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Click ‘Get Form’ to open the CalFresh Household Change Report DFA 3775 in the editor.
Begin by entering your Case Name and Case Number at the top of the form. This information is crucial for identifying your application.
In Section 1, report any income changes. Indicate if there was a change in unearned or earned income by selecting 'Yes' or 'No'. If applicable, provide details in Section 1(C) including amounts and sources.
Move to Section 2 to report household composition changes. Answer questions regarding new members, departures, or significant life events such as marriage or disability.
In Section 3, detail any resource changes. If you acquired a vehicle or your cash resources exceeded specified limits, complete the relevant fields.
Continue through Sections 4 to 12, providing necessary details about medical expenses, address changes, dependent care costs, and any other relevant updates.
Finally, review all entries for accuracy before signing and dating the certification section at the end of the form.

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