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Southeastern Minnesota Multi-County Housing and Redevelopment Authority

Rental Housing
Section 8
Home Ownership & Self-Sufficiency
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Change Form

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Change Form

Change FormSara

Change Form

1Head of Household information

2Change Reporting

3Details of Change

Please check one of the following boxes:*
- Section 8 Rental Assistance Participant
- Rental Housing Tenant
- Applicant
Property Name*
Head of Household Name*
First Last
Current Address*
Phone*

What are you reporting a change to:*
- Change in Mailing Address
- Change in Telephone Number
- Change in Email Address
- Change in Income
- Changes in Household Members
- Change in Child Care costs
- Change in Medical Expenses - Must be an elderly or disabled household
Please select all that apply

New Address*
New Phone Number:*
New Email:*
Change in Income*
- Increase in Income
- Decrease in Income
- New Income
Income Type:*
- Wages
- Self-Employment Income
- Child Support
- County Assistance (MFIP, GA, FS, MSA)
- Social Security, Disability, SSI
- Pension/Retirement
- Unemployment
- Other: Please explain
Employer Name*
Employer Address:*
Street Address Address Line 2 City State ZIP Code
Employer Phone Number:*
Number of Hours Per Week:*
Type of Self-Employment:*
Expected Income:*
Pay Rate:*
Per*
- Hour
- Week
- Month
New Child Support Amount:*
Per:*
- Week
- 2 weeks
- Month
County receiving assistance from:*
New County Assistance Amount:*
Per:*
- Month
- Week
- 2 weeks
New Social Security/Diability/SSI Amount per Month:*
Company Name:*
New Pension/Retirement Amount:*
Per:*
- Week
- 2 weeks
- Month
New Unemployment Amount per week:*
Other - Please Explain:*
Changes in Household Composition:*
- Add Adult
- Remove Adult
- Add Child
- Remove Child
Move out Date:*
MM slash DD slash YYYY
Move in Date:*
MM slash DD slash YYYY
Name of Adult or Child begin added or removed:*
First Last
Date of Birth:*
MM slash DD slash YYYY
Gender:*
- Male
- Female
Do you have custody of this child?*
- Yes
- No
Increase or Decrease in Child Care cost?*
- Increase
- Decrease
New Amount:*
Per:*
- Week
- 2 weeks
- Month
Are you receiving Child Care Assistance from the county?*
- Yes
- No
County receiving Child Care Assistance from?*
Child Care Provider Name:*
Increase or Decrease in Medical Expenses?*
- Increase
- Decrease
New Amount:*
Per:*
- Week
- 2 weeks
- Monthly
Type of medical expenses that has changed - Example: Medicare, Spenddown, Prescriptions, etc. - Please explain:*
Notes/Comments:

85771

Board of Commissions

Board Meeting Schedule & Agenda

MISSION: To enhance and strengthen communities through advocacy, collaboration and promotion of self-reliance, housing, and community development.

VISION: To be a recognized advocate and leader in creating housing opportunities and community development solutions.

Employment Opportunities

We are always accepting applications. View our current job openings and apply online.

South Eastern Minnesota Map

Semmchra’s service area includes Dodge County, Fillmore County, Goodhue County (with the exception of the City of Red Wing), Houston County, Wabasha County and Winona County (with the exception of the City of Winona).

Southeastern Minnesota Multi-County Housing and Redevelopment Authority

134 East Second Street
Wabasha, MN 55981

P: (651) 565-2638
F: (651) 565-3836

Office Hours:
7:00 AM – 4:30 PM Monday-Thursday
7:00 AM – 11:00 AM Friday
Closed to the Public.

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