Fillable HCTB1 Housing Benefit And Council Tax Benefit Claim Form (Shetland Islands Council)

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HCTB1 Housing Benefit And Council Tax Benefit Claim Form (Shetland Islands Council)

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HCTB1 notes
04/11
Housing Benefit
and Council Tax
Reduction
Notes for filling in the
claim form for Housing
Benefit and Council Tax
Reduction
•
About this form
•
About Housing Benefit and Council
Tax Reduction
•
Local Housing Allowance
•
Second Adult Rebate
•
Proof
•
Filling in the form
•
If you need help to fill in the form
•
What to do next
•
How your local council collects and
uses information
•
Changes you must tell your local
council about
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About this form
We have designed this claim form to be easy to fill in. It may look
rather long, but there have to be enough questions to make sure
that everyone who claims gets the right amount of benefit.
You may not have to fill in all parts of the form (for example, a few
questions would not apply to most pensioners) but you must fill in
any part that is relevant to you. Every part starts with a question to
help you decide if you need to fill in that part.
About Housing Benefit and Council Tax Reduction
Housing Benefit can pay all or part of your rent. It may also give
you some extra money towards things you have to pay for, like
cleaning shared areas. Council Tax Reduction can pay all or part of
your Council Tax. It cannot help with water charges or, if you live in
Scotland, the Scottish Water Authority water and sewerage
charges.
Local Housing Allowance
Local Housing Allowance (LHA) arrangements are a way of working
out Housing Benefit for people who rent from a private landlord.
Local authorities use LHA rates based on the size of household and
the area in which a person lives to work out the amount of rent
which can be met with Housing Benefit. Housing Benefit paid under
the LHA arrangements is normally paid to the tenant, who will
then pay the landlord.
To find out more about deregulated tenancies and Local Housing
Allowance, contact your local council.
Or visit
www.direct.gov.uk
2
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Second Adult Rebate
Second Adult Rebate is Council Tax Reduction for people who may
not have a partner but who share their home with someone
who:
•
is 18 or over
•
is on a low income,
and
•
does not pay them rent.
If you are just claiming Second Adult Rebate , only fill in
Parts 1
,
3, 14, 15, 16
and
17
of the form.
Proof
Your local council will need to see proof of some of the things
you write about on the form. There is a checklist in
Part 15
of
the form to help you. If you are not sure if your council needs to
see proof of something, get in touch with them. They will tell
you what they need to see. They cannot pay you benefit until
they have seen the proof they need.
Filling in the form
Use black ink to fill in the form. Do not use pencil. If you make a
mistake, just cross it out and put the right answer next to it. Do
not use correction fluid or tape.
Answer
No
or
Yes
questions by putting a
tick
in the relevant
box. If you are picking an answer from a list of answers,
tick
the
box which applies to you. Do not put a cross in any boxes. If you
answer a question with a cross, your local council may have to
send the form back, and this will delay the claim.
If someone else fills in the form for you, there is a special space
for them to sign.
3
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If you need help to fill in the form
If you need any help, contact your local council. You can find
their phone number and address in the phone book under
Council
, or at
mycouncil.direct.gov.uk
.
Or you can get in touch with an organisation like your local
Citizens Advice Bureau. You can also find their phone number
and address in the business numbers section of your local phone
book.
What to do next
When you have filled in the form, sign it and send it to your local
council with the proof they need to see.
Or you can take the form and proof to your nearest council
benefit office. Do not send valuable items such as bank books or
passports in the post. Take them to your council’s reception and
they will get the information they need and give them back to
you.
If you cannot get the proof they need straight away, do not
worry. Send the form to them with the proof you do have and let
them know that you will be sending some proof later. If you do
not send the form to them straight away, you might lose money.
Do not send valuable items such as bank books or passports in
the post.
Please turn over
▲
4
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How your local council collects and
uses information
Your local council will use the information you give in this form,
and in any supporting proof you send, to process your claim for
Housing Benefit and Council Tax Reduction.
They may pass the information to other agencies or
organisations such as the Department for Work and Pensions and
HM Revenue & Customs, as allowed by the law.
They may check information you have provided, or information
about you that someone else has provided, with other
information they hold. They may also get information about you
from certain third parties, or give information to them to:
•
make sure the information is accurate
•
prevent or detect crime,
and
•
protect public funds.
These third parties include government departments, other local
authorities and private-sector organisations such as banks and
organisations that may lend you money.
They will not give information about you to anyone else, or use
information about you for other purposes, unless the law allows
this.
Your local council is the data controller for the purposes of the
Data Protection Act.
If you want to know more about what information they have
about you, or the way they use that information, please ask
them.
5
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Changes you must tell your local council
about
For example:
•
any of your children leave school or leave home
•
anyone moves into or out of your home, including lodgers and
subtenants
•
your income or the income of anyone living with you, including
benefits, changes
•
your capital or savings change
•
you or anyone living with you becomes a student, starts a
youth training scheme, goes into hospital or a nursing home,
goes into prison, or changes or leaves a job
•
your rent changes
•
you move
•
you or your partner are going to be away from home for more
than a month
•
you or anyone living with you starts work
•
you receive any decision from the Home Office,
or
•
anything you have told us about changes.
This is not a full list. If you are not sure, ask your council for
advice. You must tell your council about most changes. Contact
them to find out how.
