Income Change Request

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.

Pembroke Housing tenants and residents that participate in the Public Housing Program may use this form to submit a change of income. Documentation of any change must be attached in order to process your request. If you are unable to attach the documentation via this form, please call for other options.