Change Report Form 430-05-65-10

(Revised 11/01/07 ML3111)

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

 

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.