If you do not tell them about any changes, you may lose money
you are entitled to or you may get too much benefit.
You must make sure that you tell them about any changes.
Do not rely on someone else to pass the message on.
It is an offence not to tell your council about any changes that
may affect your benefit. They may take court action against you,
and if they pay you too much benefit, you will probably have to
pay it back.
HCTB1NOTES_042011_003_001
6
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HCTB1 04/11
For office use only
Date form was requested
/ /
Date form was issued
/ /
Date received at:
DWP office date stamp
Initials
Local authority office
date stamp
Initials
A claim form for Housing Benefit
and Council Tax Reduction
If you are just claiming
Second Adult Rebate, only fill
in Parts 1, 3, 14, 15, 16 and 17
of this form.
Are you
(please tick every box that applies to you):
a council tenant? an owner-occupier?
a private tenant?
a housing association or
social landlord tenant?
Part 1 About you and your partner
Do you have a partner who normally lives with you?
We use partner to mean
•
a person you are married to or a person you live with as if you are
married to them, or
•
a civil partner or a person you live with as if you are civil partners.
Surname or family name
Other names
Any other names you
have used
Title
(Mr, Mrs, Ms, other)
Address, including room
number if you have one
Do not tell us your
partner’s address if it is
the same as yours.
Postcode
What date did you
move to this address?
Your daytime phone
number
What is this number?
Please tick.
Date of birth
You
Code Number
Home Work Mobile Textphone
No
Yes
If you have a partner, you must
answer all the questions about
them, as well as yourself.
Your partner
Code Number
Home Work Mobile Textphone
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Part 1 About you and your partner
continued
We need to see proof of your and your partner’s identity and NI number. See the checklist at Part 15
You
Your partner
National Insurance (NI) number
You can find this on payslips, letters about your
benefit or letters from the tax office. We cannot
normally decide your claim if we do not have your
NI number. We need to see proof of this.
Have you or your partner been paid
Housing Benefit or Council Tax Reduction before?
When did you last get Housing Benefit or Council
Tax Reduction?
Which council did you claim from?
What name did you use for the claim?
What address did you claim for?
Postcode
If you have moved from this address, have you
told the council you claimed from?
If you or your partner have moved home in
the last 12 months, tell us your last address
if it is different from above.
Postcode
Tell us whether you were the homeowner,
a private tenant, a council tenant or a lodger
at this address.
Letters Numbers Letter
If you do not have an NI number, or
cannot find it, tick this box.
No
Go to
page 3
Yes
Please tell us about it below.
No
Yes
Letters Numbers Letter
If your partner does not have an
NI number, or cannot find it, tick
this box.
No
Go to
page 3
Yes
Please tell us about it below.
No
Yes
page 2
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Part 1 About you and your partner
continued
page 3
You
Your partner
Have you or your partner come to live in
England, Northern Ireland, Scotland, Wales,
the Republic of Ireland, the Channel Islands
or the Isle of Man in the last two years?
What is your nationality?
If your nationality is not British, on what
date did you last enter and apply to stay in
the UK?
The UK is England, Northern Ireland, Scotland
and Wales.
Are you or your partner in hospital at the
moment?
When did you go in?
When will you come out, if you know?
Do you or your partner get
Disability Living Allowance?
Care
Mobility
Do you or your partner get
Attendance Allowance?
Do you or your partner have a carer who lives
somewhere else, but provides care overnight
in your home?
Does anyone get Carer’s Allowance for
looking after you or your partner?
No No
Yes
We may write to you about this.
Yes
We may write to you about this.
No No
Yes
Please tell us about it below.
Yes
Please tell us about it below.
No No
Yes
How much?
Yes
How much?
£ £
£ £
No No
Yes
We need to see proof of this.
Yes
We need to see proof of this.
No
No
Yes
We may write to you about this.
Yes
We may write to you about this.
No No
Yes
We need to see proof of this.
Yes
We need to see proof of this.
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Part 1 About you and your partner
continued
page 4
Have you or your partner been told that you
No
are entitled to Carer’s Allowance, even if you
Yes
do not receive it, because you are getting
another benefit instead?
Do you or your partner pay towards the
No
upkeep of a student?
Yes
Are you or your partner a student?
No
By student we mean anyone who is attending a
Yes
course of study at an educational establishment,
including student nurses.
Please tick if you or your partner:
•
are an apprentice
•
are on youth training
•
are in legal custody
•
are severely mentally impaired
•
are registered blind
•
have a long-term illness or disability
Do you or your partner have a vehicle
No
from a Mobility scheme?
Yes
We will contact you if we need any more information.
You
Your partner
We need to see proof of this.
No
Yes
We need to see proof of this.
Tell us if this is full or part time.
Full time Part time
£ every
How much do you pay and how often?
No
Yes
No
Yes
Tell us if this is full or part time.
Full time Part time
£ every
How much do they pay and how often?
No
Yes
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Part 2 About children
We need to know about any children in your household who are:
•
under 16,
•
aged 16 or 17 and registered for work or youth training, or
•
aged 16, 17, 18 or 19 and in education doing a course not higher than
GCE A-level, SCE Higher level or GNVQ (advanced).
Are there any children in
your household as described
above?
Surname or family name
Other names
Date of birth
Is the child male or female?
