NORWICH
City Council
www.norwich.gov.uk
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Discretionary Housing Payments
(DHP) application form
What is the DHP scheme?
The scheme is intended to help those who have special circumstances and need
extra help with rent. It’s available to people who are getting housing benefit but
do not receive the full amount of their rent and have a shortfall. It’s usually considered
on a short-term basis.
These payments are discretionary and each case is considered individually. We cannot
award DHP for some of the charges included in some rents such as water, fuel and food.
DHP can also be considered for rent in advance or rental deposits in some circumstances.
You will need to provide evidence of this.
What will I need as proof?
We will need to see…
Evidence to support all details on the income and expenditure form.
If you have a bank account we will need two full consecutive months statements
for all bank/building society/post office accounts held, whether or not they have
any money in them.
Evidence of any other savings or investments including premium bonds, shares, ISAs etc.
Any other evidence you feel is relevant to your application.
If you do not supply this information, we may not be able to consider your application.
If you would like help to complete this form please contact us on 0344 980 3333 or
email benefits@norwich.gov.uk.
For more advice with budgeting, debt and moving contact:
Norwich Home Options www.norwichhomeoptions.org.uk t: 0344 980 3333
Citizens Advice Bureau www.ncab.org.uk t: 03444 111 444
StepChange Debt Charity www.stepchange.org t: 0800 138 1111
National Debtline www.nationaldebtline.org t: 0808 808 4000
Shelter https://england.shelter.org.uk t: 0808 800 4444
www.norwich.gov.uk
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Your details
Claim number (if known)
Title First name(s) Surname
National Insurance Number
Telephone number
Email address
Your address
Are you claiming Universal Credit?
Yes No
If yes, please answer all the questions below. If no, continue to the ‘Are you applying for
help with your rent deposit’?
Tell us about all the income you and your household receive. Please send us proof of this.
Please give us the following details about the bank account you want your Discretionary
Housing Payment paid into. This account must be in your name
If your Universal Credit is subject to a managed payment we may pay your landlord direct.
Postcode
Income type Who gets this? How much
£
£
£
£
£
£
£
£
How often
Name
Sort Code
Account number
How much is your rent? £ per week/month. Please provide proof of this
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Are you applying for help with your rent deposit?
Yes No
If yes, how much money do you need towards your deposit?
(you will need to supply evidence of this)
Do you have any other resources to pay your deposit?
Yes No
If you have answered no to the above question, please complete the remaining
sections of the form.
What steps have you taken to find alternative accomodation?
Are you registered for Norwich Home Options?
Yes No
Are there any reasons why you cannot move (please include school addresses,
caring needs etc)?
Name
Tell us who lives with you
Age Relationship to you
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Other information
Is anyone in your household pregnant?
Yes No
If you have answered yes to the above, when is the baby due?
Do you or any member of your household have any disabilities, health problems or
special needs that may prevent you from moving? Please give full details, including
whether these are permanent or temporary.
Has your home been adapted for the needs of a member of your household?
Please give full details.
If you and your partner have any other persons over 18 living with you how much do
they contribute toward the rent and household bills?
If they do not contribute, please tell us why.
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Please provide any other information you feel is relevant to this application
(this should include details of jobs/extra hours applied for, alternative properties
viewed/applied for, reason for needing extra rooms etc) or any anticipated
changes due to happen in the next 26 weeks.
Are you seeking help from any debt advice agencies?
Yes No
If you have contracts for satellite/cable, mobile phones, internet, or other similar
bills, please give the date the contracts started and details of how long you are
committed to each.
Please list all bank/building Account number Current balance
society/post office accounts
As DHPs are usually only paid for a short period of time what action are you taking to
meet your housing costs on a long-term basis?
Expenses
Please give details of the weekly expenses of your family and provide evidence of each
(eg bills, receipts)
Water rates £
Gas/oil £
Electricity £
Internet £
Telephone £
Groceries £
Prescriptions £
Clothing £
TV license £
Launderette £
Hire purchase - £
Travel £
Child care £
Arrears/outstanding debts
Outstanding
amount
Payment
agreed
Frequency
(eg weekly/
monthly)
Gas £ £
Electricity £ £
Water £ £
Maintenance/CSA £ £
Bank loan £ £
Credit card £ £
You will need to supply evidence of any outstanding debts listed above.
If evidence is not provided we may not be able to consider these expenses.
please provide
details
Other expenses and debts (not listed above).
Please give details here.
www.norwich.gov.uk
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www.norwich.gov.uk
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If you would like this information in another language
or format such as large print, CD or Braille please visit
www.norwich.gov.uk/Intran or call 0344 980 3333.
The information I have provided is correct to the best of my knowledge and I understand
that giving false information is an offence for which I may be prosecuted.
Please return this form to: Benefits, City Hall, Norwich NR2 1NH
Signed
Date / /
www.norwich.gov.uk
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COM12243 10/19
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