| Updated On | [date-and-time] | Updated By | [User Name] [View History] |
|---|---|---|---|
| Effective Date of Change | [Date] | ||
| Approval Requested | [True] | Approval Status | [Approved] [View History] |
[View History]Household Member Details
| Household Member | [Full Name] |
|---|
Additional Household Member Details
| Citizen Status | [field-value] | ||
|---|---|---|---|
| Veteran Status | [field-value] | ||
| Applied for S.S.N. | [field-value] | Migrant Farm Worker | [True] |
| Start Date | [Date] | End Date | [Date] |
Residency Details
| Residency Status | [field-value] |
|---|
Race Details
| Black Or African American | [True] | White Or Caucasian | [True] |
|---|---|---|---|
| Native Alaskan Or American Indian | [True] | Native Hawaiian Or Pacific Islander | [True] |
| Asian | [True] |
Comments
| [Comments] |