The child’s relationship to you
The child’s relationship to
your partner
Usual address, if different
from yours
Child Benefit number
Who gets the Child Benefit
for them?
We need to see proof of this.
No
Go to
Part 3
.
Yes
If there are more than four children, use a separate sheet of paper to tell us all
the information we ask for on this page and send it with the form.
If you are sending a separate sheet of paper, tick this box.
First child Second child Third child
page 5
Fourth child
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Part 2 About children
continued
page 6
First child Second child Third child Fourth child
Is the child registered blind?
Does the child get Disability
Living Allowance?
Care
Mobility
Do you or your partner
pay any childminding
costs for this child to a
registered childminder,
a nursery or an
after-school club?
Tell us the name and
registration number of the
minder.
How much do you pay a
week?
No
Yes
We need to see
proof of this.
No
Yes
How much?
£
£
We need to see proof of this.
No
Yes
Please tell us about
it below.
£ a week
We need to see proof of this.
No
Yes
We need to see
proof of this.
No
Yes
How much?
£
£
We need to see proof of this.
No
Yes
Please tell us
about it below.
£ a week
We need to see proof of this.
No
Yes
We need to see
proof of this.
No
Yes
How much?
£
£
We need to see proof of this.
No
Yes
Please tell us
about it below.
£ a week
We need to see proof of this.
No
Yes
We need to see
proof of this.
No
Yes
How much?
£
£
We need to see proof of this.
No
Yes
Please tell us
about it below.
£ a week
We need to see proof of this.
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page 7
Part 3 About other people who live with you
Now tell us about all the people who usually live with you and your partner.
Do
not tell us about people who just share a hall, bathroom or toilet with you.
If you want to tell us about more than three people, use a separate sheet of paper.
Surname or family name
Other names
Date of birth
Their relationship to you or your partner
Some examples are aunt, brother, daughter,
father, grandson, grandmother, stepdaughter,
joint tenant, joint owner, subtenant, lodger,
boarder or friend.
If you are sending a separate sheet of paper, tick this box.
Do they get Income Support, income-based
Jobseeker’s Allowance, income-related
Employment and Support Allowance or
Pension Credit?
No
Yes
No
Yes
No
Yes
Are they registered blind?
No
Yes
No
Yes
No
Yes
Are they a full-time student, a
student nurse, a care worker, an
apprentice or on youth training?
No
Yes
Tell us which.
No
Yes
Tell us which.
No
Yes
Tell us which.
£ a week £ a week £ a week
Do they get Disability Living Allowance or
Attendance Allowance?
No
Yes
How much?
No
Yes
How much?
No
Yes
How much?
Do any adults usually live
with you and your partner?
By adults we mean people aged 16 or over
who nobody gets Child Benefit for.
No
Go to
Part 4.
Yes
Fill in this section.
First person Second person Third person
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Part 3 About other people who live with you
continued
page 8
First person Second person Third person
Do they pay rent or money for board and
lodgings to you or your partner?
No
Yes
Tell us about it below.
No
Yes
Tell us about it below.
No
Yes
Tell us about it below.
How much?
£ a week £ a week £ a week
Does this include money for food?
No
Yes
No
Yes
No
Yes
Does this include money for heating?
No
Yes
No
Yes
No
Yes
Are they severely mentally impaired?
No
Yes
No
Yes
No
Yes
Are they in legal custody at the moment?
No
Yes
When are they
expected to come out?
No
Yes
When are they
expected to come out?
No
Yes
When are they
expected to come out?
Are they in hospital at the moment?
No
Yes
Tell us about it below.
No
Yes
Tell us about it below.
No
Yes
Tell us about it below.
When did they go in?
When are they due to come out (if you know)?
Do they normally work for 16 hours or more
a week?
£
No
Yes
Tell us their earnings
before any deductions.
We need to see proof of their
earnings.
£
No
Yes
Tell us their earnings
before any deductions.
We need to see proof of their
earnings.
£
No
Yes
Tell us their earnings
before any deductions.
We need to see proof of their
earnings.
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Part 3 About other people who live with you
continued
page 9
First person Second person Third person
Do they have any other income at all?
Make sure you tell us about all other income
they have.
This includes any benefits or
allowances you have not told us about on this
form and interest from savings and investments.
No
Yes
Tell us about it below.
No
Yes
Tell us about it below.
No
Yes
Tell us about it below.
1 Where does this income come from?
How much is it before deductions?
£ £ £
2 Where does this income come from?
How much is it before deductions?
£ £ £
3 Where does this income come from?
How much is it before deductions?
£
We need to see proof of their
income.
£
We need to see proof of their
income.
£
We need to see proof of their
income.
Are any of the people who normally live
with you married to each other, civil
partners, or living together as if they are
married or civil partners?
We call these people partners .
No
Yes
Tell us their names below.
is the partner of
is the partner of
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Part 4 About Income Support, income-based Jobseeker’s Allowance,
Employment and Support Allowance and Pension Credit
page 10
Go to
Part 5
.
hear about a claim for Income Support,
Are you or your partner getting or waiting to No
Yes
Answer both the questions in this part and then go to
Part 11
.
income-based Jobseeker’s Allowance,
income-related Employment and Support
Allowance or Pension Credit?
You
Your partner
Are you or your partner actually getting
No No
Income Support, income-based Jobseeker’s
Yes
When did you start getting it?
Yes
When did they start getting it?
