APPLICATION FOR A DISCRETIONARY HOUSING PAYMEMT (DHP)

Name Claim reference number*

Address

Postcode

Telephone number - home

Mobile

E-mail address

*This is the 5 digit number at the top of your benefit decision notices

Please ensure that we have your current telephone number(s) and e-mail address, if you have one, as if we need to contact you about your application, we will phone first, and then e-mail.

About DHPs

A DHP is a payment made in addition to housing benefit or universal credit where the applicant needs financial assistance with housing costs. There is limited funding available for DHPs and an award will only be made where the applicant satisfies the criteria as laid down in Lichfield District Council’s Discretionary Housing Payments policy. A copy of this policy is on the website at www.lichfielddc.gov.uk/DHP

If you wish to apply for a DHP, please complete every section on this form in full. You should read the guide enclosed as you complete each section.

If the form is incomplete we will not be able to process your application. Section 1 Self help A DHP is, in most cases, only a temporary measure and it is vital that you find a more permanent and sustainable solution to your housing costs. Listed below are some alternative solutions that you need to have considered. If you cannot do any of the suggested solutions, please tell us why.

Please complete all of the boxes; answer ‘yes’ or ‘no’ to each question and also put the reason for your answer. For example

Option Yes/No Additional information/reasons Can you move house? yes I have registered with Uchoose and have contacted estate agents to get a smaller property. Do you have anyone living with you that could No There are no other adults living in the contribute to your household? household.

Please remember to refer to the guide with this application – it is there to help you.

A Have you considered moving house?

If you have answered ‘yes’, please tell us what you have done to find another property.

If you have answered ‘no’ please tell us why you could not move house.

B If you are in private rented accommodation, have you asked your landlord to consider reducing your rent?

If you have answered ‘yes’ please tell us what the outcome was.

If you have answered ‘no’, please tell us why you have not approached your landlord.

C Do you have anyone living with you that could contribute to the household?

If you have answered ‘yes’ and they are not contributing anything, please tell us why. . D Can you take in a lodger? (Subject to the landlord’s permission)

If you have answered ‘yes’ please tell us what you propose to do.

If you have answered ‘no’ please tell us why you cannot consider this.

E If working, can you increase your hours?

F If you and/or your partner are of working age, able to work but not working, are you looking for employment?

If you have answered ‘yes’ please tell us what you are doing to find employment.

If you have answered ‘no’, please tell us why.

G If you have outstanding debts or have difficulty budgeting, have you sought professional advice?

If you have answered ‘yes’ please tell us when and who you saw for advice.

If you have answered ‘no’ please tell us why you have not sought advice.

If you have answered ‘no’ to all of the above questions and have not provided compelling reasons why they are not suitable options, it is unlikely that you will be awarded a DHP.

We may ask for evidence to support some of your answers. Section 2 Eligibility criteria

We will be giving priority to applications in the following circumstances. Please tick one box in the ‘applicant’ side of the table below that best describes you. Then please consider the circumstances on the right hand side of the table below and tick up to 2 boxes that best describes you. Please do not tick any more boxes than requested – we cannot take them into account. If none of these circumstances apply to you please go to Section 3. Please remember to refer to the guide with this application – it is there to help you.

Applicant – tick one box only √ Additional information If you need more space for your answers please use section 4 A household member has a disability. Disability living allowance (DLA) must be paid, at any rate and for care and/or mobility. For anyone of pensionable age, attendance allowance (AA) must be paid. Please do not tick this box if you are not getting DLA or AA.

A household member is receiving care. Carers allowance must be paid to someone providing the care. Please do not tick this box if no-one is getting carers allowance. A household member is vulnerable. Please describe the nature of the vulnerability.

A member of the household is a frail Please tell us why you need to remain in your elderly person who would find it difficult current property. to move.

There are children in the household who We will have this information. are of school age. There are children in the household who We will have this information. are pre school age. Single/couples without children. We will have this information. Circumstance – tick up to 2 boxes √ Additional information If you need more space for your answers please use section 4 The property is significantly adapted for Please describe the adaptations that have been disablement needs of someone in the carried out. household.

