hours now?
Reduced Hours

10.

		Unemployment		Effective Date		Amount Received $$
Unemployment Income Change				01/01/1900-12/31/2100

11.

OTHER

		Child Care		Childcare provider address		Phone #		Fax#		Amount paid per week $$
Child Care

12.

		Social Security		Amount $$		Effective Date
Social Security						01/01/1900-12/31/2100

13.

		TANF		Amount $$		Effective Date
TANF						01/01/1900-12/31/2100

14.

NOTE: The court order indicating the increase or decrease must be submitted.

		Child Support		Amount $$		Effective Date
Child Support						01/01/1900-12/31/2100

15.

NOTE: Section 8/TBRA participants must receive written permission from the landlord to have any guest temporarily stay in the unit. A copy of the written permission must be submitted.

		Visitor(s) Name(s)		Beginning visit date		Ending visit date
Visitor(s)				01/01/1900-12/31/2100		01/01/1900-12/31/2100

	Reason for Preference Change

A. Displaced: Applicants displaced by government action OR a disaster recognized by Federal disaster laws.
Desplazado/a: Solicitantes desplazados por acciones del gobierno O por un desastre reconocido por las leyes federales de desastres.

B. Living and/or Working in Chandler: Applicants must physically live in the City of Chandler, OR must physically work, or be hired to work, in the City of Chandler.
Viviendo y/o Trabajando en Chandler: Los solicitantes deben vivir físicamente en la Ciudad de Chandler, O deben trabajar físicamente, o ser contratados para trabajar, en la Ciudad de Chandler.

C. Chronically Homeless: A person with a disability who lives either in a place not meant for human habitation, a safe haven, or emergency shelter continuously for at least 12 months, OR on at least four separate occasions in the last three years, where the combined length of homeless occasions is equal to at least 12 months.
Crónicamente Indigentes: Una persona con una discapacidad que viva ya sea en un lugar que no sea para ser habitado por seres humanos, un refugio seguro, o un albergue de emergencia continuamente durante por lo menos 12 meses, Ó por lo menos en cuatro ocasiones por separado durante los últimos tres años, cuando el tiempo combinado de indigencia equivalga a por lo menos 12 meses.

D. Currently Employed/Employment Program: At least one adult family member works at least 20 hours a week outside the City of Chandler, attends an employment training program, or attends school on a full-time basis.
Actualmente Empleado/a/Programa de Empleo: Por lo menos un miembro adulto de la familia trabaja por lo menos 20 horas por semana fuera de la Ciudad de Chandler, asiste a un programa de capacitación de empleo, o asiste a la escuela tiempo completo.

E. Elderly: The head and/or spouse is elderly (62+ years of age).
Personas de Mayor Edad: El/la jefe/a de la familia y/o su cónyuge es/son personas de mayor edad (62+ años de edad).

F. Disabled: Disabled families and families with a disabled household member.
Discapacitado/a: Familias discapacitadas y familias con un miembro del hogar que tiene una discapacidad.

16.	Reason for Preference Change:*

17.

If you selected "Other" on question 16, please enter the reason here.

Instructions for Attachments: Attachments or other documents related to a Change Report may be sent to the Housing Office by Email to housing.residents@chandleraz.gov; put in the City of Chandler's Utility drive-up Drop-Off Box located on Chicago Street, between Arizona Avenue and Washington Street; or by Mail to the City of Chandler Housing and Redevelopment Division, Mail Stop 101, P.O. Box 4008, Chandler, AZ 85244-4008. Make sure the documents are identified as going to the Housing Office with the head of household's full name on the front of all documents. If you have questions about this information, need assistance, or are requesting a reasonable accommodation, please contact the Housing Office by phone at 480-782-3200.

18.	I self-certify that the above information is true and correct and that the information I provided on this Change Report form may be used as a source to verify changes to the household, in particular income changes and expenses. I understand my change will not take effect until all information is verified. I also understand if additional verification is received and contradicts the information provided on this Change Report form, I may be responsible for any overpaid assistance.*

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