Allowance, income-related Employment and
Support Allowance or Pension Credit at the
moment?
Are you or your partner still waiting to
No No
hear about a claim for Income Support,
Yes
When did you claim?
Yes
When did they claim?
income-based Jobseeker’s Allowance,
income-related Employment and
Support Allowance or Pension Credit?
Which benefit are you getting Which benefit are they getting
or waiting to hear about? or waiting to hear about?
Income Support Income Support
income-based Jobseeker’s income-based Jobseeker’s
Allowance Allowance
Employment and Support Employment and Support
Allowance Allowance
Pension Credit Pension Credit
We must see proof of your benefits, allowances or pension before we can decide how much benefit
you can get. Read the checklist at
Part 15
to see what you can use as proof.
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Part 5 About being self-employed
Are you or your partner self-employed?
Tick
No
if you are a company director.
What kind of work do you do?
When did the business start?
What is the business address?
Postcode
Do you have any business partners?
Postcode
How many hours a week do you usually work?
Do you get an Enterprise Allowance?
Do you pay into a private pension scheme?
page 11
No
Go to
Part 6
.
Yes
Answer the questions on this page.
You must send us your trading accounts for the last financial year. If you have only
recently set up the business and do not have a full year’s accounts, we will need to
see some other proof of your income. We will write to you about this.
You
Your partner
No No
Yes
Tell us their name and address.
Yes
Tell us their name and address.
No No
Yes
How much and how often?
Yes
How much and how often?
£ every £ every
No No
Yes
How much and how often?
Yes
How much and how often?
£ every £ every
We must see proof of your earnings before we can decide how much benefit you can get. Read
the checklist at
Part 15
to see what you can use as proof.
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Part 6 About working for an employer
page 12
Do you or your partner work for an employer?
What kind of work do you do?
What is your employer’s name and address?
Postcode
When did you start this job?
What is your payroll, employee or staff number?
Are you employed for a limited period?
How much do you get paid and how often?
How are you paid, for example, in cash, by
cheque or straight into a bank or building
society account?
When was your last pay rise?
When will your next pay rise be?
No
Go to
Part 7
.
Yes
Answer the questions on this page. If you or your partner work for
more than one employer, tell us about all the employers on a
separate sheet of paper and send it with this form.
If you are sending a separate sheet of paper, tick this box.
You
No
Yes
When will you finish?
£ every
Your partner
No
Yes
When will they finish?
£ every
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Part 6 About working for an employer
continued
page 13
You
Your partner
How many hours a week do you usually work?
Are you getting Statutory Sick Pay (SSP),
No
No
Statutory Paternity Pay (SPP), Adoption Pay
Yes Yes
or Statutory Maternity Pay (SMP) from your
employer at the moment?
Are you getting any other sick pay or
No No
maternity pay from your employer at the
Ye Yes
moment?
Do you pay into a private or company
No
No
pension scheme?
Yes
How much and how often?
Yes
How much and how often?
£ every £ every
We must see proof of any earnings before we can decide how much benefit you can get. Read the
checklist at
Part 15
to see what you can use as proof. If you get tips or bonuses, tell us about
these in
Part 14
.
s
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Part 7 About any other work
Do you or your partner do any other work
at all?
This could be voluntary work or any other
work, even if it is not paid work.
What other work do you do?
What is the name and address of the
person you do this work for?
Postcode
When did you start this work?
How many hours a week do you usually work?
Do you get paid?
If you only get expenses or tips, still
tick
Yes
and give details.
How much do you get paid and how often?
No
Go to
Part 8
.
Yes
Answer the questions on this page.
You
No
Yes
Tell us about it below.
£ every
page 14
Your partner
No
Yes
Tell us about it below.
£ every
We must see proof of any earnings before we can decide how much benefit you can get.
Read the checklist at
Part 15
to see what you can use as proof.
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Part 8 About benefits and pensions
page 15
Go to
Part 9
.
waiting to hear about benefits you have claimed?
Are you or your partner getting any benefits or No
Yes
Read the list of benefits below and tell us about any
you or your partner are getting now or have claimed.
•
Child Benefit
•
Maternity Allowance
•
Severe Disablement Allowance
•
State Retirement Pension
•
Child Tax Credit
•
Working Tax Credit
•
Statutory Sick Pay
•
War Disablement Benefit
•
Fostering Allowance
•
Incapacity Benefit
•
Statutory Maternity Pay
•
War Pension or War Widow’s Pension
•
Contribution-based Jobseeker’s
•
Industrial Injuries Disablement
•
Statutory Paternity Pay
•
Widowed Parent’s Allowance
Allowance Benefit
•
Adoption Pay
•
Armed Forces Compensation Scheme
•
Contribution-based Employment
•
Industrial Death Benefit
•
Bereavement Allowance (AFCS)
and Support Allowance
•
Carer’s Allowance
•
Guardian’s Allowance
•
any other social security benefit
If you are getting or have claimed any benefit that is not listed, tell us
If you are sending a separate sheet of paper, tick this box.
about it on a separate sheet of paper and send it with the form.
You
Your partner
The name of the benefit or pension
Waiting to hear
How much, how often and by what method? How much, how often and by what method?
£
Getting now
every by £ every by
The name of the benefit or pension
Waiting to hear
How much, how often and by what method? How much, how often and by what method?
