Forms included here contain required information from the U.S Department of Housing and Urban Development (HUD) as well as information from HACC related to the Moving to Work Program.
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Forms

Forms included here contain required information from the U.S Department of Housing and Urban Development (HUD) as well as information from HACC related to the Moving to Work Program.

LSS Forms:

In an effort to ensure you and your household are served in a timely manner, we request that you completely fill out and sign every document in the enclosed packet. Warning: Failure to report a change of family composition could result in termination of your housing assistance.

To add a member to your household, you must enclose copies of the following for all persons being added:

  1. Social Security Card
  2. State issued Birth Certificate
  3. Valid Picture ID
  4. Marriage Certificate (if applicable)
  5. Employment verification on company letterhead or 4 paycheck stubs
  6. TANF, Social Security/SSI and Child Support print outs
  7. Proof of any other income for new member
  8. Verification of full-time student status (if applicable)

The following forms should be completed by Head of Household:

  1. Add a New Household Member Form (must be completed by Head of Household and signed by Head of Household and member being added).
  2. Statement form (stating change you are requesting).
  3. Authorization for Release of Information–Privacy Act Notice (must be signed by Head of Household and member being added).

The following forms should be completed by persons 18 and over being added to the household:

  1. Citizenship (Declaration of Section 214 Status form)
  2. Debts Owed to Public Housing Agencies and Terminations form
  3. What you should know about EIV form
  4.  Owner / Landlord Acknowledgement 

 

In an effort to ensure you and your household are served in a timely manner, we request that you completely fill out and sign every document in the enclosed packet. Warning: Failure to report a change of family composition could result in termination of your housing assistance.

To add a member to your household, you must enclose copies of the following for all persons being added:

  1. Social Security Card
  2. State issued Birth Certificate
  3. Proof of custody or guardianship
  4. TANF, Social Security/SSI, and Child Support print outs (if applicable)
  5. Proof of any other income for new member

The following packet should be completed by Head of Household:

  1. Add a New Minor Household Member Packet (must be completed by Head of Household)
  2. Statement Form (stating change you are requesting).
  3. Authorization for Release of Information–Privacy Act Notice (must be signed by Head of Household)
  4. Citizenship (Declaration of Section 214 Status form)
    • Note: Child’s Name should be in the first blank, citizenship status should be checked, and the Head of Household should sign, date and check the box indicating they are signing for a minor.

The following forms should be completed by your current Landlord:

  1. Owner Acknowledgement

FAILURE TO SUBMIT THE REQUIRED DOCUMENTATION MAY DELAY YOUR REQUEST TO ADD A MEMBER TO YOUR HOUSEHOLD.

In an effort to ensure you and your household are served in a timely manner, we request that you completely fill out and sign every document in the enclosed packet.

Warning: Failure to report a change of family composition could result in termination of your housing assistance.

To remove a member of your household, you must enclose the following:

  1. Legal evidence of new address for each household member being removed. Examples of acceptable verification include the following:
    • Legal evidence of divorce or legal separation
    • Order of protection/restraining order obtained by one family member against another
    • Lease or rental agreement showing the individual listed as a member of another household
    • Document from a court or correctional facility stating how long they will be incarcerated.
    • Current photo ID for the member being removed that shows their new address.

The following packet should be completed by Head of Household:

  1. Remove Household Member Packet (must be completed by Head of Household and signed by Head of Household).
  2.  Statement Form (stating change you are requesting).
  3. Authorization for Release of Information – Privacy Act Notice (must be signed by Head of Household).

CHANGE OF INCOME PACKET

Please complete the enclosed packet so we may process your Change of Income (COI) request. Failure to complete packet or submit supporting documentation could result in denial or delay of the request.

When submitting a Change of Income, you MUST include the following:

  • Change of Income Request Form
  • Authorization for Release of Information Form—HUD-9886
  • Proof of any change in household income since last reported to HACC;
    • Four (4) current and consecutive paycheck stubs
    • A letter from the employer indicating amount, frequency of pay, and date of hire. If any of the above documents are not provided, processing of the change of income will be delayed.

You may also have to include one or more of the following, if applicable:

  • Letter on company letterhead indicating the date of separation (if you are no longer employed)
  • Unemployment benefits award letter
  • Veterans Affairs award letter
  • TANF award letter
  • Worker’s Compensation benefit statement
  • SS/SSI award letter – must provide the actual award letter sent by the Social Security
  • Administration
  • Pension statement
  • Child support court order, a 12-month child support print out or a notarized letter indicating child support amount
  • Statement of income (you may use attached form)
  • Direct child support statement (must be signed by contributor and notarized)
  • General contributions statement (must be signed by contributor and notarized)

Completed Change of Income forms must be submitted using one of the following methods:

  • Fax: (217) 363-2348
  • Email
  • Hand-delivered to: 2008 North Market Street, Champaign, IL 61822
  • Mail to the following address:
    Housing Authority of Champaign County
    Housing Choice Voucher Department
    2008 North Market Street
    Champaign, IL 61822