Change of Income/Household Composition

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Please correct the field(s) marked in red below:

CITY OF TEMPE HOUSING SERVICES
21 East Sixth Street, Suite 214
Tempe, Arizona 85281
This form is available online and may be submitted at:  www.tempe.gov/housing


You must complete this form and provide verification for changes that occur to your family income and/or household composition within ten (10) calendar days from the effective date of the change, in writing. Changes are not accepted over the telephone.  Submit the original of this form to Tempe Housing Services.  Keep one copy for your records. 

 

WAITING LIST APPLICANTS: Any changes that occur to your waiting list preference, income and/or household composition must be reported to ensure placement on the waiting list is correct. If reporting a change in your preference, a Wait List Preference Certification form must be completed.

Check all areas below that apply to your household. Fully complete the requested information.

FAMILY INCOME 

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

Has there been a decrease in income?

 *

Has there been an increase in income?

 *

Section 8 Participants only: We will 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 COMPOSITION

Provide verification of this change and household member information. If any person is added to your household or if any person leaves your household.
Section 8 Participants only: You must obtain approval from both your landlord and Tempe Housing
Services before adding a person to your household. Examples: court order, divorce decree, birth
certificate, social security card and any earned or unearned income for the member being added.

Do you wish to add a member(s) to your household?

 *

Is a member leaving, or has left, your household?

 *

Is there other information that you would like to report?

 *
Explain:

PLEASE PRINT

 *

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