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 this form if you already receive help with your rent and/or Council Tax from Calderdale Council and the only change to report is a change of address. Have you had any changes in your circumstances other than moving house? (For example, a change in your income or a change to the number of people living in your home) You will need to fill in a new claim form (BAU1) if you have had any other changes other than moving house. 1 Details about your old address Old address: Postcode: Date you moved out of your old address: Date your tenancy ended: Was this property left furnished? (A furnished property is one that is capable of normal occupation without the tenant having to provide their own beds, chairs, tables etc.) If you have not moved into your new property yet please still send this form in but contact us after you have moved in, to confirm your move-in date. See the back page for how to contact us. Important: If you delay moving in until after your tenancy start date you will not get any help until you move in.
2 Details about you and your partner You Your partner Surname First names Date of birth National Insurance Home Telephone Mobile Email address State your preferred method of contact letter email telephone Are you the only person over the age of 18 living in the property? If you are the only adult in the property you may be entitled to a 25% single occupier discount. You may get this discount regardless of your income. This discount will be taken off your bill before your help for Council Tax is worked out. 3 Details about children and young persons living with you Have any of your children changed schools? If yes, give details 2
4 Details about your tenancy Are you? Private landlord tenant Living in board and lodging or a hostel ne of the above please describe below: Housing Association tenant (including Pennine Housing 2000) Housing Association shared ownership tenant Date tenancy started Length of tenancy Do you have a joint tenancy (not including with your partner)? If, give us the name of your joint tenants We need to know the name and address of the landlord (owner) of the property you live in. We will not accept a care-of address. If you pay your rent to an agent, we also need to know the name and address of the agent. Give full details a PO box number is not enough. Landlord s name Address and postcode Agent s name Address and postcode Phone number Phone number Are you, your partner or any of your children related to your landlord or landlord s partner If, give details Is your landlord or landlord s partner a former partner of you or your partner? If, give details Have you or your partner previously owned this property? If, on what date did you stop owning the property? Are you or your partner a director of your landlord s company? 3
5 Details about your rent We need to see proof of the rent you pay. For example, your tenancy agreement or letter from your landlord or agent. We cannot accept a photocopy. The proof you send us must show the name and address of your landlord or agent. What is the full rent charged for the property? In joint tenant cases how much are you liable to pay? How often is it due? 6 Accommodation Tick one which best describes your accommodation Terraced house Terraced bungalow Flat in a block Maisonette Caravan other Semi-detached house Semi-detached bungalow Flat over a shop Room or rooms Houseboat (please give details) Detached house Detached bungalow Flat in a house Hostel Mobile home 4
7 Occupancy details Living rooms Bedrooms Bedsit rooms Kitchens Bathrooms Toilets Other Total number of rooms in the property Number of rooms you and your family use Number of rooms you share with others Which floors do you live on? Basement Ground First Second Third Other If you only live in one room, where is it in the house? Front Centre Back How many floors are there in the whole property? Facilities: Is there a central heating system? Is it furnished? Fully Partly Meals: Are meals included in the rent? If, give details 5
8 Are any of the following included in the rent? Are any of the following included in the rent? Services Council Tax Water rates Garage Heating Hot water Cooking facilities Lighting Cleaning Laundry Gardening Nursing and personal care Medical expenses Counselling or support Other (please give details) 6
9 How you will be paid Help with your Council Tax If you are entitled to help we will reduce the amount of Council Tax that you owe and send you a new bill. Help with your Rent If you rent your home from a housing association (including Pennine Housing 2000). You can choose how Calderdale Council pays your Housing Benefit. Your money can be paid straight into a bank, building society, National Savings Bank or credit union account or direct to your landlord. Housing Benefit cannot be paid into a Post Office account. Would you like your Housing Benefit paid directly to your landlord? If you rent your home from a private landlord Calderdale Council will usually pay Housing Benefit to you. Your money can be paid straight into a bank, building society, National Savings Bank or credit union account. Housing Benefit cannot be paid into a Post Office account. It is then your responsibility to pay your landlord. In some cases, Calderdale Council can pay your money direct to your landlord where: You may have difficulties in managing your money to pay your rent You have previously had rent arrears If you feel this may apply to you then complete the application to pay Local Housing Allowance direct to landlord on the next page. Provide your bank details below: Name of the account holder Name of bank or building society Sort code Account number Roll number 7
