PHONE: 740-432-2381
800-307-8422
View GUERNSEY COUNTY DJFS
Report Changes
Reporting changes within 10 days is very important. If you do not tell GCJFS about a change, you may not get all the benefits you are entitled to receive OR you may receive more benefits than you should. If you get help you shouldn’t have received, you may have to pay it back.

You are required to report case changes within ten (10) days of that change. You are required to provide verifications of reported changes within 10 days of reporting that change.

You need to report changes to an existing case if any of the information on the
Application / Reapplication Verification Request Checklist applies to you and your circumstance

The completed, respective change report form needs to accompany the appropriate verifications listed below and can be submitted in one of the following ways:

  • In person at agency during regular business hours (M-F 7:30 am – 4:00 pm)
  • Fax to agency at 740-432-1952
  • Mail to Guernsey County JFS, 324 Highland Avenue, Cambridge, OH 43725
  • Slip in drop box at the agency front door (24/7)
I need to report a change in people living in my home.

Complete the Household Composition Change Report From and attach the appropriate verifications listed below.

Add A Person - provide verification for each person by submitting the following:

Verifications needed for each person added:

Originals must be provided to the front desk for scanning.

Name

Social Security Number (SSN)

Birth Record (Birth Certificate or hospital record with foot prints)

Estimated Gross Weekly Income (copy of last 4-6 paystubs)

Relationship to household members

Remove A Person - provide verification by submitting the following:

Written Statement - must include:

Leave date

Name

New address

Rent/utility responsibility change (if any)

Phone Number

Newborn - provide verification by submitting the following:

Verifications needed to add newborn:

Originals must be provided to the front desk for scanning.

Newborn’s birth certificate or hospital footprints

Immunization Card/Shot Record

Social Security Number (SS-5) application

Additional Required Information:

Father’s Full Name (if now in household, see Add A Person above)

Father’s Address & phone number

I need to report a change in my residence.

Complete the Residency Change Report From and attach the appropriate verifications listed below.

Renter - provide verification of residency by submitting one of the following:

Residency Verification Form

Please download this form and have your landlord complete it.

New lease agreement

Please provide your new lease agreement, stating start date, monthly rent amount, utility responsibility and a list of residents. (Rent cannot include late fees, pet fees, security deposit, extra charges for garage, barn etc)

Residing with Family or Friends - provide verification of residency by submitting one of the following:

Residency Verification Form

Print Residency Verification Form and have the person you are living with or paying rent to complete this form and return it to us within 10 days.

Residency Statement

Written statement from person with whom you are residing must include:

Move in date

Rent/utility responsibility (if any)

Copy of rent receipt or utility bill in name of person with whom you are residing

Statement as to purchasing/preparing meals together or separate

List of people residing in household

Property Owner - provide verification of residency by submitting one of the following:

Mortgage Escrow Payment

Provide mortgage payment (real estate taxes & home owners insurance (dwelling structure only) included in mortgage payment within 10 days.

Mortgage Self-paid

Provide copies of current mortgage payment, real estate taxes & home owners insurance (dwelling structure only) within 10 days.

I need to report a change in my income

Complete the Income Change Report From and attach the appropriate verifications listed below.

Earned Income

New Employment – provide verification of employment by submitting one of the following:

Confidential Wage Report Form

Please download this form and have your employer complete it.

Written Statement - must be written by employer and include:

Name of Company, person supplying information, phone number and date

Hire Date

Date of first pay

Hourly rate

Weekly hours available

Pay frequency

Job End – provide verification of employment end by submitting one of the following:

Confidential Wage Report Form

Please download this form and have your employer complete it.

Written Statement - must be written by employer and include:

Name of Company, person supplying information, phone number and date

Date last day worked

Amount of last pay

Date last pay received

Unearned Income

Social Security, Supplemental Security, Survivors Benefits, Unemployment Compensation, Workers Compensation, Veterans Benefits

Award Letter – including the following information:

Name

Effective date

1st month to receive

Amount

Red, White & Blue Medicare Card

Child Support

Name of parent paying

Name of parent/person receiving

Amount

Frequency

Child’s Name

Direct pay or through CSEA

Guernsey County JFS
324 Highland Avenue Cambridge, OH 43725
Phone: 740-432-2381 | 800-307-8422
Fax: 740-432-1952

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