1 Finance and Customer Services Revenues and Benefits CLAIM FOR HOUSING BENEFIT COUNCIL TAX REDUCTION Name Address Postcode Home Number Mobile Number Address Issuing Office Date Issued Reason Issued INCLUDES ALTERNATIVE MAXIMUM COUNCIL TAX REDUCTION AND LOCAL HOUSING ALLOWANCE DID YOU KNOW YOU CAN APPLY ON-LINE? LOGON TO AND COMPLETE THE ON-LINE BENEFITS CALCULATOR. ALTERNATIVELY, PLEASE COMPLETE ALL SECTIONS OF THIS FORM AND PROVIDE ALL INFORMATION RELEVANT TO YOUR CLAIM. IF YOU DO NOT, IT WILL TAKE US LONGER TO WORK OUT AND PAY YOUR HOUSING BENEFIT AND COUNCIL TAX REDUCTION. WE NEED TO SEE ORIGINAL DOCUMENTS AND YOU MUST PROVIDE THE EVIDENCE REQUESTED. PLEASE READ THE APPLICATION CHECKLIST IN SECTION 17 FOR GUIDANCE. If you need help to complete this form, please contact your local office or First Stop Shop (see section 18). FOR OFFICIAL USE ONLY Reference No. Admin Group Date received service and people first
2 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION 2 1. Nationality - This section must be completed The Housing Benefit/Council Tax Reduction rules say that we must ask you about your nationality. If you do not answer this question we cannot consider your claim for Housing Benefit/Council Tax Reduction. We may contact the Home Office to check this information. Have you come to live in the UK in the last five years? Yes From what date If Yes, what is your nationality? We may contact you for more information. No Go to section 2 2. About your Claim - This section must be completed Please tick all of the boxes that apply to you. Are you: A Council Tenant Renting from a Private Landlord Renting from a Housing Association A home owner or buying your home Living in board and lodgings Living with your parents or relatives Living in a hostel A student Joint owner / Tenant Other, please specify When did your tenancy begin? When did you move into this address Please state your previous address Post Code Were you, your partner or any member of your household the homeowner of the address you now wish to claim Housing Benefit/Council Tax Reduction for? Yes No Were you, your partner or any member of your household, the homeowner at your previous address? Yes No Do you, your partner or any member of your household, still own your previous address? Yes No Were you, or your partner, claiming Housing Benefit at your previous address? Yes No Were you, or your partner, claiming Council Tax Benefit/Reduction at your previous address? Yes No Why did you move from your previous address? Do you have a home elsewhere? Yes No If yes, please give details
3 3 VERSION 8 3. About You and Your Partner Do you have a partner who normally lives with you? Yes No A partner can mean your husband or wife, someone of the opposite sex you live with as though you were married or a partner of the same sex who you live with in a Civil Partnership or as though you were in a Civil Partnership. If you tick yes you must answer all the questions about your partner. Title (Mr, Mrs, Miss, Ms) Last Name Other Names Date of Birth National Insurance Number Telephone Number / Mobile Number address you your Partner Are you or your partner known by, or have been known by, any other name? Yes No Yes No If Yes, what name? Are you or your partner receiving Income Support, Job Seekers Allowance (IB), or Employment Support Yes No Yes No Allowance (IR) If Yes, when did you start receiving this? How much do you receive per week? Have you or your partner recently applied for Income Support, Job Seekers Allowance, Personal Independence Payment or Employment Yes No Yes No Support Allowance? If yes, when did you claim? Do you or your partner have an invalid vehicle or a car bought with the help of the Motability Scheme? Yes No Yes No Are you or your partner in hospital, a rest home or nursing home? Yes No Yes No If yes, from which date? We will contact you for further details. Have you or your partner ever claimed Carers Allowance? (Tick Yes even if you were not paid this because you were better off getting another social security benefit) Yes No Yes No Does anyone receive Carers Allowance for looking after you or your partner? Yes For you For your partner For both No Who receives the Carers Allowance? Do they live with you? Yes No Yes No If they do not live with you what is their address?
4 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION 4 3. About You and Your Partner (CONTINUED) Please tick if you or your partner are: you your Partner Registered or Certified blind? An apprentice On Youth Training In legal custody from from Severely Mentally Impaired A student Full Time Part time Full time Part time Evidence Required You must provide us with proof of Income Support, Jobseekers Allowance (income based), or Employment Support Allowance (income related). If you have an invalid vehicle or you are registered or certified blind, you must provide proof. 4. About YouR children Are there children in your household who you get paid Child Benefit for? Yes (fill in this section) (If you have more than four children please include their details on a separate sheet) No (go to section 5) 1st Child 2nd Child 3rd Child 4th Child First Name Last Name Other Names Date of Birth Relationship to you Relationship to your partner Is the child registered blind? Yes No Yes No Yes No Yes No Does the child get Disability Living Allowance? Yes No Yes No Yes No Yes No If Yes, how much: Care Mobility Do you or your partner pay a registered childminder, nursery or after school club any childminding costs? Yes No Yes No Yes No Yes No Tell us the name and Registration Number of the child minder No: No: No: No: How much do you pay per week? Do you get childminding costs through Tax Credits? Yes No Yes No Yes No Yes No If Yes, how much? Evidence Required You must send proof that Child Benefit is being paid for the children who live with you. This should be your Child Benefit award letter. You must provide evidence of your childcare costs.
