Benefits - Discretionary Housing Payment

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Complete this Section if you get the Housing Cost Element of Universal Credit

You must answer each question in this section if Non-Dependants live with you.

By non-dependant we mean a person who lives in your home and is not a dependant or liable to pay rent. They include children for whom you no longer get Child Benefit for.

It is reasonable that most non-dependants pay some money towards the cost of living in your home. If your non-dependant does not pay any money or very little money towards the household costs you must consider asking for some or more money before asking for a DHP. Tell us about the financial help each non-dependant gives you.

Complete this section if you, or your partner do not work and get Jobseekers Allowance, or Universal Credit with a claimant commitment to find/increase employment

Please note, if we award any DHP, it will only be for a limited time, if you apply again, we will check back on what you have told us you are doing to avoid the Benefit Cap and improve your financial situation

Checklist of the evidence you must provide:

You must provide the following proof in support of your DHP application. If you do not, your DHP application will be delayed and/or refused

FOR ALL APPLICATIONS

• Bank statements/Building society books for all accounts held by you and your partner. Statements must be for the last two full consecutive months prior to this application and must show all balances and transactions
• Rent statements for the last two consecutive months showing all credits and debits
• If you are in rent arrears, you must provide proof of any repayment arrangements you have in place with your landlord
• Proof of rent arrears, notices to quit/eviction etc
• Proof of maintenance payments

IF YOU GET THE HOUSING COST ELEMENT OF UNIVERSAL CREDIT YOU MUST ALSO PROVIDE;

• Proof of Rent showing full the breakdown of rent and all service charges
• Universal Credit award letter
• Wage slips for the last two-month period for both you and your partner
• Self Employed accounts for you/your partner
• Proof of occupational pensions/annuities
• Proof of all other income currently received by you and your partner
• Proof of Childcare payments to a registered provider

WHERE APPLICABLE

• Quote/Invoice for removal costs incurred
• Proof of assistance with your financial circumstances, such as a debt advisory agency
• Proof of arranged debt repayments; IVA, bankruptcy, debt management payment
• Medical /Support needs evidence: letter from a doctor, hospital, social worker etc
• If you have a non-dependent, evidence of their income i.e. their wage slips for the last two-month period

Check that you have completed the application properly and have all the proof we need before signing the Declaration

You and your partner must read this carefully before you sign.

This is my/our claim for Discretionary Housing Payment. The information I/we have given on this form is correct and complete as far as I/we know.

I/we give permission to you to check the information I/we have given with any of the other sections of the council, other councils and benefit authorities. I/we understand that the Chelmsford City Council Benefits Service may use the information I/we have given on this form to detect and prevent fraud, including sharing this information with other organisations and Government departments. I/we understand that I have a duty to give the council such information as it may require, to enable it to make a decision

I/we understand that I/we must tell the Chelmsford City Council Benefits Service about any changes in my/our circumstances that may affect my/our Discretionary Housing Payment. I/we understand that I/we may be prosecuted if I/we give information that is not correct or complete, or if I/we do not report any changes of circumstances which might affect my/our benefit or Discretionary Housing Payment. I/we understand I may have to repay any overpaid amounts of Discretionary Housing Payments

I/we have read and understood this declaration.