If you are a client and have:

• moved
• changed your phone number
• had a change in your employment
• had a change in your household size, such as a new roommate or family member.

Use this form to let your Caseworker know that your information has been changed. They will contact you to follow-up on the information you provide.

This form CANNOT be used for income reporting or to provide verification documents.Those documents must still be provided on paper to your local Human Services office.