For Changes to Existing Household Members
This page displayed because you indicated that there was a change to existing information to a member in your household. If this is in error, click the Previous button and correct the information.
Some items have an asterisk (*) next to them, indicating they are mandatory. You must fill in these items before you can continue to the next page.
Personal Information
Type the household member’s first name and last name in the text boxes. Be sure to use their full, legal name. Do not use nicknames on this Redetermination/Change Report/Simplified Report. If the name does not fit in the boxes, type as much as you can.
Click the Print button to print this page for your reference.
Click the Next button to save and continue with the online Redetermination/Change Report/Simplified Report.
Click the Previous button to view the previous page.
Click the Save & Exit button to exit the online Redetermination/Change Report/Simplified Report and save your progress on your Redetermination/Change Report/Simplified Report. The Redetermination/Change Report/Simplified Report is saved as Incomplete.
For New Household Members
This page asks questions to gather more details about household members. If you indicated that a person was added to the household in error, click Previous and return to the Current People in
Your Home page to correct the information.
Some items have an asterisk (*) next to them, indicating they are mandatory. You must fill in these items before you can continue to the next page.
Personal Information
Type the household member’s first name and last name in the text boxes. Be sure to use their full, legal name. Do not use nicknames on this Redetermination/Change Report/Simplified Report. The First Name text box allows a maximum of 12 characters, and the Last Name text box allows a maximum of 19 characters. If the name does not fit in the boxes, type as much as you can.
Alternative Name Information
If you select Yes in this section, enter the alternative information for the household member.
Program Selection
Place a check in the boxes beside all of the desired programs. If this person is not applying for any programs, select None. You cannot select None if any other program is selected.
Social Security Number
Type the Social Security Number in the text boxes using only numbers. Enter the first three digits in the first text box, the next two digits in the second text box, and the remaining four digits in the third text box.
Enter the date they applied for a Social Security Number if they applied for one but haven’t received one yet.
Citizenship Information
If the person’s US citizenship status is anything other than Citizen, additional questions will be displayed.
If applicable, type the alien registration number that begins with ‘A-‘and use only numbers.
Sponsor Name/Sponsor Address
If you have a sponsor, enter their name and address.
Ethnicity and Race
This section is optional. Select one of the options that describe the new household member.
To enter additional household members, select Yes to the question, “Does anyone else live in your home?” You will have the opportunity to enter the next household member’s information on the following page.
Click the Print button to print this page for your reference.
Click the Next button to save and continue with the online Redetermination/Change Report/Simplified Report.
Click the Previous button to view the previous page.
Click the Save & Exit button to exit the online Redetermination/Change Report/Simplified Report and save your progress on your Redetermination/Change Report/Simplified Report. The Redetermination/Change Report/Simplified Report is saved as Incomplete.