Medical Housing Assessment Application Form (Page 9 of 12) in pdf

Medical Housing Assessment Application Form Page 9

Do you require an extra bedroom because of your health needs or disability, in

Yes

addition to the bedrooms that you are entitled to in the Allocation Policy?

If yes, please give details below:

Government Housing Benefit Changes from April 2013 – Bedroom Tax

Please be aware the Government has introduced a change to housing benefit rules that came into effect on 1

April 2013 to

claimants of working age who under-occupy their home. At April 2013 this will be people under 61 years and 6 months old.

From April 2013 if you are under-occupying your home by one or more bedrooms your housing benefit is likely to be reduced

and you will have rent to pay. If this could apply to you then you need to consider your housing options and how you will pay

rent from your existing income.

Please give details of any other information that you think is relevant to this application:

If you want us to deal with someone else on your behalf (a representative) about this medical assessment

application, please give us their details below. If you appoint a representative, all Homes4D&G partners can

give personal information related to your application for housing to your representative. You cannot hold any

Homes4D&G partner responsible for the information that they share with your representative.

Name:

Address:

Relationship (if any) to you:

Tel no

Medical Housing Assessment Application Form Page 9