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Chandler Housing - Change Report Form
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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.
1.
Please fill out all required information.
*
Name
Social Security Number
Phone Number
Address on File
Head of Household's Email
2.
Please select one:
*
I am a waiting list applicant
I am a participant
3.
Please select the housing program:
*
Housing Choice Voucher (A.K.A. Section 8)
Public Housing
TBRA
4.
Participants only--- Please select your housing representative:
*
Vivian
Zelda
Vickie
Mayra
Carmen
Fabiola
Other, please specify
Please ONLY fill out the section for which you are requesting a change.
5.
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
6.
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
7.
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 $$
Increase in income:
01/01/1900-12/31/2100
8.
EMPLOYMENT INCOME CHANGE - DECREASE
To be effective next month, all documentation must be received by the 20th calendar day of the month to allow adequate time for processing.
Who in the family has an income change?
Name of the employer
Termination date
Phone number
Fax number
Termination
01/01/1900-12/31/2100
9.
What were your hours?
What are your hours now?
Reduced Hours
10.
Unemployment
Effective Date
Amount Received $$
Unemployment Income Change
--Please Select--
Began
Ended
01/01/1900-12/31/2100
11.
OTHER
Child Care
Childcare provider address
Phone #
Fax#
Amount paid per week $$
Child Care
--Please Select--
Increase
Decrease
12.
Social Security
Amount $$
Effective Date
Social Security
--Please Select--
Increase
Decrease
01/01/1900-12/31/2100
13.
TANF
Amount $$
Effective Date
TANF
--Please Select--
Increase
Decrease
01/01/1900-12/31/2100
14.
NOTE: The court order indicating the increase or decrease must be submitted.
Child Support
Amount $$
Effective Date
Child Support
--Please Select--
Increase
Decrease
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:
*
--Please Select--
Displaced
Living and/or Working in Chandler
Chronically Homeless
Currently Employed/Employment Program
Elderly
Disabled
Other
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.
*
--Please Select--
--None--
True
False
Submit