Discretionary Housing Payments

Transcription

1 Discretionary Housing Payments Housing Benefit Claim Number: If you have any information on any suspected Benefit, Council Tax or Blue Badge fraud ring: Name Address Office use only Date form issued Date of birth: Phone number: address National Insurance Number: Address you are applying for (if different from above) Please make sure you complete all sections. Discretionary Housing Payments (DHP) are additional payments to help with your housing costs. They are not payments of Housing Benefit. In order to be eligible for Discretionary Housing Payments you must have a liability to pay rent to live in your home and be entitled to Housing Benefit or the Housing Element of Universal Credit. You must then show that you need further financial assistance to meet your housing costs. What are you applying for? Please indicate Shortfall in rent (if your rent is more than your benefit) Rent in advance Bond Removal costs Tick if appropriate What sections of this form you need to complete 1-5, 7-9 All sections All sections All sections Section 1: Form completed by someone other than the person applying Name of the person filling in the form Relationship to the person claiming (e.g friend/relative/advisor) Why are you filling this form in on behalf of the person applying for Discretionary Housing Payments? DHP Form.Ver. 8, Oct 2014

2 Section 2: Information about your income and outgoings We need this information to decide if you need further financial assistance to meet your housing costs. If you do not provide all the information, we may not be able to deal with your application. Earned Income Type How much? How often? Nett wages (self) after tax and National Insurance Nett wages (partner) after tax and National Insurance Self employed drawings Unearned Income Type How much? How often? Universal Credit Income Support Jobseeker s Allowance (Income-based) Jobseeker s Allowance (Contribution-based) Employment & Support Allowance (Income-related) Employment & Support Allowance (Contributory) Incapacity Benefit Disability Living Allowance (Mobility) Disability Living Allowance (Care) Personal Independence Payment Carer s Allowance Child Benefit Child Tax Credit Working Tax Credit Maintenance payments Pension Credit (Guaranteed) Pension Credit (Savings) State Retirement Pension Superannuation / Private pension Contributions from children living at home Contributions from other residents Any other income (please specify) Outgoings Type Rent Council Tax Electricity How much? How often? Amount of any arrears

3 Outgoings (continued) Type Gas Water (rates or meter) Other fuel bills eg. Coal (please specify) Food Household expenses (eg. Cleaning) School Meals Clothing Car cost (petrol, road tax, MOT, insurance) Public transport Other travel costs eg. Taxis (please specify) Mobile phone Phone (land line) Broadband / Internet Satellite / Cable TV TV rental / licence Catalogue Credit cards / loans Fines / Court Orders Deductions from Benefits (evidence needed) Cigarettes Alcohol Entertainment eg. Cinema Holidays / trips Insurance premiums Maintenance payments Pension Contributions Any other outgoings (please specify) How much? How often? Amount of any arrears Section 3: Capital We need to know about all the money you have in the Bank, Building Society and Post Office. Please list all accounts, ISA s, PEP s, Stocks & Shares, etc. Type of account / investment Amount Account / roll number

4 Section 4: More information about your housing costs Have you asked your landlord to accept less rent? Yes No If Yes, what was the response and what reason/s did they give? If you didn t ask, why not? What is the difference between the rent you are charged and any Housing Benefit or Housing Element of Universal Credit you get? How much can you afford to pay towards your rent? How have you calculated this amount? What steps have you taken to reduce your outgoings? What steps have you taken to increase your income? Please list any known events that will affect any benefits you receive Have you received Discretionary Housing Payments before? Yes No If Yes, when did your last award end? Have your circumstances changed since you last received payments? If Yes, please give details: What steps have you taken since your previous application to reduce your reliance on the scheme? How long do you think you will need Discretionary Housing Payments for and why?

5 Section 4: continued Have you looked for cheaper / alternative accommodation suitable for your needs / more appropriately sized accommodation? If Yes, please give details: If No, why not? Section 5: About your accommodation Have you moved address in the last 6 months? Yes No If Yes, what date did you move? What was your previous address? Did you have to pay rent? Yes No Why did you move from the previous address? Why did you choose the property you are now living in? If your Housing Benefit is less than your rent, how did you intend to pay the difference? Did you consider any other accommodation than your current address? Yes No If Yes, please give details: Address looked at Reason(s) why unsuitable If No, why did you not consider other properties?

6 Section 6: Applying for rent in advance / a bond / removal costs Are you moving house or have recently moved and need help with rent in Yes No advance, a bond or removal costs? Are you being helped with the move by a Housing Officer, Advice Worker, or Support Worker? If Yes, please give details: Name of person helping you: The organisation they work for: Their telephone number: Their address: Have you secured a property and are ready to move? Yes No Why do you need / want to move? Please give your reason/s: What address are you moving to? Do you want a Discretionary Housing Payment for rent in advance? If Yes, please give the amount: Do you want a Discretionary Housing Payment for a deposit / bond? If Yes, please give the amount: What is the total amount you are asking for to cover rent in advance and/or a deposit / bond? Do you want a Discretionary Housing Payment for removal costs? If Yes, please give the amount: Have you received a bond, rent in advance or removal costs from Yes No the Discretionary Housing scheme previously? Please give us the details of the landlord or agent for the property you are moving in to: Landlord / agent name: Landlord / agent address: Landlord / agent telephone number: Landlord / agent address: Landlord / agent bank details (sort code and account number): Please give us your bank details (account number and sort code):

7 Section 7: Information about you and your family Please provide details of any health problems that you or your family have, which means you have to live at the address you are applying for. You should give their names and tell us what the health problems are, how long they have had the problems and why you/they have to live here. Has the property been adapted for a disabled person s needs? If Yes, please give details below: Section 8: Anything else you need to tell us

8 Please read this declaration carefully before you sign and date it I understand the following: This is my claim for Discretionary Housing Payments (DHP). Section 9: Your declaration If I give information that is incorrect or incomplete, you may take action against me. This includes recovery of overpaid DHP. I will have to repay any DHP which has been paid based on incorrect information provided by myself. You may check some of the information with other sources. You may use any information I have provided in connection with this and any other claim for Social Security benefits that I have made or may make. You may give information to other government organisations, if the law allows this. I know that I must contact you in writing immediately about any changes in my circumstances, which might affect my claim. Details of how to contact us are listed in Section 9. I declare the information I have given on this form is correct and complete. You must sign this declaration. If you do not, we will return this form to you to be signed. Your signature Date Form completed by someone other than the person applying I declare I have confirmed with the person claiming that the answers I have written on this form are correct. Signature of the person who filled in this form Date Sharing information with the person who filled in this form on your behalf If you want us to share the outcome of this application with the person filling in the form on your behaif, you need to sign in the box below to allow us to do this. Please sign here if you agree to this: Contact us Website: For more information or to check your balance visit: benefits dsp@bradford.gov.uk Phone: Text (SMS) Post ONLY: Revenues & Benefits Service, Britannia House, Hall Ings, Bradford, BD1 1HX Visit us: All these offices have disabled access and hearing aid loops: Britannia House Enquiry Centre, Ground Floor, corner of Bridge Street & Broadway, Bradford The Town Hall, Bow Street, Keighley Manningham Customer Service Centre, Family Community Library, Carlisle Road, Manningham Shipley Customer Service Centre, Shipley Town Hall, Kirkgate, Shipley The wording in this publication can be made available in other formats such as large print and Braille. Please call