Public Housing Income Change Request

125 Beltline Road, Gaffney, SC 29341
PO Box 1477, Gaffney, SC 29342
Office Hours: Monday - Thursday
7:00 AM - 5:00 PM
Phone: 864.489.3193 | Fax: 864.487.9460

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Household Member Reporting Income Change:","className":"d-block"},{"type":"text","required":true,"label":"Household Member Last Name","name":"Household-Member-Last-Name","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Household Member First Name","name":"Household-Member-First-Name","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Employer Name","name":"Employer-Name","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"New Income Amount","placeholder":"$","name":"New-Income-Amount","className":"d-block","subtype":"text"},{"type":"date","required":true,"label":"Date Income Changed:","name":"Date-Income-Changed","className":"d-block"},{"type":"select","required":true,"label":"Payment Frequency","name":"Payment-Frequency","className":"d-block","values":[{"label":"Weekly","value":"option-1"},{"label":"Biweekly","value":"option-2"},{"label":"Monthly","value":"option-3"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"2. Household Member Reporting Income Change(if needed)","className":"d-block"},{"type":"text","label":"Household Member Last Name","name":"Household-Member-Last-Name","className":"d-block","subtype":"text"},{"type":"text","label":"Household Member First Name","name":"Household-Member-First-Name","className":"d-block","subtype":"text"},{"type":"text","label":"Employer Name","name":"Employer-Name","className":"d-block","subtype":"text"},{"type":"text","label":"New Income Amount","placeholder":"$","name":"New-Income-Amount","className":"d-block","subtype":"text"},{"type":"date","label":"Date Income Changed:","name":"Date-Income-Changed","className":"d-block"},{"type":"select","label":"Payment Frequency","name":"Payment-Frequency","className":"d-block","values":[{"label":"Weekly","value":"option-1"},{"label":"Biweekly","value":"option-2"},{"label":"Monthly","value":"option-3"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"3. Household Member Reporting Income Change(if needed)","className":"d-block"},{"type":"text","label":"Household Member Last Name","name":"Household-Member-Last-Name","className":"d-block","subtype":"text"},{"type":"text","label":"Household Member First Name","name":"Household-Member-First-Name","className":"d-block","subtype":"text"},{"type":"text","label":"Employer Name","name":"text-1585410930724","className":"d-block","subtype":"text"},{"type":"text","label":"New Income Amount","placeholder":"$","name":"text-1585410943955","className":"d-block","subtype":"text"},{"type":"date","label":"Date Income Changed:","name":"Date-Income-Changed","className":"d-block"},{"type":"select","label":"Payment Frequency","name":"Payment-Frequency","className":"d-block","values":[{"label":"Weekly","value":"option-1"},{"label":"Biweekly","value":"option-2"},{"label":"Monthly","value":"option-3"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Social Security Income Change:","className":"d-block"},{"type":"text","label":"Household Member Last Name","name":"text-1585411049397","className":"d-block","subtype":"text"},{"type":"text","label":"Household Member Last Name","name":"text-1585411431468","className":"d-block","subtype":"text"},{"type":"text","label":"New Income Amount","placeholder":"$","name":"text-1585411085426","className":"d-block","subtype":"text"},{"type":"date","label":"Date Income Changed:","name":"date-1585411096733","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Child Care Expense Change:Please list any additional child care expenses you may be experiencing here:","className":"d-block"},{"type":"text","label":"New Payment Amount","placeholder":"$","name":"New-Payment-Amount","className":"d-block","subtype":"text"},{"type":"select","label":"Payment Frequency","name":"select-1585411468240","className":"d-block","values":[{"label":"Weekly","value":"option-1"},{"label":"Biweekly","value":"option-2"},{"label":"Monthly","value":"option-3"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Child Support Income Change:","className":"d-block"},{"type":"text","label":"Household Member First Name","name":"Household-Member-First-Name","className":"d-block","subtype":"text"},{"type":"text","label":"Household Member Last Name","name":"Household-Member-Last-Name","className":"d-block","subtype":"text"},{"type":"text","label":"New Income Amount","placeholder":"$","name":"text-1585611208891","className":"d-block","subtype":"text"},{"type":"select","label":"Payment Frequency","name":"Payment-Frequency","className":"d-block","values":[{"label":"Weekly","value":"option-1"},{"label":"Biweekly","value":"option-2"},{"label":"Monthly","value":"option-3"}]},{"type":"date","label":"Date Income Changed:","name":"Date-Income-Changed","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Other Income Change:","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Please list details for other incomeExample: a friend or family member pays your monthly phone bill.","className":"d-block"},{"type":"text","label":"Household Member First Name","name":"Household-Member-First-Name","className":"d-block","subtype":"text"},{"type":"text","label":"Household Member Last Name","name":"Household-Member-Last-Name","className":"d-block","subtype":"text"},{"type":"text","label":"New Income Amount","placeholder":"$","name":"text-1585411449160","className":"d-block","subtype":"text"},{"type":"select","label":"Payment Frequency","name":"Payment-Frequency","className":"d-block","values":[{"label":"Weekly","value":"option-1","selected":true},{"label":"Biweekly","value":"option-2"},{"label":"Monthly","value":"option-3"}]},{"type":"date","label":"Date Income Changed:","name":"Date-Income-Changed","className":"d-block"},{"type":"textarea","label":"Other Income","name":"Other-Income","subtype":"textarea","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Upload Files:","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Please upload documentation supporting your requested income change.Example: Paystubs, Layoff Notification, Benefit Change Letter**During the COVID-19 crisis, we are allowing residents to self-certify and waiving the documentation requirement.**","className":"d-block"},{"type":"file","label":"Please select one or more files for upload. You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format. To upload multiple files, please hold control while clicking on multiple files before clicking \"Open\".","name":"file-1585412118964","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Zero Income:","className":"d-block"},{"type":"radio-group","required":true,"label":"As a result of this income change, is the entire household, not just this member, at zero income?","name":"As-a-result-of-this-income-change-is-the-entire-household-not-just-this-member-at-zero-income","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Thank you for completing the Public Housing Income Change Request Form.","className":"d-block"}]