Housing Authority of the County of Santa Barbara Resident Programs and Services

Phone: 805-736-3423
' Fax: 805-735-7672

815 West Ocean Avenue, Lompoc, CA 93436

Please fill out the form below if you have experienced a loss or change in income. A staff member will reach out to you as soon as possible. Please include as much detail as possible.

* = required fields.

Please submit online or print the completed form with supporting documentation and drop off at any of our drop box locations listed below:

Santa Maria

Evans Park - 200 W Williams St
Central Plaza - 200 N McClelland St Rancho

Hermosa - 235 E Inger Dr

Goleta

Housing Office - 5575 Armitos Ave
Sandpiper Apartments - 375 Ellwood Beach Dr
Positano Apartments - 11 Camino De Vida

Pescadero Lofts - 761 Camino Pescadero

Lompoc

Administration - 815 W Ocean Ave
Housing Office - 817 W Ocean Ave
Lompoc Terrace - 904 W Walnut Ave
Parkside Gardens - 240 W Pine St
Homebase on G - 513 North G St
Cypress Court - 125 South 7th St

Creekside Village - 260 Gonzales Dr, Los Alamos

Reason For Request

Child Support Increase/Decrease

Please login to the California Department of Child Support Services online portal at https://www.cse.ca.gov/CustomerConnect/login(Opens in new window), print the 12 month summary of the payments that you have received, then attach it here.

Tenant First Name*

Tenant Last Name*

Date of Birth*

Phone Number*

Email*

Email Confirmation*

Are you an FSS Participant?

Specialists Name

Unit Address

Please Select Property Name*

Lompoc Properties*

Santa Maria Properties*

Goleta Properties*

Reason For Request*

Decrease of Income

Attach Supporting Documentation: Termination Letter from Employer OR Letter from employer, reduced rate of pay, hours per week and starting date. OR Last Paystub with notation of changed hours/income.

Increase of Income (New Job)

Name of Employer*

Address of Employer*

Employer Phone Number*

Employer Email

Employer Fax Number

Attach Supporting Documentation: Letter from employer, stating rate of pay, hours per week and starting date. Last Paystub.

Change in Current Employment (Raise, Shift Differential, Bonus, etc.)

Type of Change*

Name of Employer*

Address of Employer*

Employer Phone Number*

Employer Email

Employer Fax Number

Increase/Decrease of Income Benefits

Benefit Increased/Decreased*

Other Benefit*

Attach Supporting Documentation: Award letter*

Adding/Removing an Adult (18+) Household Member

Name of Household Member*

Adding a Minor Household Member

Removing a Minor Household Member

Name of Minor Household Member*

No Longer a Full-Time Student

Student Name*

School Name*

Attach Supporting Documentation: Unofficial Transcripts

Becoming a Full-Time Student

Full Time Student Name*

Full Time Student School Name*

Attach Supporting Documentation: Financial Aid & Unofficial Transcript

In Kind Income (Family/Friend Support)

Amount Frequency*

Weekly

Monthly

Dollar Amount*

I certify under penalty of perjury that I receive [$x] per [frequency]

Child Support Increase/Decrease

Supporting documentation is not required to submit this form but documentation will be required during the verification process. If documentation is submitted with the form, the verification process will move faster.

I understand that if supporting documentation for the reported change is not submitted with this request it may delay this process.

The reported change will be effective on the first day of the next month.

I Declare and Say:

I certify under penalty of perjury that the reported change(s) are true and correct and any additional changes will be reported immediately.

Signature*

Date of Signature*

HASBARCO USE ONLY

Date of Request

T Code

Days	Hours
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

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Reason For Request

Decrease of Income

Increase of Income (New Job)

Change in Current Employment (Raise, Shift Differential, Bonus, etc.)

Increase/Decrease of Income Benefits

Adding/Removing an Adult (18+) Household Member

Adding a Minor Household Member

Removing a Minor Household Member

No Longer a Full-Time Student

Becoming a Full-Time Student

In Kind Income (Family/Friend Support)

Child Support Increase/Decrease

HASBARCO USE ONLY

Catalogue title

Article Title

Job post

Job Position

Bid details

Bid Title

Income Change Request Form -HA Property

Reason For Request

Decrease of Income

Increase of Income (New Job)

Change in Current Employment (Raise, Shift Differential, Bonus, etc.)

Increase/Decrease of Income Benefits

Adding/Removing an Adult (18+) Household Member

Adding a Minor Household Member

Removing a Minor Household Member

No Longer a Full-Time Student

Becoming a Full-Time Student

In Kind Income (Family/Friend Support)

Child Support Increase/Decrease

HASBARCO USE ONLY

Article Title

Job post

Job Position

Bid details

Bid Title