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Housing Benifits

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Submitted By jamo9723
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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
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� 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.

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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

HCTB1 notes 04/13

Housing Benefit

Notes for filling in the claim form for Housing Benefit

• • • • • • • • •

About this form About Housing Benefit Local Housing Allowance 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
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.

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.gov.uk

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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.

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 www.gov.uk/find-your-local-council. 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.

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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.

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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. 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.

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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_042013_004_001

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15-May-13

A claim form for Housing Benefit
HCTB1 04/13

For office use only
Date form was requested / /

Are you (please tick every box that applies to you): a council tenant? a private tenant? an owner-occupier? a housing association or social landlord tenant?

Date form was issued / /

Part 1

About you and your partner
No Yes If you have a partner, you must answer all the questions about them, as well as yourself.

Date received at: DWP office date stamp

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. You Surname or family name Other names

Your partner

Initials

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. What date did you move to this address? Your daytime phone number What is this number? Please tick. Date of birth Code Home Work Number Mobile Textphone Code Home Work Number Mobile Textphone

Local authority office date stamp

Initials

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15-May-13

Part 1

About you and your partner continued
You Letters Numbers Letter Your partner Letters Numbers

page 2

Letter

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 before? When did you last get Housing Benefit? Which council did you claim from? What name did you use for the claim? What address did you claim for?

If you do not have an NI number, or cannot find it, tick this box. No Yes Go to page 3 Please tell us about it below.

If your partner does not have an NI number, or cannot find it, tick this box. No Yes Go to page 3 Please tell us about it below.

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. No Yes No Yes

We need to see proof of your and your partner’s identity and NI number. See the checklist at Part 15

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15-May-13

Part 1

About you and your partner continued
You Your partner No We may write to you about this. Yes We may write to you about this.

page 3

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 Yes

No Yes Please tell us about it below.

No Yes Please tell us about it below.

No Yes £ £ No Yes No Yes No Yes We need to see proof of this. We may write to you about this. We need to see proof of this. How much?

No Yes £ £ No Yes No Yes No Yes We need to see proof of this. We may write to you about this. We need to see proof of this. How much?

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15-May-13

Part 1

About you and your partner continued
You Your partner No We need to see proof of this. Yes We need to see proof of this.

page 4

Have you or your partner been told that you are entitled to Carer’s Allowance, even if you do not receive it, because you are getting another benefit instead? Do you or your partner pay towards the upkeep of a student?

No Yes

No Yes How much do you pay and how often? £ every

No Yes How much do they pay and how often? £ No Tell us if this is full or part time. Full time Part time Yes Tell us if this is full or part time. Full time Part time every

Are you or your partner a student? By student we mean anyone who is attending a course of study at an educational establishment, including student nurses. Please tick if you or your partner:
● ● ● ● ● ●

No Yes

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 from a Mobility scheme?

No Yes

No Yes

We will contact you if we need any more information.

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15-May-13

Part 2

About children

page 5

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? No Yes Go to Part 3. 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 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 Second child Third child Fourth child

Child Benefit number Who gets the Child Benefit for them? We need to see proof of this.

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15-May-13

Part 2

About children continued
First child Second child No We need to see proof of this. Yes We need to see proof of this. Third child No Yes We need to see proof of this. Fourth child No Yes

page 6

Is the child registered blind?

No Yes

We need to see proof of this.

Does the child get Disability Living Allowance? Care Mobility

No Yes £ £ We need to see proof of this. How much?

No Yes £ £ We need to see proof of this. No Please tell us about it below. Yes Please tell us about it below. How much?

No Yes £ £ We need to see proof of this. No Yes Please tell us about it below. How much?

No Yes £ £ We need to see proof of this. No Yes Please tell us about it below. How much?

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.

No Yes

How much do you pay a week?

£

a week

£

a week

£

a week

£

a week

We need to see proof of this.

We need to see proof of this.

We need to see proof of this.

We need to see proof of this.