5 5 VERSION 8 5. Other People Who Live With You (including children for whom Child Benefit is no longer being paid) Tell us about all the people who usually live with you and your partner, except for people who are sub-tenants, boarders or lodgers - See Section 6. If you want to tell us about more than three people use a separate sheet of paper. Does anyone else live with you? Yes (fill in this section) No (go to part 6) Title (Mr, Mrs, Miss, Ms) First Name Last Name Other Names Date of Birth National Insurance Number Date moved in Relationship to you (for example parent, sister or friend) 1st Person 2nd Person 3rd Person Are they severely mentally impaired? Yes No Yes No Yes No Are they in receipt of Disability Living Allowance, /Personal Independence Payment, Attendance Allowance, or registered or certified blind? Yes No Yes No Yes No Are they an apprentice or on a Youth Training Scheme? Yes No Yes No Yes No Are they a full-time student or student nurse or a care worker? Yes No Yes No Yes No Are they in legal custody? Yes No Yes No Yes No Are they in hospital? Yes No Yes No Yes No If they are working, please give gross pay before tax and national insurance are taken off How often is this paid? Number of hours they work each week Do they receive any of the following? Income Support, Pension Credit, Jobseekers Allowance (IB) or ESA (IR) Yes No Yes No Yes No If yes, please enter date claimed Pension from a former employer Yes No Yes No Yes No If Yes, please enter gross amount before tax How often is this paid (for example weekly/monthly etc) Give the amounts of any other state benefits they receive before deductions Please state name of these Benefits (for example, Incapacity Benefit etc) Child Tax Credit/Working Tax Credit
6 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION 6 5. Other People Who Live With YoU (CONTINUED) Please give the total weekly income they have from savings and investments If any of the people shown above are married or living together as a couple please give details is the partner of EVIDENCE REQUIRED You must send us proof of all income and deductions for yourself and/or your partner if you have one. These must be originals, not copies. You must ensure that other people who live with you provide us with proof of all income and deductions. These must be originals, not copies. 6. Sub-tenants, Boarders and Lodgers This section should not include anyone related to you as you should have already given their details in sections 4 and 5. - A sub-tenant is someone who pays to live in part of your home and you do not provide meals for. - A boarder or lodger is someone who pays to live with you and whom you do provide meals for. Do you, or your partner, have any sub-tenants, boarders or lodgers? Yes No (go to section 7a) If Yes, please list 1st PERSON 2nd PERSON 3rd PERSON 4th PERSON Last Name Other Names Rent Paid each week Does the rent include heating? Yes No Yes No Yes No Yes No Does the rent include meals? Yes No Yes No Yes No Yes No 7A. About working for an employer Do you or your partner work? Yes No Yes No If No for both of you go to section 7b. you your Partner If Yes when did the job start? Name and Address of your Employer Type of work done (job title) Payroll Number Number of hours you usually work each week How often do you get paid? How much do you get paid? When was your last pay rise?
7 7 VERSION 8 7A. About working for an employer (CONTINUED) When will your next pay rise be? How are you paid? For example bank transfer, cheque etc you your Partner Do you or your partner get any bonus, commission or tips on top of your normal wage? Yes No Yes No If Yes, how much? Is this a permanent job? Yes No Yes No If No, when will the job end? Do you get Statutory Sick or Statutory Maternity Pay? Yes No Yes No When did it start? How much is it? Do you or your partner have more than one job? Yes No Yes No You should supply details of each job on a separate piece of paper. Are you or your partner employed as a part time fireman or as a member of the territorial army reserve forces, coastguard or lifeboat service? Yes No Yes No EVIDENCE REQUIRED We need to see your last five consecutive wage slips if you are paid weekly or two consecutive slips if you are paid monthly. These must be originals, not copies. We may contact your employer for this information or to confirm details. 7b. About being self-employed you your Partner Are you or your partner self-employed? Yes No Yes No If No for both of you go to Section 8 What type of work do you do? When did the business start? Business name and address Telephone Number If relevant, C.I.S. Number Are there any other partners in the business? Yes No Yes No Do you or your partner receive any government business allowances? Yes No Yes No If Yes, how much and how often? Is any part of your home used for business purposes? Yes No Yes No
