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Report Income Changes - HCV

How to Report Income and Other Changes

What are the changes the family needs to report to caseworker in reference to your family circumstances?

  • Income: increase or decrease
  • Household composition: add or remove a member
  • Assets: increase or decrease
  • Expenses: increase or decreases for medical, childcare or disability assistance
  • Student status, for person ages 18 or older who attend or no longer attend school full-time

Changes must be reported within 10 days. Please review the checklist for documents needed to process your request. Note: failure to submit required documentation will result in your request being denied or delayed.

Head of Household must complete and sign all forms where required. Household members age 18 or older are required to sign each form pertaining to their requested change. Please see below for additional instructions:

  1. Complete only the sections that pertain to the change you are reporting.
  2. If there is a household member with no income contact your caseworker for a Family expense form.
  3. Attach documentation only for the change you are reporting. For example, if you are no longer employed, please submit a copy of the separation notice from your employer.

It is our goal to process your changes as quickly as possible. It is important that you provide us with complete information in order to expedite your request. Failure to supply documents will delay processing your request.

You may also submit information via email to your caseworker:

Last Name A-J: 850.243.3224 ext. 206
Last Name K-Z: 850.243.3224  ext. 218

If you email your verification, be sure to type "report Changes" in the subject line and include the first and last name of the head of household. Also if you don't receive any response back from the caseworker feel free to make contact with the caseworker by phone and find out if they have received your information.

VERIFICATION CHECKLIST Please attach the required verifications prior to submitting your request

Adding Income/Reducing Income

  • Provide a minimum of 3 consecutive paycheck stubs
  • Provide an offer letter on company letterhead that includes the rate of pay and number of hours worked per week
  • Provide Social Security or SSI benefit award letter(s), TANF, unemployment, adoption subsidy, etc.
  • Provide verification of all other income, self-employment, child support, pensions, contributions, worker's compensation, etc.

Removing Income

  • Provide a separation letter on company letterhead
  • Termination letter of benefits, i.e. child support, Social Security, SSI, unemployment, TANF, etc.
  • If a household member has zero income as a result of the change, the Zero Income Statement must be completed and signed by the member

Adding New Household Member(s) - Family Composition

  • If adding a minor as a result of birth, adoption, or court-awarded custody, provide a birth certificate, verification of adoption, or verification of court-awarded custody within 30 calendar days
  • Provide birth certificate for any new member being added
  • Provide social security card for any new member being added
  • Provide State-issued Driver's License or identification card for any adult being added
  • The adult being added must fill out a complete application and signed the Criminal Background form with all supporting documentation.
  • Complete Declaration of Citizenship Status for minors being added. If an adult is being added, adults must complete and sign for themselves
  • Provide marriage certificate (if applicable)

Removing Household Member(s) - Family composition

  • Complete the Statement of Family Member Move-Out form and proof of new resident (lease)

 Adding or Removing Assets

  • Provide bank statements, verification of stocks, bonds, certificates of deposits, life insurance policy, etc.

Change in Expenses - Medical, Disability Assistance Expense, Childcare

  • Provide a print-out from the medical provider showing the amount paid out of pocket for the past 12 months, or a copy of a new monthly premium, amount for apparatus, attendant care, etc. (must qualify)
  • Provide a written statement from the childcare provider indicating the child's name, the amount received, and frequency (weekly, bi-weekly, or monthly). The statement must include provider's contact information (must qualify)

Change in Student Status

  • High school student (school registration)
  • College student (verification of full-time student status)