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15-May-13

Part 3

About other people who live with you

page 7

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. If you are sending a separate sheet of paper, tick this box. 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. 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. Do they get Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or Pension Credit? Do they get Disability Living Allowance or Attendance Allowance? No Yes Go to Part 4. Fill in this section. Second person Third person

First person

No Yes

No Yes

No Yes

No Yes £ How much? a week

No Yes £ No Yes No Tell us which. Yes Tell us which. How much? a week

No Yes £ No Yes No Yes Tell us which. How much? a week

Are they registered blind?

No Yes

Are they a full-time student, a student nurse, a care worker, an apprentice or on youth training?

No Yes

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15-May-13

Part 3

About other people who live with you continued
First person Second person No Tell us about it below. a week Yes £ Tell us about it below. a week Third person No Yes £

page 8

Do they pay rent or money for board and lodgings to you or your partner? How much?

No Yes £

Tell us about it below. a week

Does this include money for food?

No Yes

No Yes No Yes No Yes No When are they expected to come out? Yes When are they expected to come out?

No Yes No Yes No Yes No Yes When are they expected to come out?

Does this include money for heating?

No Yes

Are they severely mentally impaired?

No Yes

Are they in legal custody at the moment?

No Yes

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 £ We need to see proof of their earnings. Tell us their earnings before any deductions.

No Yes £ We need to see proof of their earnings. Tell us their earnings before any deductions.

No Yes £ We need to see proof of their earnings.
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Tell us their earnings before any deductions.

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15-May-13

Part 3

About other people who live with you continued
First person Second person No Tell us about it below. Yes Tell us about it below. Third person No Yes

page 9

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. 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?

No Yes

Tell us about it below.

£

£

£

£

£

£

£ 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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15-May-13

Part 4

About Income Support, income-based Jobseeker’s Allowance, Employment and Support Allowance and Pension Credit
No Yes Go to Part 5. Answer both the questions in this part and then go to Part 11.

page 10

Are you or your partner getting or waiting to hear about a claim for Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or Pension Credit?

You Are you or your partner actually getting Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or Pension Credit at the moment? Are you or your partner still waiting to hear about a claim for Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or Pension Credit? No Yes When did you start getting it?

Your partner No Yes When did they start getting it?

No Yes When did you claim?

No Yes When did they claim?

Which benefit are you getting or waiting to hear about? Income Support income-based Jobseeker’s Allowance Employment and Support Allowance Pension Credit

Which benefit are they getting or waiting to hear about? Income Support income-based Jobseeker’s Allowance Employment and Support Allowance 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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15-May-13

Part 5

About being self-employed
No Yes Go to Part 6. 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. Your partner

page 11

Are you or your partner self-employed? Tick No if you are a company director.

You What kind of work do you do?

When did the business start? What is the business address?

Do you have any business partners?

No Yes Tell us their name and address.

No Yes Tell us their name and address.

How many hours a week do you usually work? Do you get an Enterprise Allowance? No Yes How much and how often? £ Do you pay into a private pension scheme? No Yes How much and how often? £ every every No Yes How much and how often? £ every No Yes How much and how often? £ 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. Previous page Next page Feedback Save

15-May-13

Part 6

About working for an employer
No Yes Go to Part 7. 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 Your partner

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?

When did you start this job? What is your payroll, employee or staff number? Are you employed for a limited period? No Yes When will you finish? No Yes When will they finish?

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?

£

every

£

every

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15-May-13

Part 6

About working for an employer continued
You Your partner

page 13

How many hours a week do you usually work? Are you getting Statutory Sick Pay (SSP), Statutory Paternity Pay (SPP), Adoption Pay or Statutory Maternity Pay (SMP) from your employer at the moment? Are you getting any other sick pay or maternity pay from your employer at the moment? Do you pay into a private or company pension scheme? No Yes No Yes

No Yes No Yes How much and how often? £ every

No Yes No Yes How much and how often? £ 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.

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15-May-13

Part 7

About any other work
No Yes Go to Part 8. Answer the questions on this page.

page 14

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.

You What other work do you do?

