Discretionary Housing Payment Application Form (Page 3 of 6) in pdf

Discretionary Housing Payment Application Form Page 3

10). Did you or have you at any time during this tenancy contacted Housing Options (The Housing Department) to

…Yes

discuss how you would sustain this tenancy.

If yes, please provide details of whom you spoke to and the outcome of this discussion.

About your home – all claimants must answer this section

11)

Are there any reasons why you and your family have to live at this address rather than other cheaper

accommodation?

12)

When you first moved into your home could you afford to pay your housing costs without the help of

…Yes

benefit?

If ‘Yes’, please tell us about the change of circumstances which led you to apply for benefit.

13)

Has the property been adapted to suit the needs of a disabled person within your household?

…Yes

If ‘yes’, please give details of the adaptations

14)

Did you move into this property because of a disaster in your previous home such as fire or flood?

…Yes

If ‘yes’ tell us about the disaster below.

15) Do you require help with your current shortfall so that you can secure alternative accommodation? For

example the money you normally put aside for the shortfall will be used to secure cheaper accommodation.

…Yes

If yes, please provide details of the amount needed to secure the cheaper accommodation.

Claim ref: .......

Discretionary Housing Payment Application Form Page 3