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Change of Household Composition Form

  1. Change of Household Composition Form
  2. Answer All Questions
  3. Are you reporting a birth?*
  4. Are you reporting an adoption?*
  5. Are you reporting a foster child?*
  6. Do you have the court documents?*
  7. Attach/Include the supporting documents-examples: Court document(s), birth certificate(s), Social Security Card(s), and letter explaining the change-signed and dated.
  8. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  9. Leave This Blank:

  10. This field is not part of the form submission.