Application Form For Housing Benefit Page 18
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23Part 8
Disability allowances
Do you or your partner have any of the following?
No
Yes
8.1
If ‘No’ go to Part 9
YOU
YOUR PARTNER
TYPE OF INCOME
AMOUNT YOU GET
HOW OFTEN
AMOUNT YOU GET
HOW OFTEN
Incapacity Benefit
8.2
Employment and support
8.3
allowance (contribution based)
Severe Disablement Benefit
8.4
Industrial Disablement Benefit
8.5
Industrial Death Benefit
8.6
Carer’s Allowance (if you receive the allowance
8.7
for looking after someone else)
Please tell us the name and address of the
8.8
person you are looking after
Carer’s Allowance (if someone else
8.9
receives the allowance for looking after you)
Do you have a carer who lives elsewhere
No
Yes
No
Yes
8.10
but who needs to stay overnight with you?
(we will contact you separately about this)
Have you or your partner ever
No
Yes
No
Yes
8.11
claimed Carer’s Allowance?
! Still tick ‘Yes’ if you were not paid any Carer’s Allowance. This could have been because you
!
were better off getting another social security benefit.
Have you or your partner ever claimed or are you
No
Yes
No
Yes
8.12
in receipt of Universal Credit?
16
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