FOOD ASSISTANCE REPORTING REQUIREMENTS

Client Name: Marilyn Pitchford Date of Notice: 08/17/2019

Client Address: 2261 Oswego ST CBMS Case#: 1B2MDV8
AURORA CO 80010

Your household has been approved for Food Assistance benefits.

Period of Time Approved: 08/2019 through 01/2020

My Household Gross Monthly Income Limit: $2311.00 per month

Do you have questions or need help with reporting a change?

If you have questions or need assistance reporting a change, please contact us at:

STE 007
14980 E ALAMEDA DR
Transfer Caseload AURORA CO 80012-1542 (303) 636-1170
County Office Representative County Office Address Phone Number

WHAT YOU NEED TO KNOW ABOUT REPORTING CHANGES

What information am I required to report while I am receiving Food Assistance?

Changes You Are Required to Report

If all of your household members are between
All other households
the ages of 18 and 49 years old
If any employed individual in your household
works less than 20 hours per week
If your household's total gross monthly
and/or income goes above $2311.00 per month
If your household's total gross monthly income
goes above $2311.00 per month

How do I know what my household's total monthly gross income is?

Your gross monthly income is the total of all the money the people in your household received in
the month before any taxes or expenses are deducted and includes both earned and unearned
income.
Example of earned income include but are not limited to: money earned from working
(continued on back)
Transfer Caseload FS3L
1B2MDV8/0424657193 Simplified Reporting Change Form6_EN
 Examples of unearned income include but are not limited to: child support, Unemployment,
Social Security benefits
What happens if I go over the gross income limit for my household size?
If your income goes over the amount listed above, tell us by the 10th day of the next month. Failure
to report going over the income limit may result in you being required to repay benefits you
received, but were not actually eligible to receive. You could be subject to legal consequences or
disqualification from receiving Food Assistance benefits if you fail to report this change.

What do I do if something has changed and I think I am eligible for more benefits?
We encourage you to report any changes that might result in an increase in your benefits.
Examples of changes that could cause your benefits to increase include but are not limited to:
loss of work hours, reduction in pay, loss of income, someone has moved into your household,
or your housing costs have increased.
I have moved. Should I report my new address?
We would encourage you to always keep your address with your county office updated.
If your address changes and we do not have your new address, you may not receive important
letters regarding your benefits.
I have other benefits too. How do I report changes for those programs? And will my changes for
those programs affect my Food Assistance benefits?
You can submit your changes through the PEAK® website Colorado.gov/PEAK, mail, fax, call, or
drop off to your county office with the information provided on this notice.
You must continue to report the changes required by each program (Colorado Works (CW), Adult
Financial (AF), Health First Colorado (Colorado's Medicaid Program)).
Changes you report to Colorado Works or Adult Financial may affect your Food Assistance
benefits.
OTHER IMPORTANT INFORMATION

Categorical Eligibility: Your household has been determined to be eligible for Food Assistance benefits
as a categorically eligible household. When you are considered categorically eligible for Food
Assistance, you also have access to domestic violence (DV) network services.

To find DV services near you, visit: https://www.colorado.gov/pacific/cdhs/domestic-violence

Colorado Coalition Against Domestic 1-888-778-7091 or 303-831-9632
Violence
National Domestic Violence Hotline 1-800-799-SAFE (7233) or TTY 1-800-787-3224

Information Received From Other Agencies: This agency receives information from other agencies
such as the Social Security Administration and the Department of Labor and Employment that the
agency is required to act on while you receive benefits. Your Food Assistance benefits may increase or
decrease during your certification period due to the information we receive. You will be notified of any
changes before they occur.

Transfer Caseload FS3L

1B2MDV8/0424657193 Simplified Reporting Change Form6_EN