Request for Addition to Household

PO Box 425 | 107 North Kimberly Shawnee, OK 74802-0425 |

Phone 405-275-1050 | Fax 405-275-0678
PROCEDURES TO REQUEST - ADDITION TO HOUSEHOLD FOR A CHILD

The request for addition to household form must be completed for each person you want to add to your household. All required documents must be submitted with the request or your request will not be processed.
The following is a list of the documents required to process your request:

1. Completed Addition to Household form

2. Social Security Card

3. CDIB

4. State Birth Certificate

5. Guardianship or Custody papers for individuals under the age of 18

6. Verification of child support income

7. Declaration of Section 214 Status (Citizenship)

Submission of your request does not guarantee approval. Individuals are not to move into your home until after you receive a letter from the Housing Authority stating your request has been approved.
Resident Name:
Address:
Account #:
I request approval for the Absentee Shawnee Housing Authority to add the following individual to my household:
Full Name:
Relation:
Social Security#
Place of Birth:
Date of Birth:
Tribal Affiliation:
Phone#
Format: (000) 000-0000.
Income being received for this minor child:
Reason for Addition:
ATTENTION! YOU MUST ATTACH HIS/HER CDIB and/or OR TRIBAL ENROLLMENT CARD IF YOU LIST THE TRIBAL AFFILIATION.

IF YOU LEAVE BLANK OR DO NOT ATTACH A COPY OF THE CARD THEY WILL NOT BE LISTED AS NATIVE AMERICAN.
File Upload Social Security Card

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File Upload State Birth Certificate

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File Upload CDIB or Tribal I.D.

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Head of Household Participant Signature:
Date

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Date
Other Adult
Date

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Date
P.O. Box 425 | 107 N. Kimberly Shawnee, OK 74802-0425 |

Phone: (405) 273-1050 Fax: (405) 275-0678

PROCEDURES TO REQUEST - ADDITION TO HOUSEHOLD FOR A CHILD