3. Household Income
What do you report?
For anyone in your household, you must
report:
• Changes in rate of pay or if employers
change.
• Changes in hours worked per week if
they are more than ve hours since you
last reported a change.
• If anyone in the household stops
working.
• If anyone starts or stops getting Social
Security, a pension, unemployment, child
support, or any other unearned income.
• If gross monthly unearned income went
up or down by more than $50 since the
last time you reported a change. ($100
for Food Assistance).
Exception: For Medicaid only (except for
Healthy Kids) you must report any change
in gross monthly income.
What must be veried? You must provide
proof of your household’s income. Pay
stubs, employer statements, the DHS-38.
Verication of Employment, DHS-431,
Self Employment & Income and Expense
Statement, or DHS-3569, Agricultural
Worker Income Verication, may be used to
verify income. For child care, if your work
schedule and/or employer have changed and
anyone has child care costs, attach a written
statement with your work schedule with the
days and times of work. The work schedule
statement must be signed by your employer
to verify the schedule.
4. Work-Related Activities
What do you report? Report if anyone in
your household participated in approved
employment-related activities. Such activities
may include:
• Work Participation program.
• High school completion.
• GED.
• College.
When do You
Report Changes?
Changes in your household
must be reported within 10
days of the change. Failure
to report changes within
10 days may result in case
closure or reduction of your benets.
Exception: For Family Independence Program
(FIP) only, you must report a child leaving your
home within ve days of the date you know he or
she will be absent for 30 days or more.
How do You Report Changes?
Reporting change is now easier! You may report
your change online through MI Bridges or by
telephone. Reporting changes by telephone allows
your specialist to gather the most information
about the change from the best source for that
information – you. If you have any doubt about
whether to report a change, contact your MDHHS
specialist. Your MDHHS specialist will tell you
if different reporting rules apply to you such as,
simplied reporters. You may also report changes
in writing, in person, or with the DHS-2240,
Change Report Form.
What to Report and Verify
1. Job Starts, Changes, Stops
Clients must report income-related changes
(starting, stopping, change in hours/rate of
pay, etc.) within 10 days of receiving the rst
payment reecting the change.
2. Persons In Your Home
Report changes about people in your home.
Examples of changes to report are anyone who:
• Moved into or out of your home.
• Temporarily left your home.
• Entered a nursing home.
• Was married, divorced or separated.
• Was born or died.
What must be veried? If anyone’s work-
related activity schedule has changed, attach
a copy of the new class schedule.
5. Child Care or Disabled Adult Care
What do you report? Report any need for,
or change in, care of a child or disabled adult.
Changes to report may include but are not
limited to:
• The days and times when the care is
provided.
• If the provider of the care has changed.
• The location where the care is provided.
• If you receive any other help in paying
for child care or disabled adult care.
6. Assets
What do you report? Report if anyone in
your household has had a change in assets.
You should report such changes as:
• Buying, selling, giving away, transferring
or receiving any assets.
Types of assets include but are not limited to:
• Bank accounts.
• Land.
• Cars and other vehicles.
• Boats.
• Life insurance.
• Investments.
• Lawsuit settlements.
• Any other property.
7. Other Changes
What do you report? Report if anyone in
your household has a change such as:
• Address.
• Rent.
• Mortgage.
• Taxes.
• Insurance for home or health.
• Utility costs.
• Child support and arrearages paid for
someone outside the household.
• Medical expenses.
• School attendance.
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;
or (3) email: [email protected].
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.
