Income Change Form

If you print this form to complete, please send to 145 W Pine Ave. Longwood, FL or Fax to 407-830-0398.

Instructions: Complete only the sections necessary to tell us how your household income has changed. Complete all items in the applicable section. 

Please make sure to read through the form in its entirety to ensure you have completed all necessary fields. Below you will find areas for employment changes, child care changes, changes in student status, and an area to choose other changes. If your change does not have its own label, please look in the area labeled "Other Income". There is also a section at the end of the form labeled "Other Change" if you are unable to find the proper box to check in "Other Income".

Important Notice: Seminole County Housing must receive your written notice of your income change within 14 days of the change. Income decreases must be received by the 15th of the month in order to adjust your rent for the following month. If this form is not completely filled out the review may be delayed. If you report change late (more than 14 days after the change) or not at all, you could owe Seminole County Housing Authority money and you may risk losing your housing subsidy.

Warning: You are hereby notified that providing any Public Housing Authority with fraudulent paperwork or statement(s) is a crime. If any paperwork or written statement(s) provided to Seminole County Housing Authority is found to be fraudulent, that paperwork will be forwarded to the Office of Inspector General for review to determine possible criminal charges.

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