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Economic Services Division Change Report

vermont department for children and families Economic Services Division Change Report You must Report changes if you receive benefits from the Economic Services Division . If you are not sure what you must Report , call the Benefits Service Center at 1-800-479-6151. The Change Report is for you to use if, now or in the future, there are any changes you need to Report . If you need more space, attach a separate sheet. A worker will process the information and you will get a notice if your benefits Change . Please print: Name Social Security no. xxx xx __ __ __ __ (last 4 digits) Phone number Please check the programs you are currently on: 3 SquaresVT Reach Up Medicaid Pharmacy Essential Person Home Heating/Fuel Assistance Please check the boxes and fill in only the things that have changed.

Vermont Department for Children and Families Economic Services Division Change Report

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