CCCSSF: EDS Increase Form

EDS Increase Form

The purpose of this form is to permanently increase your monthly DMP payment. For any other EDS inquiries, please call Client Services at 800.777.7526.

Any changes requested at least 3 business days prior to your regular EDS withdrawal date will go into effect this month. Any changes requested after that time will go into effect next month.

Client Number
First Name Last Name
Address/Apt no.
City	State	Zip
Phone	Fax
Email
Current DMP Payment __$ Amount to be increased by _$ New DMP Payment __$
By submitting this information, I confirm that I am the person named above.