8 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION 8 7b. About being self-employed (CONTINUED) How many hours a week do you usually work? Do you pay into a private pension scheme? Yes No Yes No If Yes, how much? How often? Evidence Required You must send us the most recent audited accounts. If audited accounts cannot be provided please contact any of the offices listed in Section 18 for a self employed earnings form. 8. Income Other Than Earnings Do you or your partner have income other than earnings? We need to know about all of your income. You must send us proof of all the income you mention below. We cannot pay benefit without proof of this. BENEFITS YOU Y your PARTNER HOW MUCH HOW OFTEN HOW MUCH HOW OFTEN DO YOU GET? IS IT PAID? DO YOU GET? IS IT PAID? Income Support Jobseeker s Allowance (Income Based) Jobseeker s Allowance (Contribution Based) Employment Support Allowance (IR) Employment Support Allowance (C) When did Employment Support Allowance start? Incapacity Benefit When did Incapacity Benefit start? Maternity Allowance Carers Allowance PENSIONS State Retirement Pension Pension Credit - Guarantee Credit - Savings Credit Widows Pension or Widowed Mothers Allowance War Pension War Widows Pension Works Pension / Private Pension
9 9 VERSION 8 8. Income Other Than Earnings (CONTINUED) DISABILITY Severe Disablement Allowance Disabled Person s Tax Credit Attendance Allowance War Disablement Pension YOU Y your PARTNER HOW MUCH HOW OFTEN HOW MUCH HOW OFTEN DO YOU GET? IS IT PAID? DO YOU GET? IS IT PAID? Disability Living Allowance / Personal Higher Lower Higher Lower Independence Payment (Mobility Component) Please state the rate shown in your award letter Higher Middle Lower Higher Middle Lower Disability Living Allowance / Personal Independence Payment (Care Component) Please state the rate shown in your award letter Industrial Injury/Death Benefit/ Reduced Earnings Allowance CHILDREN Child Benefit Child Tax Credit Working Tax Credit Fostering Allowance Adoption Allowance Guardian Allowance OTHER INCOME Government Training Scheme Home Income Plan Annuities Trust Fund Student Grant or Loan Maintenance Received for Children Maintenance Received for Self / Partner Child Support Rental Income from Other Properties Council Member Allowances Other, please specify
10 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION Income Other Than Earnings (CONTINUED) Have you recently applied for any benefit that you are still waiting to hear about? If Yes, please say which benefit(s) YOU your PARTNER Evidence Required We need proof of all income other than earnings received by you and/or your partner, for example, the award letter issued to you by DWP in relation to any state benefits you and/or your partner receive. 9. Capital, Savings and Investments 9a. Do you or your partner have any bank, building society or Post Office Accounts? Yes No Yes No YOU Y your PARTNER Yes No Yes No If Yes, please say what type of account you or your partner have and how much you have in each account. You can use a separate sheet if there is not enough space here. If No, go to section 9b. Name of Account holder(s) Type of Account How much? YOU your PARTNER 9b. Do you or your partner have any stocks, shares, premium bonds, unit trusts, Tessas, National Savings Certificates or ISAs? Yes No Yes No If Yes please give the following information. You can use a separate sheet of there is not enough space here. If No go to section 9c. Held by Type of Investment No of Units/Shares Issue Date Value YOU your PARTNER 9c. Do you or your partner own any other property other than the one you are claiming for? This includes property in this country and abroad, static caravans, time shares and property you own jointly with someone else. Yes No Yes No If Yes, please provide full details - we may have to contact you for more information. If No go to Section 9d.
11 11 VERSION 8 9. Capital, Savings and Investments (CONTINUED) 9d. Do you or your partner have any other kind of savings or investments, for example an endowment policy not linked to a mortgage? If Yes, please say how much. YOU Y your PARTNER Yes No Yes No Please state where the money is saved or invested. You can use a separate sheet if necessary. If No, go to section 10. Evidence Required We need proof of all Capital, Savings and Investments held by you and/or your partner. For Bank or Building Society accounts, you should supply your most recent account statement or book. For stocks, shares, bonds, unit trusts or National Savings Certificates, you should supply the certificates. For property, the title deed is usually required to establish ownership. These must be originals not copies. If you do not send us these, it could delay any benefit/reduction. 10. MONEY PAID OUT IN SOME CASES THE MONEY YOU PAY OUT CAN BE TAKEN INTO ACCOUNT WHEN ASSESSING BENEFIT 10a. PARENTAL CONTRIBUTION If you or your partner help to support a son or daughter who is at university or college please give details below. We also need to see the Student Grant Award Letter. Contribution How often? 10b. Pension Schemes If you or your partner pay money into a personal pension scheme, but not through your employer, we need proof. Please provide the policy or scheme document. Money Paid in How often? If you are a Council Tenant, please go to Section 13. If you are buying your home or already own it, please go to section 13. If you rent from a Private Landlord or Housing Association, and you want to apply for help with your rent payments, please go to Section 11.
