Income Change Request Form - HA Property

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Phone: 805-736-3423 ' Fax: 805-735-7672
815 West Ocean Avenue, Lompoc, CA 93436
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Please fill out the form below if you have experienced a loss or change in income. A staff member will reach out to you as soon as possible. Please include as much detail as possible.

* = required fields.

Please submit online or print the completed form with supporting documentation and drop off at any of our drop box locations listed below:

Santa Maria
Evans Park - 200 W Williams St
Central Plaza - 200 N McClelland St Rancho
Hermosa - 235 E Inger Dr

Goleta
Housing Office - 5575 Armitos Ave
Sandpiper Apartments - 375 Ellwood Beach Dr
Positano Apartments - 11 Camino De Vida
Pescadero Lofts - 761 Camino Pescadero

Lompoc
Administration - 815 W Ocean Ave
Housing Office - 817 W Ocean Ave
Lompoc Terrace - 904 W Walnut Ave
Parkside Gardens - 240 W Pine St
Homebase on G - 513 North G St
Cypress Court - 125 South 7th St
Creekside Village - 260 Gonzales Dr, Los Alamos

Reason For Request Child Support Increase/Decrease

Please login to the California Department of Child Support Services online portal at https://www.cse.ca.gov/CustomerConnect/login, print the 12 month summary of the payments that you have received, then attach it here.

Decrease of Income

Increase of Income (New Job)

Change in Current Employment (Raise, Shift Differential, Bonus, etc.)

Increase/Decrease of Income Benefits

Adding/Removing an Adult (18+) Household Member

Adding a Minor Household Member

Removing a Minor Household Member

No Longer a Full-Time Student

Becoming a Full-Time Student

In Kind Income (Family/Friend Support)

Child Support Increase/Decrease

The reported change will be effective on the first day of the next month.

I certify under penalty of perjury that the reported change(s) are true and correct and any additional changes will be reported immediately.

HACSB USE ONLY