DHP Application Form

For official use only – date For official use only – date issued received

If you would like a large print version of this form, please ask for one Discretionary Housing Payment and Council Tax Discretionary Reduction Application form

Discretionary Housing Payments: If the amount of Housing Benefit you receive is less than the amount you have to pay or you need help with moving costs, you may be able to get help from the Discretionary Housing Payments fund. Except in exceptional circumstances, Discretionary Housing Payments do not cover cash deposits but you may be able to get a Deposit Bond from the Council instead.

Discretionary Housing Payments can only be made to people in receipt of Housing Benefit or the housing costs element of Universal Credit. Our Crisis Support Payments Scheme can provide assistance with rent in advance or moving costs to those on in receipt of Housing Benefit or the housing costs element of Universal Credit.

Awards for ongoing assistance with rent shortfalls are often made for short term periods and Discretionary Housing Payments should not be considered as a permanent or long term additional income. An ongoing award is in most cases intended to give you an opportunity to sort out your financial situation and/or find more affordable alternative accommodation. We may advise you if we think that you need to move to cheaper accommodation or consider other options to reduce your financial difficulties. The Housing Options Team will be able to offer you advice about looking for affordable accommodation. If it is suggested that you move somewhere cheaper but you do not do so or you do not follow any other advice given to you, further Discretionary Housing Payment awards may not be made.

Payments for moving costs (such as removals, rent in advance, storage costs etc.) will only be made if the new property is affordable and normally also if you will not need assistance from the fund towards your new rent liability unless circumstances change.

Please also note the following;  For rent in advance, the maximum award is one month’s rent so if the new landlord agent is asking for more than this you will need to demonstrate that you will be able to pay the balance yourself. You could also ask the new landlord if they would accept less rent in advance.  We cannot make an award to help you to move where the rent at the new property is more than 10% above the Local Housing Allowance rate which is applicable to your household.

V1_20160801  We can only make an award for help with moving costs if you have an urgent need to move.

2 Council Tax Discretionary Discount Scheme: If you are unable to pay your remaining amount of council tax after we have calculated your Council Tax Support then you may be able to get help from the Council Tax Support Exceptional Hardship Fund.

Although anyone in receipt of Council Tax Support can submit a claim you will be more likely to receive help if you are in one of the vulnerable groups below:

 You are disabled  You are a lone parent with children under 5 receiving certain benefits  You are a carer receiving certain benefits due to a low income  Have suffered domestic violence in the last 12 months  You are a foster carer  You are a care leaver under 22  You have been in a hostel for at least 3 months  You are attending a rehabilitation programme for drug or alcohol dependency

Any award from the Council Tax Support Exceptional Hardship Fund will reduce the remaining council tax liability for a specific period. The duration and amount of reduction will be dependent on the specific circumstances of each applicant and each decision will be decided on its own merits.

If you are not receiving Council Tax Support but are suffering financial hardship or can show that your personal circumstances justify a reduction in council tax you may be able to get a temporary discretionary Council Tax discount. Your circumstances would need to be exceptional for an award to be made.

The money for Discretionary Housing Payments and the Council Tax Discretionary Discount Scheme comes from a limited fund and there is no automatic entitlement. Because the amount that the council is able to pay each year is limited, not all applications will be successful. This means that we have to look at your circumstances very closely, and may need to ask you some personal questions about your financial situation. This is because we need to make sure funds go to those people who need them most. An award can only be made if council funds are available.

If you would like to make an application for Discretionary Housing Payments and/or the Council Tax Discretionary Discount Scheme please complete this form as fully as possible.

3 Section 1: Personal details:

Address

Housing Benefit claim number / Council Tax Support reference number

Email address

Daytime telephone number

Preferred method of contact

Telephone Email Letter

Section 2: About your application

Are you applying for help with your council tax, your rent (including moving costs) or both?

Council Tax Rent Both

If you are only applying for help with your council tax you can skip Section 3 and go to Section 4: About your council tax

4 Section 3: Rent

(a) Details about rent

Are you applying for help with moving costs, rent arrears or ongoing assistance towards your rent?

Moving costs Rent in advance/ Rent arrears Ongoing assistance deposit bond

If your application is for moving costs or rent in advance and/or a deposit bond, please answer the following;

Address of the property you will be moving into:

Date you are hoping to move in:

Name, address and contact number for the new landlord/agent:

Do you give permission for the council to contact the landlord should any details need to be verified?

Yes No

5 Please provide details of what costs you are applying for help with below (please include the cost of each item and please note we will need proof of these. For rent arrears we need a schedule of arrears, for removals 3 quotes need to be provided).

If you are asking for help with moving costs, please provide the reasons why you feel you need to move:

Section 4: About your Council Tax

If you are not applying for help with your council tax, please skip this section and go to Section 5: About your financial circumstances

If you have any exceptional circumstances which have led you to ask for extra help with your council tax please give full details?

7 Every applicant needs to complete all the remaining sections of this form

Section 5: About your financial circumstances

If you are asking for help with rent in advance or a deposit, we will need to see up to date statements and proof of your current balance.

Please fully complete the table below indicating how many accounts of each type you have (if none please write “none”) and the current balance of all accounts declared. If you do not have an account, please write “N/A” in the current balance box.