£
Getting now
every by £ every by
The name of the benefit or pension
Waiting to hear
How much, how often and by what method? How much, how often and by what method?
£
Getting now
every by £ every by
We need to see proof of your and your partner’s benefits and pensions See the checklist at Part 15.
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Part 9 About other money coming in
page 16
No
Go to
Part 10
.
Yes
Answer the questions on this page.
You do not need to tell us about payments from
the Independent Living Fund, the Eileen Trust, the
MacFarlane Trust or the Skipton Fund.
Do you or your partner
•
have any money coming in that you have not
already told us about?
•
expect to have any other money coming in?
This includes occupational pensions, work
pensions and private pensions, maintenance or
child support for you, your partner or any of the
children you have told us about on this form,
money from a trust fund, training allowances, a
student grant or loan, and any cash payments.
Also tell us about any money you get from
people living in your house as boarders, lodgers
or subtenants.
What is the money for?
Who gets it?
How much do they get paid and how often?
How is this paid?
When did they start getting this income?
When is the income likely to go up?
Other money 1
£ every
Other money 2
£ every
Other money 3
£ every
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Other money 1 Other money 2 Other money 3
Does anyone owe money to you or your No No No
partner?
Yes
Tell us about it below.
Yes
Tell us about it below.Tell us about it below.
Yes
What for?
How much?
Who is it owed to?
Are you or your partner expecting to get any
money in the next 12 months?
For example, a redundancy payment or a
payment instead of notice or holiday.
What for?
How much?
£
No
Yes
Tell us about it below.
£
£
No
Yes
Tell us about it below.
£
£
No
Yes
Tell us about it below.
£
We must see proof of any money coming in before we can decide how much benefit you can get.
Read the checklist at
Part 15
to see what you can use as proof.
Part 9 About other money coming in
continued
page 17
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Part 10 About bank accounts, savings, investments and property
page 18
We need to know if you or your partner have any bank accounts, savings, investments or
property in the UK or abroad.
This includes cash, current accounts and savings accounts with a bank or building society, Post
Office® accounts, Premium bonds, National Savings Certificates, stocks and shares and money
or property held in trust, including any trusts set up for your children.
Do you or your partner have any of the following?
Bank accounts
No
Yes
How many accounts? Total amount
£
Building society accounts
No
Yes
How many accounts? Total amount
£
Post Office® accounts
No
Yes
How many accounts? Total amount
£
Premium bonds
No
Yes
How many bonds? Total amount
£
Unit trusts, ISAs, PEPs, TESSAs,
No
TOISAs or other investments
Yes
How many? Total amount
£
Income bonds or capital bonds
No
Yes
How many bonds? Total amount
£
Money or property held in trust No
Yes
How many? Total amount
£
Any other savings or investments
No
Yes
How many? Total amount
£
Type of other savings or investment
Name of the company the shares are held in Number of shares held
Shares – approximate value
£
Shares – approximate value
£
Shares – approximate value
£
We may ask to see proof of any accounts, savings, investments or property before we can decide
how much benefit you can get. Read the checklist at
Part 15
to see what you can use as proof.
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Part 10 About bank accounts, savings, investments and property
continued
page 19
Do you or your partner have any National
Savings Certificates?
Do any of your or your partner’s savings or
investments include:
•
money from the sale of a house, or
•
money from a charity?
Apart from your home, do you or your partner
own any other property or land in this country or
abroad?
If it is on a mortgage or a loan, still tick
Yes
.
Do any children you are claiming for:
•
own property or land in this country, or
•
have any money or property held in trust?
No
Yes
We may need to see the
original
certificates as
proof. We will return the certificates to you.
No
Yes
We will write to you about it.
No
Yes
We will write to you about it.
No
Yes
We will write to you about it.
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Part 11 About where you live
page 20
Do you use your home for business?
No
Yes
Do you or your partner have a main home
somewhere else?
If your main home is somewhere else in the UK or
abroad, tick Yes, even if you do not pay rent for it.
No
Yes
Tell us about it below.
What is the address?
Postcode
Do you or your partner pay rent on this home?
No
Yes
How much?
£
Do you own your home or have a mortgage?
No
Go to the next question.
Yes
Go to
Part 12
.
Are you a council tenant?
No
Answer the questions below.
Yes
Go to
Part 12
.
What sort of building do you live in?
Tick one box only.
House
Flat
Care home or, in
Scotland, care home
service
Other
– give details
Bedsit or rooms
or a studio flat
Hostel
Caravan, mobile
home or houseboat
Board and lodgings
Hotel
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Part 11 About where you live
continued
page 21
Does your home have any of these?
Tick the boxes that apply.
Who is responsible for decorating your home?
How many floors are there?
Do you and your household occupy only
part of the building you have ticked?
Which floors do you live on?
For example, ground floor, first floor.
How many rooms are there in the building?
Living rooms
Bedsitting rooms
Bedrooms
Bathrooms or shower rooms
Toilets
Kitchens
Other rooms
central heating
a garden
a garage
a parking space
No
Yes
As you look at the building from the street, where in the building do you live?
At the left
At the right
At the front
In the middle
At the back
Just for you and That you share
your household with other people
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Part 12 About rent
Who has to pay the Council Tax bill for your
home?
Tick the box that applies.
What is the Council Tax reference number?
Do you or your partner pay rent for your home?