12 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION About Your Rent (Private Tenant or Housing Association Tenant) If you are a Council Tenant, please go to Qu.11(B). Name, home address and postcode of your landlord (this is the owner of the property you live in) Landlord / Agent address Telephone Number Are you, your partner or your children related in any way to your Landlord/ Landlords Agent? YOU Name, address and postcode of the person you pay rent to (if not your landlord) Landlord / Agent address Telephone Number your PARTNER Children Yes No Yes No Yes No If Yes what is the relationship? How much is your rent? How often is the rent due - for example, weekly, calendar monthly, four weekly, fortnightly etc Please state the sort of tenancy you have: Assured Short Assured Registered Other (Please say what it is) How long is your tenancy for? Does anyone, other than your partner, share the rent payment with you? If Yes, how many people share the rent with you? What is your share? Yes No If you have a Registered tenancy you must send us the Notice of Registration form RO5 What type of accommodation do you live in? Terraced House Semi-detached House Detached House Bed-Sit Terraced Bungalow Semi-detached Bungalow Detached Bungalow Shared Room Flat in a House Flat in a block Flat over a shop or office Maisonette Caravan Hostel Other What is your flat or room number?
13 13 VERSION 8 11(A). About Your Rent (CONTINUED) How many rooms do you have in your home? Bedroom Living Dining Kitchen Bathroom Toilet Other Total number of rooms in the house Rooms that only you use Rooms that you share Does your rent include any of the following services? Description Yes No If Yes, how much? Description yes No If Yes, how much? Council Tax Satellite dish or TV aerial Water Rates Lift Heating your Garden Maintenance accommodation Lighting your Warden, Caretaker accommodation porter Hot Water Laundry service Fuel for Cooking Laundry facilities Lighting or cleaning of shared areas Cleaning your accommodation Personal or nursing care Window cleaner Does your rent include payment for meals? Yes No If Yes which are provided? Breakfast Lunch Evening Meal Other (specify) If you are single and under 35 your rent may be restricted - to find out more about this you can contact your local office or visit our website at Evidence Required Please send proof of your rent. This must be in the form of a tenancy agreement OR a rent book accompanied by a letter from your landlord. A lease must contain the tenancy start date, rent charge, length of tenancy, services provided by your landlord, the address of the property and must be signed and dated by you and your landlord. 11(B). ABOUT YOUR COUNCIL TENANCY How many rooms do you have in your home? Bedroom Living Dining Kitchen Bathroom Toilet Other Total number of rooms in the house Are you a joint tenant? Yes No If yes, please provide the name of the joint tenant/s and any members of their household.
14 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION HOW YOU WILL BE PAID HOUSING ASSOCIATION TENANTS ONLY Do you want us to pay your housing benefit direct to your landlord? Yes No I understand that you may not agree to this but if you do, you may end this arrangement at any time. I will give 4 weeks notice if I want to end this arrangement. IF YOU ARE RENTING FROM A PRIVATE LANDLORD All new Private Landlord Housing Benefit Applications we receive from 7 April 2008 will be covered by the Local Housing Allowance scheme rules. This means payments should be paid to you, the tenant. This will be paid into your bank by a BACS credit to your account. PLEASE PROVIDE THE FOLLOWING INFORMATION: Bank Mandate for Payment by BACS 1. Name on Bank Account 2. Claimant Address 3. Claimant Post Code 4. Name of Bank 5. Bank Address 6. Bank Sort Code 7. Bank Account Number 8. Acc. Roll Number I hereby confirm that the above are true details to be used for the purpose of receiving Housing Benefit payments from North Lanarkshire Council. The information I have provided may only be given to other council sections/government organisations if law allows this. 9. Authorised signature 10. Please Print Name 11. Date In some circumstances your Local Housing Allowance can be paid directly to your landlord or your landlords agent. We can make payments directly to your landlord where you have difficulty managing your affairs and where the Revenue and Benefits Section considers you as being vulnerable. To allow the Revenue and Benefits Section to carry out this assessment please ask for the form - Request for Payments to be made direct to Landlord. You must complete this form and return it to the Revenue and Benefits Section as soon as possible.
