Fillable DISCRETIONARY HOUSING PAYMENT APPLICATION FORM A Discretionary Housing (Aberdeen City Council)

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DISCRETIONARY HOUSING PAYMENT APPLICATION FORM A Discretionary Housing (Aberdeen City Council)

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Revision 23.3.2016
1
DISCRETIONARY HOUSING PAYMENT APPLICATION FORM
A Discretionary Housing Payment (DHP) is an additional payment which can help pay your rental liability
if you are on a low income and in receipt of Housing Benefit or the Housing Element of Universal Credit.
The money available for DHP’s is limited and we can only help those with the greatest need.
We cannot award DHP to cover, rent arrears at your previous property, increases in rent due to
outstanding rent arrears, recovery of an overpayment or due to a sanction on your state benefits, or
certain service charges.
We need to assess your situation fully. Please fill in this application form and answer in full all the
questions that apply to you.
If you are a Council Tenant or Housing Association Tenant affected by Social Sector Size Criteria,
Please complete sections 1,2,3,8 & (10 if applicable). If you are applying for any other reason
such as Local Housing Allowance Rates, Benefits Cap or any other shortfall please complete the
application form in full.
You can find more information about Discretionary Housing Payments on our website at
https://www.aberdeencity.gov.uk/DHP
If you are having difficulty completing the form or if you want to discuss applying please call
03000 200 292 (visit the Contact Us page on our website for up to date opening hours).
If you would like to speak to someone in person you can arrange an appointment at one of our offices by
calling 03000 200 292.
• Customer Service Centre in Marischal College, Broad Street, Aberdeen, AB10 1AB
• Mastrick Customer Access Point, Spey Road, Mastrick, Aberdeen, AB16 6SH
• Tillydrone Community Campus, Hayton Road, Aberdeen AB24 2UY
Please return this form to: Revenues and Benefits, Aberdeen City Council, Business Hub16, Marischal
College, Aberdeen, AB10 1AB.
NB: Please note that if DHP is granted, there may still be a shortfall between the extra help
granted and your contractual rent.
Personal details:
Name:
Address:
Benefit Ref:
National Insurance Number:
Date of Birth:
Telephone Number:
Email address:
Revision 23.3.2016
2
1. Please briefly explain why you are claiming a Discretionary Housing Payment.
2. Please provide the number of Bedrooms in your property …………
3. Please provide the full names of all people resident in the property on a permanent basis
and their dates of birth.
4. If you have rent arrears and are under the threat of eviction or have received a notice to
quit please provide the following information, and supporting evidence such as your letter
of intent from your landlord:
Date you received formal notice . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount of your arrears . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Has your property been adapted to meet the needs of a disability for you or a member of
your household? YES / NO (delete as appropriate)
If yes, please provide the name of the person affected and the nature of the illness:
6. Are there any deductions being made to your state benefits/Universal Credit?
YES / NO (delete as appropriate)
If YES, what are these deductions for, how much is being deducted weekly and when will the
deductions cease?
7. If your application is successful and you are a Private Tenant do you wish any DHP
payment to be made to your landlord?
YES / NO (delete as appropriate)
For a DHP to be paid for private tenancies we will require the bank details for the person to be
paid (either yourself or your Landlord):
Revision 23.3.2016
3
Account Name:
Sort Code:
Account Number:
Please note that if you have stated that you are in rent arrears the Local Authority
reserves the right to pay any successful award to your landlord until the arrears are up
to date.
8. Do you give the Local Authority Permission to contact your Landlord for any additional
information that may be required regarding your tenancy: YES/NO (delete as appropriate)
If Yes, please provide your Landlords contact details:
Name:
Address:
Tel:
Email:
9. If this is a repeat application, please tell us of any advice or support you have received in
order to improve your financial situation.