Tick
Yes
if you would pay rent but you already get
Housing Benefit.
Do you or your partner pay rent to the council?
What is your landlord’s full name and
business address?
By landlord we mean the person or
organisation who owns the property you live
in.
Postcode
If your landlord has an agent, tell us their full
name and address.
By agent we mean the person or organisation you
actually pay your rent to.
Postcode
Is your landlord or agent, or your landlord or
the agent’s partner either
•
your former partner, or
•
your partner’s former partner, or
•
related to you or your partner, or
•
related to your children, or
•
related to your partner’s children?
page 22
You or your partner
Your landlord
Someone else Tell us who it is.
No
Go to
Part 13
.
Yes
Answer the next question.
No
Answer the questions below.
Yes
Go to
Part 13
.
No
Yes
What is the relationship?
is my landlord’s
or agent’s
Related includes related through marriage or civil partnership, even if it has ended. For
example, ex-wife, ex-husband, ex-civil partner, aunt, brother, daughter, father,
grandson, grandmother, son-in-law or stepdaughter.
When did you or your partner start renting your
home?
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Part 12 About rent
continued
When did you move to this address?
If you have not moved in yet, tell us when you
expect to move in, then tell us when you have
actually moved in.
What sort of tenancy do you have?
For example, shorthold, assured tied rent or
something like this.
How long is the tenancy for?
How much rent do you or your partner pay and
how often?
For example, every week, every fortnight, every
four weeks or monthly.
Does anyone else share the rent with you and
your partner?
Tell us their names and their relationship to you
and your partner.
How much of the rent do they pay and how often?
For example, every week, every fortnight, every
four weeks or monthly.
Has your rent changed in the last 12 months?
When is the next rent increase due?
page 23
to
£ every
No
Yes
Tell us the details below.
£ every
No
Yes
Send us proof of the date it changed and how much it changed.
We must see proof of your rent and tenancy before we can decide how much benefit you
can get. Read the checklist at
Part 15
to see what you can use as proof.
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Part 12 About rent
continued
page 24
Has your rent been registered as a fair rent by a
No
rent officer?
Yes
Please send us the notice of registration form
RO5
.
Do you have any weeks when you do not No
have to pay rent?
Yes
How many weeks in a year?
Are you behind with your rent?
No
Yes
By how many weeks?
Does your rent include money for the following?
Tick the boxes if your rent includes money for the things we have listed.
If you tick a box, fill in the details to the right.
Meals
How much?
£ every
Which meals?
Breakfast Lunch Evening meal
Water authority charges
How much?
£ every
Heating
How much?
£ every
Lighting
How much?
£ every
Hot water
How much?
£ every
Electricity
How much?
£ every
Fuel for cooking
How much?
£ every
Laundry
How much?
£ every
Cleaning rooms or windows
How much?
£ every
Gardening
How much?
£ every
Garage or parking space
How much?
£ every
Do you have to rent the garage as part of your
No
tenancy agreement?
Yes
every
Personal care and support
How much?
£
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Part 12 About rent
continued
Do you pay any service charges separate from
your rent?
For example, for
•
general counselling or support
•
an emergency alarm system
•
window cleaning, or
•
lift maintenance.
Are you living away from home at the moment?
Why are you not living at home?
When did you last live at home?
When do you expect to go back home?
What is the address of where you are living at the
moment?
Postcode
Have you sublet your home?
page 25
No
Yes
£ every
How much?
What for?
No
Go to
Part 13
Yes
Tell us about it below.
No
Yes
Who lives
there now?
We must see proof of your rent and tenancy before we can decide how much benefit you
can get. Read the checklist at
Part 15
to see what you can use as proof.
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Part 13 How we pay you
If you are a council tenant
Your council will pay any Housing Benefit you are awarded into your
rent account.
If you rent your home from a private landlord
Your council will usually pay your benefit to you. Your council can pay your
money
•
straight into a bank or building society
•
by cheque.
It is then your responsibility to pay your rent to your landlord.
In some cases, your council can pay your money direct to your landlord.
If you are unable to manage your rent payments, contact your council.
Your local council may ask you for more information.
If you rent your home from a housing association
You can choose how your council pays your benefit. Your council can pay
your money
•
straight into a bank or building society
•
by cheque, or
•
direct to your landlord.
page 26
If you are awarded Council Tax Reduction
Your council will pay your Council Tax Reduction into your Council
Tax account.
Your council will normally pay your money into an account
Many banks and building societies will let you collect your money at the
post office.
Your council will tell you if the amount they pay into the account is going
to change.
Finding out how much your council has paid into the
account
You can check your payments on account statements. If you think a
payment is wrong, get in touch with your council straight away.
You
must
tick
one
of these boxes.
Tick this box if you would like to be paid into an
account
Tick this box if you would like to be paid by cheque
Tick this box if you have rented your home since before
14 January 1989, and would like your Housing Benefit to
be paid straight to your landlord.
Tell us about the account you want to use on the next page. By giving us your
account details you agree that your council will pay you into an account.
If you are going to open an account, please tell your council your account details
as soon as you get them.
Fill in the rest of this form. You do not have to wait until you have opened an
account or contacted us.
Go to
Part 14.
Go to
Part 14.
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Part 13 How we pay you
About the account you want to use
•
You can use an
account in your name,
or a
joint account
.