The applicant has received formal notice We will need to see a copy of the notice. from the landlord to leave the property and is therefore potentially homeless. The current property is required to Please tell us how far your work place is from maintain employment i.e. it is close to where you live and how you get there for example your place of work. it may be within walking distance or a short bus ride away.

The applicant is fleeing domestic Please tell us briefly about your circumstances. violence.

A member of the household is on the We will need to see evidence of this. child protection register. Access to specific services, for example Please tell us what services you use. hospitals, support services or a day centre is required. How far away are the services you use? For example “2 miles”

How do you get there? For example car, bus.

A member of the household is providing We will need to see evidence of the carers care, for which carers allowance is paid. allowance. The applicant is in supported or We will have this information. temporary accommodation. The applicant is affected by the welfare Welfare reform is where housing benefit has been reform reduced because you are under occupying your property (spare room subsidy); you are subject to the benefit cap or your rent is higher than the Local Housing Allowance. Please tell us how you have been affected. Section 3 Financial assistance

We need to compare your income to expenditure. Please tell us about your income and capital (including current accounts) from all sources. You do not need to tell us about housing benefit as this will be on our records. If you need additional space, please use section 4

If you do not complete this section, we cannot process your application.

Type of income How much? How often are you paid this i.e. weekly/fortnightly/monthly Your wages

Your partner’s wages (if you have one)

Benefits/Allowances (please list) If you are having deductions from any of these benefits – please provide the notification letter from the Dept. for Work and Pensions to confirm. Tax credits

Child Maintenance

Pensions

Contributions from people living with you

Anything else – please tell us what it is

Capital/Savings/Money in all accounts - including post office, bonds, current accounts etc.

Name of bank/building society Type of account Balance Please tell us what your weekly/monthly expenditure is for the following.

Expenditure How much? Weekly/monthly Rent (this should be the amount you pay in addition to any Housing Benefit). Provide a recent rent statement if you are paying extra for arrears.

Council tax.

Gas. Please send us evidence of this ie latest bill or 2 months receipts.

Electricity. Please send us evidence of this ie latest bill or 2 months receipts.

Water . Please send us evidence of this ie latest bill or 2 months receipts.

Maintenance/child support.

TV licence.

Court fines. Please send us evidence of your payments.

Debts related to income tax/VAT.

Food

Other household items including toiletries

School meals

Payment for child care costs

Clothing

Phone - landline

Phone – Mobile

Broadband/internet

Sky/Cable TV package

Leisure – please specify

Health related – cost of dental treatment, glasses, prescriptions etc. Give details. Vet bills and/or pet insurance

Car Tax

Car insurance

MOT or other running costs

Petrol – please describe what your petrol costs are attributable to, for example travel to work, school run, leisure

Public transport costs

Buildings and contents insurance

Life insurance

Any other insurance. Please describe what they are

Pension contributions

Outstanding debts/arrears

Please tell us about any outstanding debts you have that you are making a regular payment to. For example this can be for arrears of rent, council tax or other utilities; loans or credit cards/store cards; hire purchase, catalogue payments etc. We may ask for evidence of these payments. Type of debt Amount Amount of How often do you pay this i.e. outstanding payment weekly/monthly Section 4 Other information and declaration

Please use the box below to give us any information that you have not been able to fully explain in the form provided or anything else you think is important to your application.

Declaration I declare that the information provided on this form is true and complete. I understand that you will use the information submitted with my claim for housing benefit/universal credit to help determine this application. I know that if I deliberately give false information or fail to tell you about a change in my circumstances, you can take legal action against me. I understand that I have to pay back any money that I am overpaid. My partner agrees to me making this application for both of us.

Signed……………………………………………………………….Date………………………… Discretionary Housing Payments – guide to application

Please refer to this guide as you complete the form because it contains information to assist you and tells you what information we will need to process your application.

