Report by the 10th day of the month after the change when your household's gross monthly income (before deductions, such as taxes) is more than the amount for your household size in the table.
How to report: in writing, online, email, in person or by calling the ONE Customer Service Center at 1-800-699-9075 or 711 (TTY).
How to use this form: attach proof of income changes. Complete only the parts that describe your changes. Sign and date the form.
More benefits: you can report changes that could increase benefits.
Notice: if a change affects your benefits, the Oregon Department of Human Services (ODHS) will send you a notice.
| Question | Answer |
|---|---|
| Form Name | ODHS 0853 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 18 |
| Avg. time to fill out | 3 min |
| Edition | 10/2025 |
| Where to send | In writing, online, email, in person or by calling the ONE Customer Service Center at 1-800-699-9075 or 711 (TTY) |
| Other names | ODHS 0853, DHS 0853, SNAP change report, Simplified Change Report, SNAP report form |
| Official source | ODHS 0853 (Rev 10/2025), Oregon Department of Human Services |
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