15 15 VERSION Backdating We can usually award housing benefit/council tax reduction from the Monday after the day we receive your claim. Sometimes we can pay housing benefit/council tax reduction from an earlier date if you have a good reason for not claiming sooner. If you want us to consider paying your housing benefit/council tax reduction from a date before the date you made this claim, please tell us when you want benefit from and why you did not claim earlier. Date you want to claim housing benefit/council tax reduction from During this earlier period, were your circumstances different to those you have told us about on this form? Yes No If they were different, what has changed? We need proof of the changes in your circumstance for this period Why have you not claimed before? 14. ETHNIC QUESTIONNAIRE Under the Race Relations Act we have a responsibility to gather details about our client s backgrounds. This information is confidential and will only be used to help us with our equal opportunities policy and to improve access to our service. The completion of this survey is voluntary. What is your ethnic group? Choose ONE section from A to E, then tick the appropriate box to indicate your cultural background A White C Black Scottish Irish Other British Any other White background Caribbean African Any other Black background Please state Please state B Asian Indian Pakistani D Mixed Please state Any Mixed background Bangladeshi Chinese Please state Any other Asian background E Other ethnic background Please state Any other background
16 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION Declaration YOUR DECLARATION PLEASE READ THIS CAREFULLY BEFORE YOU SIGN AND DATE IT I UNDERSTAND THE FOLLOWING: - I must let North Lanarkshire Council know about changes in my circumstances which might affect my claim and ensure I report any change(s) to the appropriate council offices - If I give information that is incorrect or incomplete North Lanarkshire Council may take action against me - North Lanarkshire Council will use the information I have provided to process my claim for housing benefit and/or council tax reduction. They may check some of the information with other sources, for example, within the council, other councils and government agencies - The information I have provided may be used in connection with this and any other claim for Social Security benefits that I have made or may make and that the information may be given to other government organisations, if the law allows this I agree: - Where payment is made directly to my landlord or landlord s agent, information can be provided to them regarding the progress of my claim. - My landlord or landlord s agent can be informed of the type of information still required to complete my application for housing benefit (for example, proof of identify), when my next payment is due and how much that payment will be. I declare the information I have given on this form is correct and complete. Signature of person claiming Date Partner s signature Date If you have filled in the form on behalf of the person(s) claiming, please complete this part. Why you are filling in the form on behalf of this person(s) What is your name What is your relationship to the person(s) making the claim DECLARATION - PLEASE READ CAREFULLY AND SIGN This form has been completed by me, based on the information provided and is an accurate record. I understand that if I knowingly allow false information to be included in this application, legal action may be taken against me. Signature of the person who filled in the form Date Remember that if you do not provide all of the evidence we have asked for on this form we may not be able to pay you any HOUSING benefit/council TAX REDUCTION
17 17 VERSION Other Information Please use this space to tell us about anything else you think will help us to deal with your claim. Use a separate sheet if necessary.
18 CLAIM FOR HOUSING BENEFIT/COUNCIL TAX REDUCTION Application Checklist PLEASE CHECK THAT YOU HAVE PROVIDED THE FOLLOWING: Two forms of identification for yourself and your partner Such as a birth certificate, marriage or civil partnership certificate, passport, medical card, driving licence Proof of your address Such as a recent paid gas or electricity bill or a TV licence Proof of your and your partner s National Insurance Number Such as a National Insurance number card, payslips or letters from DWP or Tax Credits office Proof of your household composition Such as a Child Benefit or Tax Credit award letter Proof of your and your partner s earned income Such as wage slips or if you are self employed, your accounts or self employed earnings forms Proof of your and your partner s benefits, allowances or pensions Such as current award letters please let us know straight away if you do not have proof Proof of any other income you or your partner receive Such as pension slips from a previous employer, or a letter from court showing how much maintenance you receive. We need to see proof of how much money people pay you for board and lodgings Proof of all savings and investments held by you and your partner Such as bank, building society or post office accounts, full bank statements, Premium Bond and National Savings Certificates, Property and Land Proof of private rent and tenancy Such as a rent book, rent receipts, a tenancy agreement or a letter from your landlord Proof of other money paid out Such as letters about student grants, maintenance agreements or receipts from registered child carers Have you completed all the questions on the application form? Have you enclosed any additional documents not listed above? Please give details
19 19 VERSION What to do next Please detach and retain this page for your information Please remember that if you have not completed all the sections and provided all the necessary information, it will take us longer to work out and pay your benefit. We understand that it is not always possible to provide all the evidence at once, for example if you have just started to work you will not have When 5 consecutive you have filled pay in slips, the form but send don t or delay bring it, in along returning with, the the proof form. we Provide need to your what nearest evidence local you office can (see and list supply below) further proof as it becomes available. Remember if you have not completed all sections and provided all the information relevant to your claim it will take us longer to When work you out have and filled pay your in the benefit form,. you can either post it in the envelope provided, or hand it in to any of the designated offices as listed below. Remember to include the proof we need. Airdrie FSS Bank Street, Airdrie, ML6 6AF Bellshill FSS 26 Motherwell Road, Bellshill, ML4 1RE Coatbridge FSS The Buchanan Centre, 126 Main Street, Coatbridge ML5 3BJ Cumbernauld FSS 2/4 Forth Walk, Cumbernauld, G67 1BT Kilsyth FSS 9 Parkfoot Street, Kilsyth, G65 9AA Moodiesburn FSS Blackwood Crescent, Moodiesburn, G69 OEN Motherwell FSS Merry Street, Motherwell, ML1 1JJ Shotts FSS Station Road, Shotts, ML7 4AW Viewpark FSS 135 Burnhead Street, Viewpark, G71 5DD Wishaw FSS 236 Main Street, Wishaw, ML2 7ND If you are the tenant of a Private Landlord or Housing Association, please post the form and evidence in the envelope provided and return to the address below or alternatively you can call in to any of the designated offices listed above. Private Benefits Section Finance & Customer Services, P.O Box 9060, Motherwell, ML1 1SH CHANGES IN CIRCUMSTANCE You must tell us straight away if: Any of your children leave school or leave home Anyone moves into or out of your home (including lodgers and sub-tenants) Your income including benefits changes, or the income or benefits of anyone living with you changes You are under 60 and your capital or savings change by more than 250 You are over 60 and your capital or savings change by more than 500 You or anyone living with you - becomes a student - goes on a Youth Training Scheme - goes into hospital or a nursing home - goes into prison - becomes employed - changes or leaves employment you are a private tenant and your rent changes you move you or your partner are going to be away from home for more than a month you receive any decision from the Home Office anything you have told us about changes You must tell us about these changes in writing (letter or statement) a phone call is not enough. If you don t tell us about these changes you may lose money you are entitled to or get too much benefit. Do not rely on someone else to pass the message on. It is an offence not to tell us about any change of circumstances that affects your benefits. We may take court action against you and if we pay you too much benefit, you will have to pay it back.
