RBBNBDHP Benefit Ref : Date of issue:... To :........ Application for a Discretionary Housing Payment Please return this form by post to: Harrogate Borough Council, Benefit Services, PO Box 787, Harrogate, HG1 9RW Or visit our Customer Service Centres at: Council Offices, Crescent Gardens, Harrogate HG1 2SG (Monday to Friday - 8:30am to 4:30pm) or Town Hall, Market Place South, Ripon HG4 1DD ( Tuesdays - 8:30am to 4:30pm)
About Discretionary Housing Payments Discretionary Housing Payments give extra financial help to people who are already claiming Housing Benefit or Universal Credit. If you are in receipt of these benefits but do not have the full amount of your weekly rent met by them, you may be able to claim more money to help you meet the shortfall. These extra payments called Discretionary Housing Payments can be paid on top of your usual Housing Benefit or separately to your Universal Credit. Who can Apply You can apply for a Discretionary Housing Payment if:- You are receiving Housing Benefit now but it does not cover all of your weekly rent or you are receiving Universal Credit that has a restricted housing element included and You are having difficulty in paying the shortfall in your rent and can satisfy the Council that you need extra financial help with this. A Discretionary Housing Payment cannot cover the cost of any deductions that are already being made from your benefits for ineligible services such as deductions for water charges, heating, meals etc. These are costs that you have to meet yourself. To qualify for an award you must be able to show that you cannot meet your rent payments and that you are unable to alter your expenditure to enable you to meet rent payments. How to Claim a Discretionary Housing Payment To make an application for a Discretionary Housing Payment, please complete the rest of this form. It is important that you complete all questions fully and give us as much information as you can, so we are aware of all the facts when we deal with your application. If you need help to fill in the form, you should ring us for advice or ring us to make an appointment for help at one of our Customer Service Centres call us on 01423 500600 and ask for Benefits. We can arrange to see you at:- - Council Offices, Crescent Gardens, Harrogate HG1 2SG (Mon to Fri 8.30am to 4.30pm) or - Town Hall, Market Place South, Ripon HG4 1DD (Tuesdays 8:30am to 4:30pm) You may also wish to contact your local Citizens Advice Bureau for help. Dealing with your Request Once we receive your application, we aim to make a decision within 28 days. We will write and tell you about our decision. If you are not happy with the decision we make, you can write and ask us to look at it again. Awards are only intended to be short-term awards and will only be given for a temporary period. There are limited funds available for making awards and the Council has discretion about whether or not it makes a payment to you. Other Support Available Before applying for a Discretionary Housing Payment you should ensure that you have considered other avenues of support, debt advice and budgeting assistance that are available to help you. The Benefits Service provides a free, debt advice service. Details of this and other support agencies are shown on the back of this application form.
Discretionary Housing Payments Name :.. Address:.. Tel. Benefit Reference: Part A - About your application 1. Are you asking for extra help to pay your rent? 2. How much extra money do you think you need to help you meet your full rent cost? every week / month / 4 weeks 3. Are you receiving Universal Credit? If, please give details of any service charges that are included in your rent e.g. water charges; heating; hot water; lighting; fuel for cooking, meals; laundry; cleaning of rooms. Tell us how much these services cost, if you know this. 4. Are there any changes expected to your household, financial or personal circumstances within the next 12 months, that could affect your ability to pay your rent? If, please tell us what these are 5. Do any of the following apply to you? Please tick the relevant box. - A carer provides regular, overnight care for you or your partner. - A disabled child lives with you and cannot share a bedroom with other children - You are a foster carer - Your home has been adapted to meet disability needs - A member of your household has died within the last 12 months
Part B - About your rent 1. Did you enquire about the levels of Housing Benefit you would receive before you moved into the accommodation? Please give details below. 2. Could you afford the rent when you first moved in? If, please explain what has changed since then and why you are now asking for help 3. Have you considered moving to cheaper accommodation? Give reasons for your answer below: 4. Have you asked your landlord to reduce your rent? Give reasons for your answer below:
5. Are you in arrears with your rent? If yes, please provide proof of this. If, please state how much and the period your arrears cover From To: 7. Has your landlord started action to recover the arrears? If yes, please provide the letter or notice you have received from your landlord. Part C - About your accommodation 1. Why did you choose to live at this address? 2. Do you, or anyone else who lives with you, have any disabilities or health issues that affects your choice of accommodation? If, please give details below 3 Does your landlord provide any special facilities? (e.g. disability adaptations to your home, care, support). If, please give details below. If your accommodation has been adapted to meet disability needs, please give full details of what the adaptations are.
Part D - About you and your family 1. If there are other adults living with you (apart from joint tenants or a partner) could they contribute more financially towards your rent? one else lives with me If or, please give details below 2. Do you have any friends/relatives who could help you financially or temporarily house you? If, please give details below Part E - About other help available 1. Have you already received a Discretionary Housing Payment from us in the last 12 months? If, describe any steps you have taken since then, to try and improve your financial situation. 2. Have you contacted the Citizens Advice Bureau or any other voluntary/statutory organisation to make sure you are claiming all the benefits you are entitled to? If, please give details below
3. Have you contacted any debt counselling or debt support agency to request help and advice with money management? If, what advice were you given? Describe any changes that have been made to your income and expenditure as a result. 4. Our Benefits Service do provide a debt management and budgeting service. You can access this service by contacting us on 01423 556427 or 556483. Please indicate whether you would like further details of this service. 5. Are you on any re-housing lists or Home Swap schemes? If, please give details 6. Discretionary Housing Payments are only intended to be short-term awards. What steps do you intend taking to ensure you can meet your housing costs in the future?
