Change Report Form 430-05-65-10

(Revised 01/01/04 ML2893)

View Archives

 

 

The SFN 378 - Change Report Form, must be provided to all households. This form is automatically provided to newly certified households and at recertification by TECS. A new form must be provided whenever the household returns a form. It is not mandatory for households to use this form to report changes.

 

A change report form will automatically be sent each month to food stamp fluctuating income cases, when a "Y" is placed by the change report form indicator on the CHRS screen.

 

Special Assistance to Households

The worker must provide assistance to households in completing and filing change report forms if all members:

1. Are mentally or physically incapacitated.
2. Are non-English speaking.
3. Lack reading or writing skills.

 

Special assistance may include a special telephone number for households to call to report information, home visits by workers (scheduled in advance), or special arrangements for reporting in person at the county.