Please rate Pa564 Pa 564 11-19
The information on the semi-annual reporting form is also needed to calculate the amount of your monthly cash and/or SNAP benefits.
How to return: mail the completed form in the return envelope provided or fax it to the county assistance office
Proof: send proof of all household members' income from work and proof of any changes reported on this form
Signature: an unsigned form is considered incomplete
Good cause: you may claim good cause if you have a good reason for not completing the form or for returning it late
Not returned: if you do not return the form, action may be taken to close your case
| Question | Answer |
|---|---|
| Form Name | PA 564 |
| Form Length | 12 pages |
| Fillable? | Yes |
| Fillable fields | 84 |
| Avg. time to fill out | 14 min |
| Edition | Rev 11/19 |
| Issuing agency | Pennsylvania Department of Human Services |
| Where to send | The county assistance office, in the return envelope provided or by fax |
| Filing deadline | By the date shown on page 1 of the form |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | PA 564, PA564, Form PA 564, Pennsylvania semiannual reporting form, PA semi annual reporting form, SAR form |
| Official source | PA 564 (Rev 11/19), Pennsylvania Department of Human Services |
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