Part F - More information If extra money is not paid to you, please describe the problems that you and your family will face. We need you to tell us why you need extra money and how it will affect you if you do not receive it. We need to establish that you are suffering from extreme hardship because of your financial and personal circumstances. Please give as much detail as you can so that we can consider all the facts when we make our decision. It may be relevant to include problems caused by illness, disability, bereavement; domestic violence, being cared for or caring for someone; your children s schooling.
Part G - About your income Please complete this part to tell us about the total income that you and your partner have. Income Amount How Often Your wages (after tax and national insurance) Your partners wages (after tax and national insurance) Income Support / Job Seekers Allowance (Income based) Universal Credit - Please provide your award letter Job Seekers Allowance (Contribution based) Incapacity Benefit / Employment Support Allowance Working Tax Credits Child Tax Credits Child Benefit Maintenance Pension Credits State Retirement Pension Private /Superannuation Pension Income received from other adults in the household Any other income you have - Please describe below Part H - About your capital Please complete this part to tell us about the total savings that you and your partner have. Capital Total Value - Bank, Building Society and Post Office Accounts Shares, unit trusts, premium bonds, National Savings Certificates Value of any property you own Money you are keeping at home Any other capital you have
Part I - About your outgoings Please tell us about any money that you or your partner pay out on a regular basis. Outgoings Amount How Often Arrears Owed Rent - Please send us proof of your rent if you get Universal Credit Council Tax Water charges Gas Electricity Telephone (landline) Telephone (mobile) Internet or broadband TV Licence Food/Housekeeping School Meals Child care Maintenance payments Clothing Prescription charges Vehicle running costs - road tax Vehicle running costs - insurance Vehicle running costs MOT/servicing/repairs Vehicle costs - fuel Travel costs bus/train/taxi Life assurance Insurance - Please state what this is for Rental/HP Payments - Please state what this is for
Outgoings Amount How Often Arrears Owed Mail order Fines Credit cards Other Please describe below If any of your outgoings are unusually high, please explain why. Please write below, any other details you wish to tell us that you have not been able to give elsewhere on this form. Part J - Your Declaration This is my application for a Discretionary Housing Payment. I understand that if I give information that is incorrect or incomplete, I may be prosecuted. I understand that I must tell you immediately about any changes to my income, capital or circumstances which may affect my entitlement to a payment and that I will repay money to you if I fail to do this. I authorise the Council to make any necessary enquiries to verify the information I have given. I declare that the information I have given on this form is correct and complete. Your signature: Date: If someone else has filled this form in for you, please ask them to complete and sign the details below. Their full name: Their address: Their daytime tel no. Their signature: Date:
Benefit Services - Debt Management Service The Benefits Service offers a free, confidential budgeting service. Our advisors are fully trained by the Consumer Credit Counselling Service and can help you if you are finding it difficult to manage your finances. We will look at your income and expenditure with you and help you work out a realistic budget to cover your essential expenses. For more information please call our friendly team on 01423 500600 Ext : 56483 Other Support Available Citizens Advice Bureau Citizens Advice Bureau Audrey Burton House, Queensway, Sharow View, 75, Allhallowgate Harrogate Ripon Tel: 08444 111 444 Tel: 0844 411 1444 Visit: www.harrogatecab.org.uk Visit: www.citizensadvice.org.uk/riponcab.htm Shelter confidential advice on housing, welfare benefits and debt management. Tel: 0808 800 4444 - http://england.shelter.org.uk/get_advice National Debtline free, confidential debt advice by telephone, e-mail or on-line. Tel: 0808 808 4000 - www.nationaldebtline.co.uk The Money Advice Service Tel: 0300 500 5000 - www.moneyadviceservice.org.uk Christians Against Poverty free debt and money management advice Tel: 0800 328 0006 to book an appointment www.capuk.org Stonham Homestay free, confidential housing support service. Tel: Freephone 0300 555 0515 or local Tel: 01423 704109 / 704110 www.stonhamhomestay.org.uk Essential Needs provision of low cost furniture, household and electrical goods. Tel: 01423 870040 - www.essentialneeds.org.uk Energy Trusts financial help with domestic energy and essential household debts www.britishgasenergytrust.org.uk www.npowerenergyfund.com www.edfenergytrust.org.uk Yorkshire Water Community Trust - help with your water bill. Tel: 0845 124 2426 www.yorkshirewater.com/your-account/help-with-your-bill.aspx Local Financial Assistance Scheme - rth Yorkshire County Council scheme to help vulnerable people and families under pressure. Provision of essential household furniture; beds and bedding; home repairs; children s clothing and clothes vouchers; utility reconnection charges & top ups; food vouchers. Tel: 0845 872 7374 www.northyorks.gov.uk/article/25908