20 19. What happens next Housing Benefit/Council Tax Reduction will normally only start on the Monday following the week your completed claim form is received at any of our designated offices, highlighted in Section 18. We will work out your Housing Benefit/Council Tax Reduction and write to you telling you how much you will get, when it will start and how long it will last for. Please check all the details. If you disagree with any of the details, please write to us within one month of the date of our letter, so that we may reconsider your claim. You have the legal right to an explanation of how we have worked out your Housing Benefit/Council Tax Reduction. If you are not satisfied with our decision, you can ask us to look at your claim again, and to appeal to an independent Tribunal if you are still not satisfied. We may also visit you in your home to verify the information contained within your claim. You can access further information on housing benefit and council tax reduction by logging on to FAIR PROCESSING STATEMENT The information on this form and from supporting evidence collected by North Lanarkshire Council will be used to process your Housing Benefit and Council Tax Reduction claims. The information may be passed to the Department for Work & Pensions and Her Majesty s Revenues & Customs as permitted by law. We may check information provided by you, or information about you provided by a third party, with other information held by us. We may also get information from certain third parties, or give information to them to check the accuracy of the information, to prevent or detect crime, or to protect public funds in other ways, as permitted by law. These third parties include Government Departments, Local Authorities Credit Reference Agencies. Benefit fraud investigations may include checks on any undeclared cohabiters and your information may be shared with other Council departments with a view to providing you with access to other benefits to which you may be entitled. We will not disclose information about you to anyone outside North Lanarkshire Council nor use information about you for any other purpose than outlined in this notice unless the law permits us to. North Lanarkshire Council is the Data Controller for the purposes of the Data Protection Act If you want to know more about what information we have about you, or the way we use your information, you can ask at any of the offices listed. BENEFIT FRAUD IS A CRIME AGAINST US ALL FRAUD IS THEFT! If you know a Benefit Thief call our free 24 hour hotline in complete confidence Revenues and Benefits -
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Housing Benefit claim form Application form for the Local Council Tax Reduction Scheme Filling in the form If you are just claiming Second Adult Reduction, only fill in Parts 1, 3, 16, 17 and 18 of this
Claim for Housing Benefit and Application for Council Tax Support (Help with your rent and Council Tax) Please complete this form in BLACK ink, and place a TICK (a) in the relevant boxes. Please read the
Benefits Section Pippbrook Dorking Surrey RH4 1SJ Tel: 01306 879187 Fax: 01306 879395 Email: email@example.com Name: Address: OFFICIAL USE ONLY Ben Ref: Date requested: Date issued: Claim type:
Benefits Service Benefits Service PO Box 1, Town Hall, Ripley PO Derbyshire, Box 1, Town East Hall, Midlands, RipleyDE5 3BT Derbyshire, Phone: 01773 East 841470 Midlands, DE5 3BT Phone: Fax: 01773 01773
2014/15 Council Tax Support and Housing Benefit Claim Form Don t delay - claim today! Please return this form as quickly as possible, even if you do not have everything we ask for, to make sure that you
Revenues & Benefits Service Community Contact Centre Town Hall, Queens Square Hastings TN34 1TL Tel: 01424 451080 Fax: 01424 451541 firstname.lastname@example.org www.hastings.gov.uk FOR OFFICE USE ONLY Date
For office use only Reference Date issued Date received stamp Housing Benefit and Council Tax Support application form If you want to claim help with paying your rent or Council Tax, please fill in this
ISSUE CLAIM REF. DATE: TYPE: NO: APPLICATION FORM FOR HOUSING BENEFIT AND/OR COUNCIL TAX SUPPORT Before completing this application please ensure that you read the notes. In addition to this the evidence
Application Form Housing Benefit Council Tax Reduction Alternative Council Tax Reduction This form can be made available in other languages and formats (including large print, audio tape and Braille as
Claim_rev 39 17/9/09 22:22 Page 1 Housing Benefit and Council Tax Support Claim form Do not write in this box. It is for office use only. Date of issue: Version: Sept 2009 Office receipt date stamp Please
Housing Benefit and Council Tax Reduction Change of Address form. Name Address Don t delay claim today! Please return this form as quickly as possible, even if you do not have everything we ask for. You
A claim form for housing benefit and council tax benefit Isle of Wight Council Offices, Broadway, Sandown, PO36 9EA Tel: (01983) 823950 Name, address and postcode For official use only Hb ref: Date received
Name: Current address: Post code: CHB1 Home telephone number: Mobile number: Email address: IMPORTANT INFORMATION THE MORAY COUNCIL COUNCIL TAX REDUCTION & HOUSING BENEFIT CLAIM FORM 1st contact Issued
