
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.
- Press the ‘Get Form’ button to access the WA DSHS 14-076 document and open it for editing.
- 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.
- 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.
- 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.
- 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.
- 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.
- In Section 4, declare any changes to your household's resources. This includes bank accounts, vehicles, or any lump sum payments received.
- Section 5 addresses changes in income. List any new, ending, or altering jobs, including starting or stopping dates and gross income amounts.
- In Section 6, include any additional household changes. This could involve changes in child care costs, marital status, or medical coverage.
- Section 7 allows you to terminate any assistance programs. Check the applicable boxes to indicate your decisions.
- 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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