Discretionary Housing Payment Application Form printable pdf download

Discretionary Housing Payment Application Form

DISCRETIONARY HOUSING PAYMENT APPLICATION FORM

The Council have been granted very limited funds from which to make Discretionary Housing Payments. Therefore,

it is necessary for us to be able to assess your situation fully. In order to do this please complete this application and

answer all the questions. All information is treated in the strictest confidence.

NAME:

CLAIM No.

ADDRESS:

DATE OF BIRTH:

Telephone Number:

email address:

When did you move to this address

Are you renting from:

A private landlord

A Housing Association

the Local Authority

The rent on your home

week/month

1). How much rent are you charged per week/month?

2) Does this rent include any services, if so,

week/month

how much are these services

After taking into account the amount of benefit you receive,

week/month

how much rent are you expected to pay each week/month?

4) Have you only recently had a shortfall of rent to pay?

Yes

If yes, from what date have you had to pay this shortfall ?

If no, have you been making up this shortfall ?

Yes

If ‘yes’, how have you paid for other things?

If ‘no’, is the landlord taking any legal action about the arrears?

When is your tenancy agreement due to end

Discretionary Housing Payment Application Form