City of Tempe, AZ : Online City Forms

Survey/Form Review

Section 8 Participant Change Form

You must complete this form and provide written verification for changes that occur to your family income and/or household composition WITHIN 10 CALENDAR DAYS from the effiective date of the change. Changes are NOT accepted over the telephone. KEEP A COPY OF THIS FORM FOR YOUR RECORDS.

1. Head of Household LAST NAME

Last name

2. Head of Household FIRST NAME

First name

3. Household Address

Address

4. Email Address

5. Phone Number

FAMILY INCOME: Provide verification to this change. This includes earned and unearned income and all assets. Examples include: letter from employment with effective date of change with beginning or termination date, paystubs, employment contract, child support letter, benefit award letter, etc.

6. A change in household income

A decrease in household income

An increase in household income

Effective Date

7. Explain the Decrease and/or Increase in household income. Please include effective date(s) of change.

8. If household income change is due to the addition/termination of employment, please provide: Employer Name, Employer Address and Employer Telephone Number

Employment/Employer Information

PLEASE NOTE: The City of Tempe wil determine if your change will result in a change to your portion of the rent. DECREASES IN INCOME may result in a decrease in your portion of the rent. Changes reported after the 20th of the month, will be delayed an additional 30 days.

HOUSEHOLD COMPOSITON. If any person is added to your household or if any person leaves your household, please provide verification of this change and household member information. Section 8 Participants MUST obtain approval from both your landlord AND Tempe Housing Services BEFORE adding a person to your household.

9. I have a change is houshold composition to report.

I have a household member leaving the household

I have a household member joining the household

Effective Date of Change

10. Other information I would like to report

Other Info

11. Certification

I hereby certify that the information reported on this form is true and correct. I understand that giving false, incomplete, and/or inaccurate information is punishable under Federal and State law and is grounds for termination from the Section 8 rental assistance program.

Date

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