•
You can use
someone else’s account
if:
–
the terms and conditions of their account allow this, and
–
they agree to let you use their account, and
–
you are sure they will use your money in the way you tell them.
•
You can use a
credit union account.
You must tell us the credit union’s
account details. Your credit union will be able to help you with this.
•
If you are an
appointee
or a
legal representative
acting on behalf of the
customer, the account should be in your name only.
page 27
Please tell us your account details below.
It is very important you fill in all the boxes correctly, including the
building society roll or reference number, if you have one. If you tell us
the wrong account details your payment may be delayed or you may lose
money.
You can find the account details on your chequebook or bank statements.
If you do not know the account details, ask the bank or building society.
Name of the account holder
Please write the name of the account holder
exactly as it is shown on the chequebook or
statement.
Full name of bank or building society
Sort Code
Please tell us all 6 numbers, for example: 12-34-56.
Account number.
Most account numbers are 8 numbers long. If your
account number has fewer than 10 numbers,
please fill in the numbers from the left.
Building society roll or reference number
If you are using a building society account you may
need to tell us a roll or reference number. This may
be made up of letters and numbers, and may be up
to 18 characters long. If you are not sure if the
account has a roll or reference number, ask the
building society.
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Part 14 Anything else you need to tell us
page 28
Please use this space to tell us anything else
If you are sending any separate sheets of
you think we should know about.
paper with this form, tell us how many.
Use a separate sheet of paper and attach it to
this form if you need to.
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•
Proof of identity
Such as a birth certificate, marriage or civil partnership certificate,
passport, medical card, driving licence, UK residence permit, ID
Card (Resident permit), EEC identity card or recent gas or
electricity bill. We may need to see several of these documents
for each person.
•
Proof of your address
Such as a recent gas or electricity bill or a TV licence.
•
Proof of National Insurance number
Such as a National Insurance number card, payslips or letters
from social security or the tax office.
•
Proof of capital, savings and investments
Such as all your bank, building society or post office books, full
bank statements, or certificates for premium bonds, National
Savings Certificates, ISAs, stocks, shares and unit trusts. We need
to see proof of any interest or dividends you get on investments
and savings. The proof you send must show details for at least
the last three months.
•
Proof of earnings
We also need this for any other adults living in your home.
This means your last five payslips if you are paid every week,
your last three payslips if you are paid every two weeks, or
your last two payslips if you are paid every month. If you or
your partner are self-employed, we need to see your
accounts for the last financial year or, if you have been
trading for less than six months, a summary of your trading
records so far.
•
Proof of other income
We also need this for any other adults living in your home.
Such as pension slips from a former employer or a letter from
the court showing how much maintenance you are getting.
We need to see proof of any money people pay you for board
and lodgings.
•
Proof of benefits, allowances or pensions
We also need this for any other adults living in your home.
Such as current award notices or letters from your Jobcentre
Plus office, social security office or Pension Centre confirming
how much you get. If you do not have proof, let us know
straight away.
•
Proof of private rent and tenancy
Such as a rent book, rent receipts, a tenancy agreement or a
letter from your landlord.
•
Proof of other money paid out
Such as letters about student grants, maintenance
agreements or receipts from registered child minders.
Make sure you read and sign the declaration on page 30.
Part 15 Checklist
Do not delay in sending this form in.
Please tick to say what proof you are sending with this form. We
must see
original documents
, not copies.
Please do not send valuable items through the post. If you can,
bring them into your nearest council benefit office. We will take the
details we need and give you the documents back straight away. If
you cannot get into the office, phone us for more advice.
If you do not provide all the proof we need, we might not be able
to pay you any benefit. We need the same proof for your partner,
if you have one.
If you cannot send the proof we need at the moment, send the form
back to us now and send the proof later. We can start to process
your claim,
but we will not be able to pay you any benefit until we
have all the proof
.
page 29
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Part 16 Backdating
page 30
We can usually award benefit from the Monday after the day we receive your claim. Sometimes we can pay benefit
from an earlier date if you have a good reason for not claiming earlier. If you want us to consider paying your
benefit from an earlier date, tell us when you want benefit from and why you did not claim earlier.
Date you want to claim benefit from
During this earlier period, were your
No
circumstances different to those you have told
Yes
Please tell us about it below.
us about on this form?
What has changed?
We need proof of any changes in your
circumstances for this period.
Why you have not claimed before?
Part 17 Declaration
Even if someone else has filled in this form for you, you must sign this declaration if you can.
If you have a partner, getting them to sign this form should allow us to process your claim
more quickly, but they do not have to sign.
Please read this declaration carefully before you sign and date it.
•
I understand
that this claim is made to you, my local council.
•
I declare
that the information I have given on this form is correct and
complete as far as I know and believe.
•
I understand
that if I knowingly give information that is incorrect or
incomplete, I may be liable to prosecution or other action.
•
I agree
that you will use the information I have provided to process my claim
for Housing Benefit or Council Tax Reduction, or both. You may check some of
the information with other sources as allowed by the law.
•
I understand
that you may use any information I have provided in
connection with this and any other claim for social security benefits
that I have made or may make. You may give some information to
other organisations, such as government departments, local
authorities and private-sector companies such as banks and
organisations that may lend me money, if the law allows this.
•
I know
that I must let you know in writing straight away about any
change in my circumstances which might affect my claim.
