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  • Wa Dshs 14-076 2022

Get Wa Dshs 14-076 2022-2026

YOUR NAMECLIENT ID OR SOCIAL SECURITY NUMBERChange of CircumstancesRead all sections carefully. Check all boxes that apply to your household. Sign, date, and return this form to your local office.

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How to use or fill out the WA DSHS 14-076 online

Filling out the WA DSHS 14-076 form is a crucial step in reporting changes in your circumstances that may affect your benefits. This guide will provide you with a thorough walkthrough of each section to help you complete the form accurately and efficiently.

Follow the steps to successfully fill out the WA DSHS 14-076 online.

  1. Press the ‘Get Form’ button to access the WA DSHS 14-076 document and open it for editing.
  2. Begin by entering your name and client ID or social security number at the top of the form. This information is essential for identifying your case.
  3. Carefully read all sections of the form. It is important to check all boxes that apply to your household's situation to ensure all changes are reported.
  4. In Section 1, report any changes to your address. Fill in the date of the move, new living address, and mailing address if it differs.
  5. In Section 2, update your shelter costs. Indicate if you are renting, buying, or in subsidized housing. Provide the monthly rent or mortgage amounts and any related costs.
  6. Section 3 requires you to report any individuals who have moved in or out of your household. Provide their names, relevant dates, and relationships to you.
  7. In Section 4, declare any changes to your household's resources. This includes bank accounts, vehicles, or any lump sum payments received.
  8. Section 5 addresses changes in income. List any new, ending, or altering jobs, including starting or stopping dates and gross income amounts.
  9. In Section 6, include any additional household changes. This could involve changes in child care costs, marital status, or medical coverage.
  10. Section 7 allows you to terminate any assistance programs. Check the applicable boxes to indicate your decisions.
  11. Complete the declaration and signature portion at the end of the form. Sign and date the form, providing a contact number for follow-up.

Complete the WA DSHS 14-076 form online to ensure timely processing of your changes.

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