If you need any help please ring: ( 0845 070 1066 Charged at local rate Name and address Date Issued Ref Housing Benefit & Council Tax Support - NEW CLAIM and Free School Meals Use this form to claim Housing
2013/14 Housing Benefit and Local Council Tax Support claim form Don t delay - claim today! Please return this form as quickly as possible, even if you do not have everything we ask for. can send the rest
Herefordshire Council Claim form for Housing Benefit, Council Tax Reduction and free school meals Crystal Mark 9252 Do not write in this box it is for office use only. Date form sent out: Form to be returned
Benefits Section Town Hall The Parade EPSOM Surrey KT18 5BY Tel: 01372 732269 Name: Address: OFFICIAL USE ONLY Ben Ref: Date requested: Date issued: Claim type: A claim form for Housing Benefit and Council
2012/13 Please use capital letters Name Address Housing Benefit & Council Benefit Claim Form Don t delay - claim today! Do not delay returning this form if you do not have all the information that is asked
Date requested Date issued Ratepayer ID Occupancy ID THIS BOX FOR OFFICIAL USE (Find these details on your rate bill) START THE FORM HERE Claim number r name and address FOR OFFICIAL USE HELP WITH RATES
2014/15 Local Council Tax Support and Housing Benefit Claim Form Don t delay - claim today! Please return this form as quickly as possible, even if do not have everything we ask for. can send rest to us
Housing benefit & council tax support New claim www.portsmouth.gov.uk You must complete and return the form immediately, even if not all the evidence is available. Delay may affect the start date of your
Claim for Council Tax Support and Housing Benefit Do not fill out this form until you have read these notes. After you have read and understood them, remove the notes by tearing along the perforated line.
Housing Benefit, Council Tax Rebate and Second Adult Rebate Claim Form Date Issued 1st Contact Claim Number If you have any special needs that prevent you getting to our offices or you need help in filling
EDf EnErGY trust APPLiCAtion for financial ASSiStAnCE BEforE CoMPLEtinG the APPLiCAtion form, PLEASE CArEfULLY read the notes BELoW. When you have completed the application form, you should detach these
Claim form for Housing Benefit and application for Council Tax Reduction Name and address of the person claiming or applying: Reference number: For office use only Issue date: Date received: Revenues and
Cambridge City Council Revenue Services (Benefits) FREEPOST PO Box 130 Cambridge CB2 1BR Tel (01223) 457721/86, 457693/97 Email: email@example.com Website: www.cambridge.gov.uk Thank you for downloading
A claim form for: Housing Benefit An application for: Council Tax Reduction Scheme Second Adult Rebate Name: Address you are claiming or applying for: Address and postcode: Please read the guidance notes
www.islington.gov.uk Application form for Housing Benefit (including Local Housing Allowance) and/or Council Tax Support (including Second Adult Discount) If you are on a low income, you could get Housing
South Norfolk Council Swan Lane Long Stratton Norwich Norfolk NR15 2XE Housing Benefit and Council Tax Support Application Part 1 About you and your household This is my claim for: Housing Benefit Council
Housing Benefit and Council Tax Support (reduction) Claim Form Don t delay - claim today! Please return this form as quickly as possible, even if you do not have everything we ask for. You can send the
Help with your Rent and Council Tax Please tear off pages 1 to 4 for your reference Important information if you or your partner are awarded Universal Credit from the DWP If you or your partner are awarded
Malvern Hills District Council 9973 Application for Council Tax Support or Housing Benefit (or both) Name For our use only Date you first contacted us Address Address and and Date you first contacted us
Housing Benefit and Council Tax Reduction Claim Form Please detach this information sheet and keep for future reference. tes for filling in the Housing Benefit and Council Tax Reduction claim form About
Housing Benefit & / or Council Tax Reduction Application Form for Applicants of Working Age PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS Name Address Are you? (Please tick all that apply): An Owner Occupier
Change of Address Form Help with your Rent and Council Tax Please do not write in this box. It is for office use only. Office receipt date stamp of issue: Please read all of the notes shown on this page
APPLICATION FOR HOUSING BENEFIT, LOCAL HOUSING ALLOWANCE AND COUNCIL TAX REDUCTION Please note this form is also available in Welsh Housing Benefits Ty Elwyn, Llanelli, SA15 3AP. Tel: (01554) 742100 E-mail:
For Office Use Only Date of issue First point of contact Ref Name and address of applicant (including room or flat number) Name: Address: : Application form for Housing Benefit and/or Council Tax Reduction
APPLICATION FOR FINANCIAL ASSISTANCE ALTERNATIVELY APPLY ONLINE VIA THE FUND S WEBSITE WWW.NPOWERENERGYFUND.COM BEFORE COMPLETING THE APPLICATION FORM, PLEASE CAREFULLY READ THE NOTES BELOW. When you have
FOR OFFICIAL USE ONLY Receipt Number Date issued Date Received Returned for Cert. HOUSING BENEFIT, COUNCIL TAX BENEFIT - (For Applicants of Pensionable Age only) This form should only be completed to advise
