Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering the date at the top of the form, followed by the head of household's name, social security number, and address details including apartment number, city, state, and ZIP code.
3. Provide your phone numbers, including home phone, work phone, cell phone, and any other contact numbers, along with your email address.
4. Indicate any changes in your household composition by checking the appropriate box for removing or adding a household member. Fill out the required details for each member, including name, relationship, and other identifying information.
5. For each household member being removed or added, follow the instructions to provide necessary documentation, such as a court-awarded change of custody or proof of new address.
6. Report any changes in income by selecting whether you are reporting an increase or decrease. Provide the name and contact information for the income source, along with details about the new income and reasons for the change.
7. If applicable, report changes in medical or child care expenses by filling in the details required for each category, including provider information and total expenses.
8. Review the certification statement carefully. By signing, you attest that all provided information is accurate. Ensure that you include the date next to your signature.
9. Once you have completed the form, save your changes. You may then download, print, or share the completed form as needed.

Get started on completing your Interim Change Request Form online today!