Edit, Download, and Sign the Arkansas DHS Change Report Form Instructions
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How do I fill this out?
To fill out this change report, gather all necessary information regarding your household's circumstances. Be sure to accurately report any changes related to income, savings, and household composition.

How to fill out the Arkansas DHS Change Report Form Instructions?
1
Gather necessary personal and household information.
2
Identify any changes in income, savings, or household members.
3
Complete each section of the form as it applies to your situation.
4
Submit the form as instructed to your local DHS office.
5
Keep a copy of the submitted form for your records.
Who needs the Arkansas DHS Change Report Form Instructions?
1
Individuals receiving TEA benefits need to report changes in income.
2
Medicaid recipients must inform DHS of any changes in household composition.
3
SNAP participants must report increases in savings if it exceeds $2,250.
4
Households experiencing a change in address must update their information.
5
Anyone whose income exceeds program limits should submit this report.
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What are the instructions for submitting this form?
Submit your Change Report form to your local DHS County Office by mail, fax, or online if available.
What are the important dates for this form in 2024 and 2025?
Stay updated with the Arkansas DHS for any specific deadlines related to your benefits.

What is the purpose of this form?
The Change Report form keeps the Arkansas Department of Human Services updated about household circumstances.

Tell me about this form and its components and fields line-by-line.

- 1. Name: The name of the individual filling out the form.
- 2. Budget Unit ID Number: Identifies the budget unit for benefits.
- 3. Date of Birth: The date of birth of the individual.
- 4. Medicaid ID Number: The Medicaid ID number.
- 5. Check all that you receive: Indicates which benefits you receive.
- 6. Address: The current address of the household.
- 7. Phone #: A contact number for the household.
- 8. E-mail address: An email address for communications.
- 9. New Address: The new address if the household has moved.
What happens if I fail to submit this form?
Failure to submit the form may affect your benefits.
- Disruption of Benefits: May result in suspension or reduction.
- Legal Issues: Incorrect information could lead to legal issues.
- Repayment of Benefits: You may need to repay improperly received benefits.
How do I know when to use this form?

- 1. Income Changes: Report changes in your income.
- 2. Household Composition: Notify of any member moving in/out.
- 3. Change of Address: Submit your new address if relocated.
- 4. Savings Update: Inform about increases in savings.
- 5. Dependent Care Costs: Update changes in dependent care costs.
Frequently Asked Questions
What is the purpose of the Change Report form?
It is used to report changes in circumstances that may affect benefits.
How can I edit the Change Report PDF?
Edit the PDF using PrintFriendly's online editor.
Is it necessary to report all changes?
Yes, reporting all changes is crucial.
Can I save the edited PDF?
You can download the edited PDF.
What should I do if I miss a change?
Report any missed changes as soon as possible.
How long will it take to process my changes?
Typically, you'll receive communication from DHS within weeks.
What if I submit my form late?
It may affect your benefits.
Can I print the edited PDF?
Yes, you can print the edited PDF.
Is there a cost to use the editor?
The editing features are free for users.
What types of changes do I need to report?
Report changes in income, household size, savings, or residence.
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