Type Number of accounts of Current balance this type held Bank account £ Building Society account £ Post Office account £ ISA £ Shares £ Any other capital £

Is there anybody else that might be able to help you with your rent or council tax? Do you have to spend any money on unusual items? If so please specify what these are and how often they are bought? Do you or your household have any disabilities which mean you need to spend extra money eg special diets, additional heating, transport costs etc? Looking at the money you are spending carefully, do you feel that there are any areas where you could make savings? If you pay rent, do you have any rent arrears? If yes, please provide evidence from your landlord If you pay rent, have you received a notice seeking possession? If you pay rent and there are services included please specify which ones (gas, electric, water rates etc) and provide proof from your landlord as to how much of your weekly or monthly rent is paid towards these

8 About your income

Please ensure that all income that you or any member of your household receives is included below

Income type Received by Amount How often paid Earnings £ Working Tax Credit £ Child Tax Credit £ Disabled Tax Credit £ Income Support £ Jobseekers Allowance £ Employment and £ Support Allowance Universal Credit £ Industrial Injuries £ Disablement Benefit State Retirement £ Pension Pension Credit £ Widows Benefit £ Attendance Allowance £ Disability Living £ Allowance (Care component) Disability Living £ Allowance (Mobility Component) Please indicate if this goes towards a car Personal Independence £ Payment (Mobility Component) Please indicate if this goes towards a car Personal Independence £ Payment (Daily Living Component) Carers Allowance £ Child Benefit £ Other state benefit £ (please specify) Maintenance £ Occupational or £ company pension Personal £ pension/annuity Services pension £ Other (please specify) £

9 About your expenditure

Please take time to complete this section of the form carefully. It is important that you do not miss anything out as we need a full picture of your finances. We may ask you to provide proof of some items.

Expense Amount Frequency Rent £ Council tax £ Electricity £ Gas £ Water rates £ Landline telephone £ Food & grocery shopping £ Toiletries £ Launderette £ Bus fares £ Taxi fares £ Mobile phone £ TV Licence £ Satellite/cable TV £ Internet £ Household insurance £ Life insurance £ Car insurance £ Petrol/diesel £ Car tax £ Car repairs/MOTs £ Drinking £ Smoking £ Clothing and shoes £ including school uniform School expenses £ Gambling £ Christmas/birthdays £ Loans £ Credit cards £ Catalogue payments £ Any other debts (please £ specify) Regular or occasional £ expenditure associated with illness or disability Other (please specify) £

10 Section 6: Other information

Do you have a support worker? If so, please confirm their name and which organisation they work for?

How did you find out about Discretionary Housing Payments/ Council Tax Discretionary Reduction Please give any additional information that you feel is relevant to your application. Use an additional sheet if necessary

Section 7: Declaration

To be signed by you and your partner, if applicable.

I / we declare that the information provided on this form is correct and complete.

I / we have read and understood the advice and explanations on pages 1 & 2 of this application form.

I / we undertake to notify the council promptly of all changes of circumstances which might affect benefit payments after this form has been signed. I / we understand that if incorrect information is supplied or fail to notify the council of a change in circumstances and Discretionary Housing Payments are paid as a result, action including prosecution may be taken against me, and Torbay Council will seek to recover any overpayments. I /we authorise the council to make necessary enquiries to verify the information on this form, this may include an interview or home visit.

Data Protection: I / we understand that the information on this form will be verified against my/ our Housing Benefit or Council Tax Support claim, and any discrepancies will be investigated.

I / we understand that if Discretionary Housing Payments are found to have been overpaid, this could be recovered from a landlord, agent or third party.

Relevant information may be passed to the Department of Work & Pensions, or Inland Revenue as permitted by law. We will not disclose any information about you to anyone outside Torbay Council nor use information about you for other purposes unless the law permits or requires us to. Contact may also be made with the council’s Housing Section.

Your signature Partner’s signature

Date Date

11 The Deposit Bond Scheme- an alternative to cash deposits.

The Council now runs a deposit Bond Scheme.

How does the Deposit Bond Scheme Work

Instead of you paying a cash deposit to your landlord, which your landlord has to place in one of the Tenancy Deposit Schemes, the Council does not pay money to your landlord at the start of your tenancy but acts as a guarantor against damages. If your tenancy ends whilst the Bond is in place your landlord can ask the Council to pay for the cost of the damages up to the maximum value of the Bond.

The Bond would normally cover damages up to the value of one months rent unless your landlord asks for less.

If the Council assists you with a Bond you will be required to save for your own deposit to give the landlord when the Bond ends. The Council would give you a Bond for long enough to allow you to save the deposit you need.

If the Council has to cover the cost of damages to your accommodation then you will be asked to repay this.

There is more information about the Bond Scheme on the Council’s website. You should check whether your new landlord will accept a Bond instead of a cash deposit before applying to the Bond Scheme or for help with rent in advance.

If your landlord will not accept the Bond then you would need to fund any cash deposit yourself or look for a different property where the bond would be accepted.

Having difficulty paying your council tax?

If you are having problems meeting your monthly payments, please talk to us. We can offer debt advice, and a range of payment options that may help.

By talking to us you could avoid additional costs being added to your account, and further action being taken due to non-payment.

Our helpline number is 01803 207201.

You can also find out further information on the Council’s website.

Equality Statement

We are committed to ensuring that no member of the public or employee is treated less favourably than any other on the grounds of gender, sexual orientation, race, colour, religion, ethnic origin, age, disability or any other condition that cannot be justified during our contact with you.