
Interim Recertification Information Form
YOU MUST SCAN AND UPLOAD, EMAIL, FAX (303-987-7693) OR PUT IN THE MWHS DROPBOX OUTSIDE OUR BUILDING THE VERIFICATION(S) NEEDED TO COMPLETE YOUR ONLINE CERTIFICATION.
What You Are Reporting
NEW EMPLOYMENT/CHANGE OF EMPLOYMENT
EMPLOYMENT LOSS
BENEFIT AMOUNT
☐ Social Security/SSI/SSDI
☐ TANF/AND/OAP
☐ Unemployment
☐ Worker’s compensation
☐ Veterans’ benefits
☐ Pension
☐ Any other benefit
CHILD SUPPORT PAYMENTS
FULL-TIME STUDENT STATUS
MONEY FROM FAMILY/FRIENDS
ADDITION OF ADULT HOUSEHOLD MEMBERS
REMOVAL OF ADULT HOUSEHOLD MEMBERS
ADDITION OF MINOR HOUSEHOLD MEMBERS
REMOVAL OF MINOR HOUSEHOLD MEMBERS
Verification Needed
☐ Completed Employment Verification form
☐ Completed Declaration of Employment Loss form or termination letter from employer
If you lost a benefit, provide:
☐ Letter from the agency with the date of termination
If you began receiving a benefit, provide:
☐ Letter from the agency with start date and monthly amount
☐ 12 months print out from Family Support Registry
☐ Notarized letter from person providing support stating start date or end date and monthly support amount
☐ Completed Verification of Full-Time Student Status form
☐ Completed Non-Wage Income Verification form
☐ Birth certificate and social security card and photo ID
☐ Permanent residence card (if applicable)
☐ Declaration of 214 status form
☐ Letter from landlord stating approval of edition
☐ Letter from landlord stating that the household member is no longer living in the unit
☐ Birth certificate and social security card
☐ Declaration of 214 status form
☐ Court Ordered Guardianship verification (if applicable)
☐ Written declaration
ALL HOUSEHOLD COMPOSITION AND/OR INCOME CHANGES MUST BE REPORTED ON RENT CAFÉ WITHIN 10 DAYS OF THE CHANGE
