Change of Household Composition

Pembroke Housing Authority
606 Lumbee Street
Pembroke, NC 28372
Phone: 910-521-9711
Fax: 910-521-8765
www.pembrokeha.com

Fields marked with * must be completed or form will not submit.

Anyone you list as a household member must use the subsidized unit as their primary residence (at least 51% of the time). All adults must have an acceptable criminal background, cannot owe any housing authority money, and, if s/he previously participated in a federally subsidized housing program, must have acceptable compliance history. All adult additions must be approved in writing by your landlord and by Hollywood Housing before the additional person can move in.

Note: The fields at the bottom of this form marked "For Landlord Use Only" and "For PHA Use Only" should not be completed when submitting this form.