Partner’s signature
Signature of person
claiming
Date Date
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Part 17 Declaration
continued
page 31
If this form has been filled in by someone other
than the person claiming
Please tell us why you are filling in this form for
the person claiming.
I declare
that as far as possible, I have confirmed with the person
claiming that the answers I have written on this form are correct.
Name of the person who filled in the form
Signature
Relationship to the person claiming
Date
Part 18 What to do next
You should now have:
•
filled in and signed the claim form for Housing Benefit and Council Tax Reduction, and
•
collected any proof to support your claim – but remember not to send valuable
items.
Send the above documents to us straight away. You can find our address in the
phone book under Council, or at
mycouncil.direct.gov.uk
If you are going to send proof at a later date, you should also send this to us.
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Sharing information with your landlord
Sharing information with your landlord
Sharing information with your landlord could help us
deal with your claim more quickly and reduce the risk
of you falling behind with your rent because of your
claim being delayed.
We may need to confirm information with your
landlord before we can make a decision on your claim,
for example, the start date of your tenancy.
In these circumstances, we can contact your landlord
without your permission.
The law requires that we inform your landlord of
certain decisions we make on your claim, for example,
when a decision is made to pay your benefit to your
landlord.
Under the Data Protection Act 1998 we need your
permission to discuss anything else.
HCTB1
tear-off
1
If you give us permission, we would be able to tell
your landlord whether:
•
you have claimed Housing Benefit, or
•
we have made a decision on your claim, or
•
we need more information to make a decision on
your claim, and what that information may be.
We will not give your landlord any information
about:
•
your personal or household circumstances, or
•
your financial circumstances.
You can withdraw your permission at any time.
It will not affect your claim if you do not give us
permission to discuss your claim with your landlord.
If you want to give us permission to discuss your claim
with your landlord, please sign below.
I give my local council permission to share information
about the progress of my Housing Benefit claim with my
landlord or their representative.
Address
Signature
Full name
Postcode
LETTERS)
(in CAPITAL
Date
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Paying benefit to your landlord
HCTB1
tear-off
2
If you want us to pay your benefit straight to your landlord, you must sign this declaration.
Then tear this page off and give it to your landlord to sign.
Your declaration
Please pay my Housing Benefit straight to my landlord.
•
I understand
that I must always tell you, my council, about any change in my circumstances.
•
I understand
that if I do not tell you about any change of circumstances and you pay me too
much benefit because of this, I may have to pay back the extra benefit.
•
I understand
that I may be prosecuted if I do not tell you about any change of circumstances.
Signature
Date
Full name
(in CAPITAL
LETTERS)
Your landlord’s declaration
I agree to accept Housing Benefit payments for the tenant named in this form.
I understand that by law:
•
I must tell you, the council, straight away if I find out about any change in the tenant’s
circumstances
•
you can stop paying benefit to me if I do not tell you about any change of circumstances
•
I can be prosecuted if I accept Housing Benefit which I know I am not entitled to,
and
•
if you pay me too much Housing Benefit for any tenant, I may have to repay it. You can
take the amount of overpaid benefit from the benefit I get for any other tenants. This
will not affect their rent.
Signature
Date
Full name
(in CAPITAL
LETTERS)
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A
Please indicate which background you feel you belong to:
Asian
Please specify
Bangladeshi
Indian
Pakistani
Other Asian
background
Black
African
Caribbean
Other black
background
Please specify
Chinese
Any Chinese background
Mixed ethnic background
Asian and white
Black African and white
Black Caribbean and white
Other mixed ethnic
background
Please specify
White
Any white background Please specifyAny other ethnic
background
Any other ethnic background
Please indicate your nationality:
British or mixed British
Scottish
English
Welsh
Irish
Any other
nationality
Please specify
B
Questionnaire
HCTB1
tear-off
3
Under the Race Relations Act we have a responsibility to gather details of
our clients’ backgrounds. This information is used to help us with our equal
opportunities policies.
This information is confidential and will be used only to improve access to
our services and help provide equal opportunities for everyone.
The completion of this survey is voluntary.
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Help using this PDF claim form
In this PDF form we have introduced a special feature that lets you save it in
Adobe Reader 8.1.2 and later. This means that you no longer have to complete
the form in one session.
This form will only work if you:
• save it to your computer, then
• open it in Acrobat Reader version 8.1.2 or later.
The form will not work in:
• older versions of Acrobat Reader
• other pdf readers, for example
Preview
on a Mac or
Foxit
on a PC
• your web browser window.
If you are having technical difficulties:
• downloading the form
• Navigating around the form, or
• printing the form
Please contact the
eService helpdesk
.
Phone:
0845 601 80 40
Minicom (textphone):
0845 601 80 39
Email:
eservicehelpdesk@dwp.gsi.gov.uk
Opening hours
Monday to Friday: 08.00am - 09.00pm
Weekend: 08.00am - 04.00pm
Closed on all Public and Bank Holidays.
For help and advice on the information you need to put on the form or about
the benefit you want to claim, contact the office that deals with the benefit.
We would like your feedback
about this PDF claim form
We would like your feedback about this form. We will use any comments to
improve future versions. Please email your comments to:
forms.feedback@dwp.gsi.gov.uk
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HCTB1 Housing Benefit And Council Tax Benefit Claim Form (Shetland Islands Council)

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