Before you start

If you do not get any housing benefit or universal credit you cannot be awarded any DHP but if you do qualify, an award cannot be made if you are already getting all of your rent paid via housing benefit.

DHP cannot be paid to cover the following costs  Ineligible service charges as specified in Schedule 1 of the Housing Benefit Regulations 2006 and Schedule 1 of the Housing Benefit (Persons who have attained the qualifying age for pension credit) Regulations 2006  Increases in rent due to outstanding rent arrears  Sanctions and reductions in benefit for example a reduction in another primary benefit or shortfalls caused by HB/UC overpayment recovery  Any restriction in benefit due to a breach of a Community Service Order  Benefit that has been suspended

There are sections in the form where we ask for evidence, please send this with the form if you can. We may ask for other evidence we need to support your application; if you do not send evidence when requested, we cannot process your application.

What happens to the application?

An officer in the benefits section will consider your application carefully. If you satisfy the criteria in all 3 sections, you will be awarded a DHP and you will get a letter confirming how much you will get and how long it will be paid for. This will be paid with your housing benefit where appropriate.

If you are unsuccessful, you will get a letter explaining why. You can also ask the council to look at the decision again. Your letter will tell you how to do this. A panel of independent officers within the council will consider your request and will write to you with their decision. Section 1

A Moving House

If you have been affected by the spare room subsidy or any of the other welfare reforms that have resulted in an increased rent to pay, moving house is an option you may wish to consider.

You could ask your landlord if they have any alternative accommodation that would better suit your needs.

The Council has housing advice and guidance on the website at http://www.lichfielddc.gov.uk/info/200052/housing_advice/1456/housing_options This includes a housing options directory that describes the type of affordable housing options you could choose from locally.

You could also go to the U-choose website at https://www.uchoosehomes.co.uk/

U-Choose is the place to find details of homes available to rent in southern Staffordshire and northern Warwickshire.

If you feel you could not afford the costs associated with a move, such as a deposit on a new property or hire of a removal van, please tell us. We may be able to help with these costs via the DHP funding.

We will need to see evidence of what action you have taken, whether that is registering on U- Choose or with a Letting Agency. We will contact you about this.

B Asking the landlord to reduce your rent

If you are in privately rented accommodation, your landlord may be willing to negotiate a lower rent.

C Do you have anyone living with you that could contribute to the household?

If there is another adult in the household, your benefit may be reduced by a ‘non-dependant’ deduction. Your non-dependant may or may not be contributing towards the household costs, but you should consider asking them to increase any contribution they make. D Can you take in a lodger? (Subject to the landlord’s permission)

For some people, offering a spare room to a lodger may be an option. This would mean that Housing Benefit would no longer consider the room to be spare. In addition to this, the first £20 of weekly income from a lodger is ignored and won’t affect your benefits. If you receive more than £20 a week in rent the extra cash is likely to affect your benefits although overall you should be better off. The Department for Work and Pensions or the Local Authority will be able to advise you on the effects additional income will have on your benefit.

Homeowners and tenants who let furnished accommodation and take a lodger are exempt from paying tax on rental income of up to £4,250 a year and because it’s tax free it also won’t affect the amount that you receive in child tax credit or working tax credit either.

Step by step guide to renting out a room

1. If you are a tenant, you must ask your landlord for permission to rent out a room. 2. Make sure your home and the room you want to rent out is safe, fire proof and that you have general safety sorted. 3. Check to see what effect the extra income has on your benefits. 4. Advertise your spare room – this could be a notice in your local shop or go on-line and advertise for fee through one on the many websites available. Simply put ‘rent a room out’ in the search engine. 5. Find someone that is right for you. Letting someone live in your home is a big step, so it pays to be prepared. Take your time to talk to the people viewing your property to make sure they are a good fit for your home. It is also good to lay down some simple ground rules early, so you both know what to expect. 6. Get references. Ask your new lodger if they can provide references from an employer or previous landlord. This can give you extra peace of mind that the agreement you are entering into is likely to be alright. 7. Always have a written agreement between you and your lodger. This should include the rent figure and payment details; which rooms/facilities the lodger is entitled to use; services you agree to provided; any share of household bills; how long until the payment amount is reviewed; house rules and notice period. 8. Safety tips – always have a friend accompany you to interview new lodgers; keep valuables locked away during the interview and use the interview as an opportunity to ask about anything that concerns you.

