Follow the steps to successfully complete your mid-certification review form.

1. Press the ‘Get Form’ button to access the WA DSHS 14-467 form and open it in the online editor.
2. Complete section one by providing your name, current address, contact information, and client identification number. Be sure to input your primary and any secondary phone numbers.
3. In section two, indicate whether anyone has moved into or out of your home. If applicable, provide details such as their relationship to you, names, and the relevant dates.
4. For section three, if applicable, report any changes in pregnancy status for individuals in your household and include due dates.
5. In section four, specify whether anyone has cash resources. If so, indicate the owner and provide details about accounts held.
6. In section five, disclose any recent vehicle changes. Include ownership, make, model, year, current value, and any outstanding amounts owed.
7. Section six asks about new income or income that has stopped. Provide names, sources of income, and relevant dates for any changes.
8. If applicable, in section seven, mention any lottery or gambling winnings that exceed $3,500. Include the winner's name, amount, and date received.
9. Section eight relates to earnings or self-employment income. Provide the names of those earning income, their employers, and payment details.
10. In section nine, report any changes in child support obligations, including amounts and names of relevant parties.
11. Section ten focuses on income from other sources. List all applicable income sources and amounts received.
12. In section eleven, outline your monthly expenses for rent or mortgage, and if someone else contributes to those costs.
13. For section twelve, detail the utilities paid separately from your rent or mortgage.
14. In section thirteen, indicate whether you wish to register to vote or update your voter registration.
15. Finally, provide your signature and date in section fourteen, confirming the information provided is true and complete.
16. Once all sections are complete, save your changes. You can then download, print, or share the completed form as needed.

Complete your WA DSHS 14-467 form online today to ensure your benefits continue without interruption.