Change Report DHS 2240 Form – Fill Out and Use This PDF

Change Report DHS 2240 Form PDF Details

The DHS 2240 Change Report form is a required Michigan Bridges document used by Department of Human Services recipients to report household changes that affect public assistance benefits. Recipients of SNAP, Medicaid, Family Independence Program (FIP), or State Disability Assistance (SDA) must submit this form whenever a reportable change occurs.

What Changes Must Be Reported

Michigan law requires DHS recipients to report the following changes using the DHS 2240 form within 10 days of the change:

• Income and employment: starting a new job, raises, overtime, loss of employment, or changes to self-employment income
• Household composition: people moving in or out, new births, deaths in the household, or changes in dependent status
• Address changes: moving to a new Michigan residence or a change in living situation
• Work and education activities: starting or stopping school, training programs, or work-related activities
• Child or disabled adult care: changes to care provider, schedule, care location, or costs
• Assets and property: buying or selling a vehicle, real property, or receiving a lump sum payment
• Other expenses: changes to shelter costs, utility costs, or other deductible expenses

Reporting Deadline

All changes must be reported to Michigan DHHS within 10 days of the date the change occurs. For earned income changes, the 10-day rule is strictly enforced. Failing to report changes on time may result in benefit overpayments you are required to repay, or program disqualification.

How to Submit the Form

You can submit your completed Michigan DHS 2240 form in several ways:

• Online: complete the form and upload it through the Michigan Bridges online portal
• By mail: mail your completed change report form to your local MDHHS county office
• In person: deliver the completed form to your local Michigan DHHS office

Keep a copy of all submitted DHS change report forms for your records. The DHS 2240 form covers two pages and includes sections for income changes, work activities, child care updates, and other household changes. The form is also known as the michigan bridges change report form, mi dhs change report form, dhs change form, and mi dhs2240.