Process For Requesting A Change In Household Income Form printable pdf download

PROCESS FOR REQUESTING A CHANGE IN HOUSEHOLD INCOME

CMHA requires program participants to report interim changes to CMHA within thirty (30) calendar days of when the

change occurs. Failure to comply with this requirement may result in termination of housing assistance and/or retroactive

rent charges. Also, CMHA is unable to accept any change in household income requests, if the income change will not

last at least thirty (30) days; CMHA is unable to process an interim adjustment.

The completed Change in Household Income Request form, accompanied by all required verification must be hand-delivered to

CMHA’s Housing Choice Voucher Program Office during normal business hours.

MANDATORY DOCUMENTATION AND VERIFICATION:

 Change in Household Income Request form (see reverse side)

MANDATORY VERIFICATION, IF REPORTING A CHANGE IN EARNED (EMPLOYMENT) INCOME:

 Increased or decreased household earned income (hours, wage or employer), attach the following:

Paycheck stubs (only if new employer, increased or decreased employment income), or

Letter on employer’s letterhead listing start end date, hours worked, rate and frequency of pay.

If the participant’s employment is being reported through the “Work Number”, CMHA is able to obtain the necessary

verification.

 Employment Termination/Separation (*pay check stubs are not an acceptable form of verification*)

Letter on employers letterhead indicating date of termination/separation, and anticipated return date, if applicable

 If program participants are unable to obtain the required verification, as listed above, documentation of their attempts must be

provided to CMHA.

Only with approved documentation of a participant’s inability to obtain the mandatory verification, the Change in Household



Income Request form may be used as a “Self-Certification” for the purpose of verifying current household income.

MANDATORY VERIFICATION, IF REPORTING A CHANGE IN UNEARNED INCOME:

 Most recent award letter from:

Hamilton County Department of Jobs and Family Services (OWF/TANF)

Social Security Administration (SS/SSI benefits)

State Unemployment Compensation Benefits

Worker’s Compensation Benefit Statement

Current Pension Benefit Statement (i.e. Retirement, Veteran’s Administration etc.)

 Child support court order or 12-month child support payment print-out

 General contributions statement (must be signed by contributor)

When reporting a change in Childcare and/or Medical expenses, please attach applicable verification, to include: Completed



CMHA expense verification form, payment receipts, or 12-month payment history print-out.

* Failure to complete the Change in Household Income Request form and submit all required mandatory verification and/or

documentation will result in your interim request being canceled.

Reasonable Accommodation: If you, or any household member, have a disability that could prevent your full access to or utilization of CMHA’s

Housing Choice Voucher Program and its related services, you have the right to request a reasonable accommodation. A reasonable may include a

modification of a rule, policy, procedure or service that will assist an otherwise eligible disabled applicant or resident to make effect use of its programs.

If you believe you require a Reasonable Accommodation, please contact your Housing Specialist

HOUSING CHOICE VOUCHER PROGRAM, 1635 WESTERN AVENUE, CINCINNATI, OHIO 45214

Phone: (513) 977-5800 Fax: (513) 977-5858 TDD: (800) 750-0750 Website:

Equal Opportunity Employer, Equal Housing Opportunities

Process For Requesting A Change In Household Income Form

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