10 Application to pay Local Housing Allowance direct to your landlord If you think that receiving Local Housing Allowance payments will cause you serious problems, we may be able to pay your Local Housing Allowance to your landlord. We will need to decide if you are having or are likely to have problems managing your money and paying your rent. If you would like us to consider making payment to your landlord, complete this form and return it to us together with the proof we need. Explain below why you consider that Local Housing Allowance payments should be paid to your landlord. Tick any of the following that apply. If you have problems managing your money because of learning difficulties or because of physical disabilities If you have a medical condition or a mental health problem which makes it difficult to manage your money If you have difficulty speaking and understanding English / have serious difficulties reading and writing If you are dealing with an addiction to drugs, alcohol or gambling If you are escaping from domestic violence If you have recently been released from prison If you have severe debt problems, have been declared bankrupt or are unable to open a bank account If you have a history of rent arrears or homelessness If you have had the rental amount reduced in order to maintain / secure the tenancy Complete the section below Explain why you consider that Local Housing Allowance payments should be paid to your landlord (Provide written proof from care workers, your doctor, social services, the probation service, current / previous landlord for proof of rent arrears, proof of court orders, CCJs, solicitors, creditors etc.) 8
10 Application to pay Local Housing Allowance direct to your landlord (continued) Provide your landlord s bank details below: Name of the account holder Name of bank or building society Sort code Account number Roll number For office use only: Pay to landlord? If, tick why 8 weeks in arrears Less than 8 weeks in arrears Claimant unlikely to pay rent Difficulty managing financial affairs Secure a tenancy If, state why Officer s name Date 9
11 Sharing information with your landlord If your Housing Benefit is to be paid directly to your landlord the Revenues and Benefits Service will automatically share information about your award with your landlord. We may also contact your landlord if further information about the tenancy is required. If you are happy for the Revenues and Benefits Service to contact your landlord for further tenancy information or to provide award details then answer the following statements to say that you give your permission. If you do not give permission then no information will be given or contact made with your landlord. On no account will any personal information in connection with your household, income or capital be provided to any third party without your permission to do so. I give permission for the Revenues and Benefits Service to provide information to my landlord regarding my Housing Benefit award. This will include the amount awarded, frequency paid and the date initial payment due I give permission for the Revenues and Benefits Service to contact my landlord for further information in connection with my tenancy If your landlord contacts us to advise that you are in arrears with your rent, we will take this information from them, even if you have ticked to sharing information with your landlord, and a decision will be made as to who Housing Benefit will be paid to. If the decision is to pay your landlord they will receive a notification advising of this and the amount of Housing Benefit awarded. 12 Any further information you wish to tell us Write below any details you wish to provide which you have not been able to give us elsewhere on this form 10
13 Declaration Please read this carefully before you sign and date it I understand the following: I confirm there have been no other changes in my circumstances other than moving house The information I have given is true and correct I will tell you if any of the details of any letter you send me are incorrect I agree that you will use the information I have provided to process my claim for help with rent and/or Council Tax, and to award a single occupier discount if applicable. You may cross check some of the information with other sources as allowed by law I understand that you may contact government departments (for example, the Department for Work and Pensions or the Home Office) or other local authority offices to check the information I have given on the form and to get other information I will write to Calderdale Council s Revenues and Benefits Service straightaway if there are any changes in my circumstances, so that you can work out my benefit or discount again. If I do not and I get too much benefit or discount, the Council can ask me to pay it back and may prosecute me I understand that the Council can prosecute me if I withhold or give false information, or provide false or altered documents with my claim. Signature of person claiming Date Partner s signature Date Form filled in by someone other than the person claiming Tell us why you are filling in this form for someone else Name of the person who filled in the form Signature Date Relationship to the person claiming If you wish to act as the personal representative of the person claiming help with their rent and / or Council Tax in the future, ring 01422 288003 and ask for an appointee form. 11
Where to send or deliver this form In Person Brighouse Customer First Brighouse Civic Hall Bradford Road Brighouse HD6 1RW Elland Customer First The Precinct 39-41 Southgate Elland HX5 OBW Halifax Customer First Calderdale Council 19 Horton Street Halifax HX1 1QE Hebden Bridge Customer First Hebden Bridge Town Hall Saint George s Street Hebden Bridge HX7 7BY Sowerby Bridge Customer First Carlton Mill Riverside Wharf Street Sowerby Bridge HX6 2AS Todmorden Customer First Todmorden Community College Burnley Road Todmorden OL14 7BX By Post Revenues and Benefits Service PO Box 51 Halifax HX1 1TP What happens next Your claim will be looked at by a Benefits Assessment Officer to ensure that the claim has been completed in full and that all relevant documents and information have been requested. If further contact is needed we will do so by various methods (telephone, email and letter). Your claim can only be processed once the additional information requested has been received so ensure that you provide your supporting information and documents as soon as possible. If there is going to be a delay for any reason or if you need further assistance or advice in providing your evidence then contact our Customer Services team at benefits.unit@calderdale.gov.uk or by calling 01422 288003. Arrangements can also be made for a welfare visit as required. If they are claiming help with their rent and/or Council Tax: Telephone the Investigation Team direct on 01422 393650 Telephone Fraud Hotline on freephone 0800 169 7451 Visit Calderdale Council s Revenues and Benefits Service in Halifax. If they are claiming any other benefit: Telephone the National Benefit Fraud hotline on 0800 854 440 If you would like this information in another format or language contact 01422 288003. Produced by Calderdale Council January 2014