This page is displayed because you indicated that you are homeless and did not provide a residence or mailing address on the previous page.
Address Line 1 and Address Line 2 fields should only contain letters, numbers and ‘-‘, ‘#’, and ‘/’. City should only contain letters. Zip Code should contain only numbers.
Click the Print button to print this page for your reference.
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Click the Save & Exit button to exit the online Redetermination/Change Report/Simplified Report/LaCAP Re-Enrollment and save your progress on your Redetermination/Change Report/Simplified Report/LaCAP Re-Enrollment. The Redetermination/Change Report/Simplified Report/LaCAP Re-Enrollment is saved as Incomplete.