Declaration of Change in Household Composition
This form is used to report changes in your household composition, income, or assets since your rental subsidy application. Required for adding or removing household members and reporting income adjustments. Ensure all necessary documentation is submitted with the form.
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How do I fill this out?
To fill out this form, begin by providing detailed information about any changes in your household. Follow the specific sections for adding or removing members and for reporting income changes. Ensure that you have all necessary documentation ready for submission.

How to fill out the Declaration of Change in Household Composition?
1
Review the form and determine which sections apply to your situation.
2
Complete Parts A, B, and C as necessary for household members.
3
Attach relevant documentation required for new household members.
4
Sign the declaration at the end of the form to confirm accuracy.
5
Submit the completed form through the listed submission methods.
Who needs the Declaration of Change in Household Composition?
1
Families applying for rental subsidies may need this form to report changes.
2
Individuals adding a new member to a household for housing benefits.
3
Tenants who need to report income changes to comply with rental agreements.
4
Landlords managing rental properties seeking updated tenant information.
5
Social workers assisting clients with housing subsidy applications.
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What are the instructions for submitting this form?
This form can be submitted via multiple channels. You may email your completed form to DTRInitials@hpd.nyc.gov. Alternatively, you can submit it through the online portal at www.nyc.gov/dtrownerportal or fax it to 212-863-5299.
What are the important dates for this form in 2024 and 2025?
Key dates for the use of this form include the annual review for rental subsidy eligibility, typically required in the Spring of each year. Ensure that you submit the form promptly to avoid any delays in processing your application. Review the specific deadlines outlined by your local housing authority.

What is the purpose of this form?
The purpose of this form is to ensure that the housing authorities have up-to-date and accurate information regarding the composition and income of a household receiving a rental subsidy. It allows households to report changes which might affect their eligibility for assistance programs. Timely completion and submission of this form are crucial to maintaining compliance with housing regulations and ensuring continued support.

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

- 1. PART A: Request to Add a Person: Gather information about the new member, including relationship and personal details.
- 2. PART B: Request to Remove a Person: Provide information on the member being removed and reason for removal.
- 3. PART C: Declaration of Income and Assets: Report income and asset changes for household members.
- 4. PART D: Certification: Capital certifications required under penalty of perjury.
What happens if I fail to submit this form?
Failure to submit this form on time can result in ineligibility for rental assistance or delayed processing of your application. It is essential to ensure that all necessary documentation accompanies the form. Not reporting changes may lead to adjustments in housing assistance.
- Loss of Housing Assistance: Failure to report changes may lead to losing your rental subsidy.
- Delays in Processing: Incomplete submissions can cause significant delays in your application.
- Potential Legal Issues: Misreporting information can lead to legal repercussions.
How do I know when to use this form?

- 1. Adding a Household Member: When a new member needs to be added to the household for subsidy considerations.
- 2. Removing a Household Member: When a household member moves out or passes away.
- 3. Reporting Income Changes: To inform of any income changes either from new or existing members.
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