10. If you believe there is any further information which we should know in support of your
application, please give full details below:
Revision 23.3.2016
4
YOUR INCOME AND EXPENDITURE
You must now complete the tables shown in page 6 and 7. All expenses and income for both
you and any partner must be declared. Once the tables have been fully completed you must
read the declaration below. If you fully understand the declaration, sign it below.
DECLARATION AND SIGNATURE
1) Please read these notes carefully and sign in the box below.
• The information I/we have given on this claim form is correct and complete to the
best of my knowledge.
• I/we authorise the local authority to make any necessary enquiries to verify the
information on this claim form.
• I/we authorise the local authority to cross check the information I/we have given
with other sections within the local authority, Rent Officer and other Benefit
authorities within the terms of the Data Protection Act, 1998.
• I/we understand that if I/we give information that is incorrect or incomplete I/we
may be prosecuted.
• I/we know that I/we must notify the local authority promptly in writing, of any
changes in circumstances that occur after this claim.
• I/we understand that failure to report any change in circumstances will result
in recovery of any overpaid Discretionary Housing Payments.
• I/we have read and understood the above declaration.
Revision 23.3.2016
5
How we collect and use your information
Your data - Information you provide as part of your application for Housing Benefit /Council Tax
Reduction or Discretionary Housing Payment is processed by Aberdeen City Council in
accordance with Data Protection legislation. In addition to the information you provide, we may
receive information about you from, and share information about you with the DWP, HMRC and
other organisations to administer your application and to prevent and detect fraud. We may
share also your information internally for specified lawful purposes as permitted by the Welfare
Reform Act 2012.
Section 2A of the Public Finance and Accountability (Scotland) Act 2000 (as amended) allows
us to share the information, you provide for data-matching purposes to prevent and detect fraud
and as directed by Audit Scotland. This is called the National Fraud Initiative (NFI). An
explanation of how we will use this information is available at:
www.auditscotland.gov.uk/our-work/national-fraud-initiative
More information about how we use and manage your information is available on our website
at:
www.aberdeencity.gov.uk/your-data/privacy-notices/your-data-housing-benefit-and-
council-tax-reduction.
This page also has links to further information about your rights, and who to contact if you have
a complaint about how we use your data.
Claimants Name
Claimants Signature
Partners Name
Partners Signature
Date
Revision 23.3.2016
6
YOUR INCOME: DHP CLAIM
Income Details
Per Week
Per Month
Claimant
Partner
Claimant
Partner
Attendance Allowance
Carer's Allowance
Child Tax Credit
Disability Living Allowance
Earnings
Employment Support Allowance
Industrial Injuries Benefit
Income Support
Job Seeker's Allowance
Maintenance for a child
Maternity Allowance
Pension Credit
Personal Independence Payment
Rent from boarders/sub-tenants
Severe Disablement Allowance
State Retirement Pension
Statutory Maternity Pay/Sick Pay
Occupational/Private Pension/Works
Pensions
Universal Credit
Working Tax Credit
Other Income (Please state name of
income)
TOTAL INCOME
Revision 23.3.2016
7
YOUR EXPENDITURE: DHP CLAIM
Expenditure Details
Per Week
Per Month
Claimant
Partner
Claimant
Partner
Mortgage / Rent (Inc. Arrears)
Council Tax (Inc. Arrears)
Housing Benefit Overpayment
Electric (Inc. Arrears)
Gas (Inc. Arrears)
Mobile Telephone
Broadband / Telephone
TV License
House Insurance
Life Assurance (Inc. Endowment Policy)
Child Minding
Clothing
Housekeeping
Maintenance for a child
School Meals
Travel Expenses(Inc. Arrears)
Car Loan Repayment / Car Insurance
Petrol
Credit Cards Repayments
Loans Repayments
Hire Purchase
Other (List Details)
TOTAL EXPENDITURE
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DISCRETIONARY HOUSING PAYMENT APPLICATION FORM A Discretionary Housing (Aberdeen City Council)

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Completed 6 February 2021

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