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The document is a Simplified Report form from the Louisiana Department of Children and Family Services, which is required for individuals receiving Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance. It outlines the process for reporting changes in personal information, household members, income, and expenses to maintain eligibility for benefits. The form includes sections for updating address, household composition, earned and unearned income, child support obligations, and resources. It also provides instructions for voter registration and penalties for providing false information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date, your Social Security Number (SSN), and CID at the top of the form.
In Section 1, confirm if your mailing address is correct. If you have moved, provide your new address and any associated housing expenses.
Proceed to Section 2 to list all household members. Indicate their relationship to you and whether they are U.S. citizens.
In Sections 3 and 4, report any changes in earned or unearned income. Attach necessary proof if applicable.
Complete Section 5 regarding child support obligations, followed by Section 6 for resources.
Fill out Section 7 with Social Security Numbers for all household members as required.
Finally, review Section 8 for penalty warnings and sign the form before submitting it along with any required documentation.

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