For further advice, the following websites may help. A general guide to letting a room is available at https://www.gov.uk/government/publications/letting-rooms-in-your-home-a-guide-for-resident- landlords and other information on can be found at https://www.gov.uk/rent-room-in-your-home/rent-bills-and-tax https://gov.uk https://adviceguide.org.uk E If working, can you increase your hours?

If you are in employment, your employer may be willing to increase your hours. .

F If you and/or your partner are of working age, able to work, but not working, are you looking for employment?

If you are a job seeker, your benefit will only be paid if you are actively seeking work. You should be receiving the appropriate support from an advisor at the job centre. Please tell us what support you are receiving from the job centre.

If you are looking for work, please tell us what you are doing.

Further help is available from https://www.gov.uk/moving-from-benefits-to-work https://www.gov.uk/jobsearch

Lichfield District Council also runs work clubs http://www.lichfielddc.gov.uk/info/100008/jobs_and_careers/1389/work_clubs_across_lichfield_distri ct

G If you have outstanding debts or have difficulty budgeting, have you sought professional advice?

If you need debt advice to assist with managing your non-priority debts to a level that enables you to pay your essential expenditure, there are many organisations that can help you and their information is on the internet.

You may find the following useful. http:/www.lichfielddc.gov.uk/manageyourmoney

Alternatively you may choose to visit http://www.adviceguide.org.uk/england/debt_e/debt_help_with_debt_e/debt_budgeting_e.htm Section 2 Eligibility criteria

Eligibility will depend on certain conditions as described below. Some of the information we will already know from your application form, but we may ask for evidence.

Information on benefits

 Disability Living Allowance is a tax free benefit for disabled children or adults administered by the Department for Work and Pensions. It has two parts, called ‘components’; a care component – if you need supervision or help looking after yourself, and a mobility component, if you can’t walk or find it very difficult to walk. In some cases, people may qualify for both components. These are now being replaced by Personal Independence Payments (PIP).  Attendance Allowance is paid to people aged 65 or over who need help with personal care because they are physically or mentally disabled. It is paid at two different rates and depends on the level of care required.  Carers allowance is paid to someone who is looking after another person with substantial care needs. You don’t have to be related to, or live with the person you care for, however you must be aged over 16 and spend at least 35 hours a week caring for them. Carer’s allowance is taxable and can affect other benefits. For more information on all of the above benefits please go to www.gov.uk

Vulnerability

If you feel that you are vulnerable in some way that we have not already covered in this form, we need you to tell us about this. It may be that you just need some help on a short term basis. Examples of vulnerability are  Young people leaving care  Mental health problems  Addiction problems  Learning difficulties  People who have been institutionalised e.g. prisoners This list is not exhaustive and we would encourage you to let us know about anything that affects you, preventing you from moving or changing your circumstances in some way.

Section 3 Financial Assistance

Please complete this section as fully as you can. Where you have bills, such as utility or credit cards, we may ask to see evidence from the provider of the amount you are charged.

There are some items of expense we will know about, for example your rent and council tax. We will need to see your gas, electricity and water bills to confirm what you are paying and we may ask for evidence of other items.

Income from Disability Living Allowance and Personal Independence Payments will not be counted but we still need to know about it.

In the first instance we will look at your priority expenditure/debts. These are the bills that you must pay because if you do not, the consequences of not paying them can be more serious than for other debts. Secondly we will consider payments that you have committed to and are unable to withdraw from the agreement without financial penalty. Any other payments that are not essential may not be used to reduce your income.