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State of CaliforniaHealth and Human Services AgencyDepartment of Health Care Services MICHELLE BASS DIRECTORGAVIN NEWSOM GOVERNOR October 26, 2021, James G. Scott, Director Division of Program Operations
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Go to the website of the organization where you want to fill out the online statement of change.
02
Look for the section or tab related to statements or account changes.
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Click on the option to fill out the online statement of change.
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Provide your personal information as requested in the form, such as your name, address, and contact details.
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Fill in the fields for the specific changes you want to make, such as updating your address or adding/removing a beneficiary.
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Who needs online statement of change?

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Anyone who requires to make changes to their account or personal information with the organization may need the online statement of change. This can include individuals who have moved, had a change in their family status, or want to update their beneficiaries, among other reasons.
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Online statement of change is a legal document submitted electronically to report any changes to a business entity's information.
All business entities are required to file online statement of change when there are any changes to their information.
Online statement of change can be filled out by visiting the relevant website, logging in, and updating the necessary information.
The purpose of online statement of change is to ensure that accurate and up-to-date information about a business entity is maintained.
Information such as changes to business address, ownership, officers, and other key details must be reported on online statement of change.
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