Report Change in Family Income
Enter the information below to determine income change eligibility.
I understand that if I knowingly provide false information or fail to disclose a material fact
to make myself appear eligible for child care services,
I may have to repay the child care program for services received fraudulently,
and criminal charges may be filed against me with the local prosecuting authority.
By submitting this form, I understand that: (1) a person who obtains or attempts to obtain,
by fraudulent means, services to which the person is not entitled may be prosecuted under applicable state and federal laws,
(2) I am receiving services from Workforce Solutions Panhandle CCS and all information on this submission represents a complete
and accurate statement of my household income; and family size at the time of submission.