Public Housing Income Change Request

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Housing Authority of South Bend
Phone: 574.235.9346 • Fax: 574.544.5165
501 Alonzo Watson Dr. • South Bend, IN 46601
Monday-Thursday 8:30 am-5:30 pm (Closed Fridays)

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Housing Authority of South Bend tenants and residents that participate in the Public Housing Program may use this form to submit a change of income. Documentation of any change must be attached in order to process your request. If you are unable to attach the documentation via this form, please call for other options.

Fields marked with * must be completed or form will not submit.

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Household Member Reporting Income Change (if needed)","className":"d-block"},{"type":"text","label":"Household Member 2 Last Name","name":"Household-Member-2-Last-Name","className":"col-md-6","subtype":"text"},{"type":"text","label":"Household Member 2 First Name","name":"Household-Member-2-First-Name","className":"col-md-6","subtype":"text"},{"type":"text","label":"Household Member 2 Employer Name","name":"Household-Member-2-Employer-Name","className":"d-block","subtype":"text"},{"type":"text","label":"Household Member 2 New Income Amount","placeholder":"$","name":"Household-Member-2-New-Income-Amount","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Household Member 2 Date Income Changed:","name":"Household-Member-2-Date-Income-Changed","className":"col-lg-4"},{"type":"select","label":"Household Member 2 Payment Frequency","name":"Household-Member-2-Payment-Frequency","className":"col-lg-4","values":[{"label":"Select One","value":"Select One","selected":true},{"label":"Weekly","value":"Weekly"},{"label":"Biweekly","value":"Biweekly"},{"label":"Monthly","value":"Monthly"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"3. 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