• Alamance County Department of Social Services Change Form

    Alamance County Department of Social Services Change Form

  • Please complete the information below.

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  • Household Services:

  • Please complete the appropriate section that pertains to your case change:

    • Change in Address 
    • CHANGE IN ADDRESS:

    • Change in Household 
    • Change In Household

       SOMEONE MOVED INTO MY HOME:  (INCLUDING NEWBORNS)

       

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    • SOMEONE MOVED OUT OF MY HOME:

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    • Change in Income 
    • EARNED INCOME

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    • UNEARNED INCOME

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    • Additional Changes 

    • Medicaid Changes Only 
    • Reporting Pregnancy

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    • Requesting A New Primary Care Doctor

    • Tax Filing Questions

    • If Yes, continue answering the questions below.  If No, skip to question C.

    • Evaluation of Current Medicaid Coverage

       

      Do you, your spouse, or children receive Family Planning Medicaid and need help paying medical bills during the last 3 months?  If yes, provide medical bills or complete the following information.

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