What must be veried?
Changes in your household’s shelter costs
must be veried. Shelter costs include:
• Rent.
• Mortgage.
• Taxes.
• Special assessments.
• Homeowners insurance.
• Heat and/or utility costs.
• Getting or losing a telephone expense.
You may verify these changes by:
• Mortgage or rental contracts.
• Statements from the mortgage company
or landlord.
• Copies of tax or insurance bills.
• Copies of assessment bills.
• Current bills or a written statement from
the telephone or heat/utility provider.
• Receipt of a Home Heating Credit
Warrant.
• DHS-3688, Shelter Verication Form.
Changes in your household’s obligation to
pay child support and arrearage expenses
must also be veried. Child support and
arrearage verication may include but is not
limited to:
• Wage withholding statements.
• Proof of withholding from unemployment
compensation.
• Statements from the parent who has
custody of the child, verifying the amount
of direct child support.
DHS Publication-280 (Rev. 8-17) Previous edition obsolete.
This institution is prohibited from discriminating on the basis of race,
color, national origin, disability, age, sex and in some cases religion
or political beliefs.
The U.S. Department of Agriculture also prohibits discrimination
based on race, color, national origin, sex, religious creed, disability,
age, political beliefs or reprisal or retaliation for prior civil rights
activity in any program or activity conducted or funded by USDA.
Persons with disabilities who require alternative means of
communication for program information (e.g. Braille, large print,
audiotape, American Sign Language, etc.), should contact the
Agency (State or local) where they applied for benets. Individuals
who are deaf, hard of hearing or have speech disabilities may
contact USDA through the Federal Relay Service at
800-877-8339. Additionally, program information may be made
available in languages other than English.
To le a program complaint of discrimination, complete the USDA
Program Discrimination Complaint Form, (AD-3027), found online
at: http://www.ascr.usda.gov/complaint ling cust.html, and at any
USDA ofce, or write a letter addressed to USDA and provide in the
letter all of the information requested in the form. To request a copy
of the complaint form, call 866-632-9992. Submit your completed
form or letter to USDA by: (1) mail: U.S. Department of Agriculture
Ofce of the Assistant Secretary for Civil Rights, 1400 Independence
Avenue, SW Washington, D.C. 20250-9410, (2) fax: 202- 690-7442;
For any other information dealing with Supplemental Nutrition
Assistance Program (SNAP) issues, persons should either contact
the USDA SNAP Hotline Number at 800-221-5689, which is also in
Spanish or call the State Information/Hotline Numbers (click the link
for a listing of hotline numbers by State); found online at:
http://www.fus.usda.gov/snap/contact info!hotlines.htm.
To le a complaint of discrimination regarding a program receiving
Federal nancial assistance through the U.S. Department of Health
and Human Services (HHS), write: HHS Director, Ofce for Civil
Rights, Room 515-F, 200 Independence Avenue, S.W., Washington,
D.C. 20201 or call 202-619-0403 (voice) or 800-537-7697 (TTY).
This institution is an equal opportunity provider.
The Michigan Department of Health and Human Services
(MDHHS) does not discriminate against any individual or
group because of race, religion, age, national origin, color,
height, weight, marital status, genetic information, sex,
sexual orientation, gender identity or expression, political
beliefs or disability.
Using the Change Report Form
You may use the DHS-2240, Change Report
Form, to report changes to your specialist. If
you choose this method you must answer all
questions on the form for everyone in your
household. If any questions do not apply to your
household situation, answer the question N/A,
not applicable. Be sure to answer all questions in
sections 1-7. You may attach a separate piece of
paper to your Change Report Form if you need
additional room to report changes.
Remember to: Sign and date the form and attach
all required verications. Be sure to write your
name and case number on any verications you
send in.
REPORTING
CHANGES
When to Report
How to Report
What to Report
This brochure is a guide to reporting
changes. It provides information on
when changes must be reported, ways
to report changes, what changes you
must report, and what changes require
verication.