A CLAIM FOR DISCRETIONARY HOUSING PAYMENTS (DHP) Claim Ref: SECTION 1 INFORMATION If you are getting Housing Benefit and Local Council Tax Support but you are still having problems meeting your rent and
Glasgow City Council Housing Benefit and Council Tax Reduction Application Information Section 1 Personal Details To help us process your application and allow us to contact you if we need more information,
Getting your deferment application form right Use these notes to help you complete your student loan deferment application form If you need any help, please go to www.erudiostudentloans.co.uk or call us
Housing Benefit claim form Application form for the Local Council Tax Reduction Scheme Filling in the form If you are just claiming Second Adult Reduction, only fill in Parts 1, 3, 17, 16, 18 17 and 19
Help to Buy South West Application Form Please circle the correct answers Would you consider buying a home? Would you consider renting a home? Yes / No Yes / No I/We can confirm that our household income
Revenues and Benefits Civic Centre The Water Gardens For Official Use Only Harlow, Essex, CM20 1WG Council Tax ref: Date Issued: Date Received: Telephone: 01279 446688 E-mail: firstname.lastname@example.org
For Official use only Date Requested... Date Issued... Originating Office... Claim Reference... Name... Address......... Postcode... Housing benefit and council tax reduction application form Please use
Housing Benefit, Council Tax Reduction and Free School Meals tification of Change of Address Mae r ffurflen hon ar gael yn Gymraeg o Ganolfan Ddinesig This form is also available in large print from the
Sheffield Benefits Service April 2013 Housing Benefit & Council Tax Support for people of working age Housing Benefit and Council Tax Support Housing Benefit is a national welfare benefit, administered
HC BEN 1 Application form for Housing Benefit, Council Tax Reduction and Second Adult Rebate If you and/or your partner have capital of more than 16,000 and you or your partner are in receipt of Job Seeker
Phone: 01656 643643 Minicom: 01656 643671 E-mail: email@example.com Bridgend County Borough Council PO Box 107 Bridgend CF31 1WB Name: Address: Reference number: Date issued: Date of first contact:
HOUSING BENEFIT AND COUNCIL TAX SUPPORT 2015-16 www.havering.gov.uk What are Council Tax Support and Housing Benefit? Council Tax Support helps people pay their Council Tax. The Government decided to replace
Please read the benefit information booklet supplied with this form before completing your claim Keep it safe as you may need to refer to it in future or translated into another language please call us
Application form for You need a Personal Public Service Number (PPS.) before you apply. How to complete this application form. Please tear off this page and use as a guide to filling in this form. Please
Please read the benefit information booklet supplied with this form before completing your claim Keep it safe as you may need to refer to it in future or translated into another language please call us
Application form for Invalidity Pension Social Welfare Services INV 1 Data Classification R You need a Personal Public Service Number (PPS.) before you apply. How to complete this application form. Please
Application form for Blind Pension Social Welfare Services BP 1 Data Classification R How to complete this application form. Please use this page as a guide to filling in this form. Please use black ball
Universal Credit Universal Credit (UC) is a new benefit for people of working age. You can get it if you have a low income or do not work. Some people started getting it in April 2013. In this factsheet
Ochil View Housing Association Ochil House Marshill Alloa FK101AB 01259 722899 firstname.lastname@example.org Registration Form National Housing Trust properties at The Glen Coalsnaughton Mid-market
HB1- HOUSING BENEFIT CLAIM FORM FOR NEW CLAIMS Do not use this form if you currently receive Housing Benefit and are moving home ask for a Change of Address form instead. Complete all the sections that
Help with your Rent and Council Tax Change of Address form Name: New address: For office use only Reference : Date Stamp Postcode: Prop ref of new address: Date you moved into your new address: Complete
Housing Benefit and Council Tax Support Please return this form immediately so that you do not lose benefit even if you do not have all the supporting documentation. Housing Benefit reference: (if known)
Housing Application Form 1 Red Row Renton Office Use Only: G82 4PL Date received: 01389 721216 Reference Number: 07974 745 462 email@example.com www.cordalehousing.org.uk This is a housing application
Carer s Allowance Claim form l Use this form to claim Carer s Allowance. l Please read the tes that came with the claim pack before you fill in the form. l The form must be filled in by you, the carer,
Application for Discretionary Housing Payment/Council Tax Discretionary Relief Name & Address: Date of Issue: Council Tax Account Number: Email Address and Contact Number: Housing Benefit Claim Reference:
For office use Registration No. Tenant transfer application Main applicant Place passport sized photo of main applicant here Place passport sized photo of joint applicant here If you would like any part