Your partner

What is the name and address of the person you do this work for?

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 Yes Tell us about it below. No Yes Tell us about it below.

£

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.

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15-May-13

Part 8

About benefits and pensions
No Yes Go to Part 9.

page 15

Are you or your partner getting any benefits or waiting to hear about benefits you have claimed? Read the list of benefits below and tell us about any you or your partner are getting now or have claimed.
● ● ● ● ●

Child Benefit Child Tax Credit Fostering Allowance Contribution-based Jobseeker’s Allowance Contribution-based Employment and Support Allowance

● ● ● ● ● ●

Maternity Allowance Working Tax Credit Incapacity Benefit Industrial Injuries Disablement Benefit Industrial Death Benefit Carer’s Allowance

● ● ● ● ● ● ●

Severe Disablement Allowance Statutory Sick Pay Statutory Maternity Pay Statutory Paternity Pay Adoption Pay Bereavement Allowance Guardian’s Allowance

● ● ● ● ● ●

State Retirement Pension War Disablement Benefit War Pension or War Widow’s Pension Widowed Parent’s Allowance Armed Forces Compensation Scheme (AFCS) any other social security benefit

If you are getting or have claimed any benefit that is not listed, tell us about it on a separate sheet of paper and send it with the form. You The name of the benefit or pension Waiting to hear Getting now

If you are sending a separate sheet of paper, tick this box. Your partner

How much, how often and by what method? £ every by

How much, how often and by what method? £ every by

The name of the benefit or pension Waiting to hear Getting now How much, how often and by what method? £ The name of the benefit or pension Waiting to hear Getting now How much, how often and by what method? £ every by How much, how often and by what method? £ every by every by How much, how often and by what method? £ 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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15-May-13

Part 9

About other money coming in
No Yes Go to Part 10. 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.

page 16

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.

Other money 1 What is the money for?

Other money 2

Other money 3

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?

£

every

£

every

£

every

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15-May-13

Part 9

About other money coming in continued
Other money 1 Other money 2 No Tell us about it below. Yes Tell us about it below. Other money 3 No Yes

page 17

Does anyone owe money to you or your partner? What for?

No Yes

Tell us about it below.

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?

£

£

£

No Yes Tell us about it below.

No Yes Tell us about it below.

No Yes Tell us about it below.

How much?

£

£

£

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.

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15-May-13

Part 10 About bank accounts, savings, investments and property
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 Building society accounts No Yes Post Office® accounts No Yes Premium bonds Unit trusts, ISAs, PEPs, TESSAs, TOISAs or other investments Income bonds or capital bonds No Yes No Yes No Yes Money or property held in trust Any other savings or investments No Yes No Yes How many? Total amount £ How many? Total amount £ How many bonds? Total amount £ How many? Total amount £ How many bonds? Total amount £ How many accounts? Total amount £ How many accounts? Total amount £ How many accounts? Total amount £

page 18

Type of other savings or investment Name of the company the shares are held in 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. Previous page Next page Save Number of shares held

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15-May-13

Part 10 About bank accounts, savings, investments and property continued
Do you or your partner have any National Savings Certificates? No Yes No Yes We will write to you about it. We may need to see the original certificates as proof. We will return the certificates to you.

page 19

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 will write to you about it.

No Yes We will write to you about it.

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15-May-13

Part 11 About where you live
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. What is the address? No Yes Tell us about it below.

page 20

Postcode Do you or your partner pay rent on this home? No Yes Do you own your home or have a mortgage? No Yes Are you a council tenant? No Yes What sort of building do you live in? Tick one box only. House Flat Bedsit or rooms or a studio flat Hostel Caravan, mobile home or houseboat Board and lodgings Hotel How much? £

Go to the next question. Go to Part 12. Answer the questions below. Go to Part 12. Care home or, in Scotland, care home service Other – give details

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15-May-13

Part 11 About where you live continued
Does your home have any of these? Tick the boxes that apply. central heating a garden a garage a parking space Who is responsible for decorating your home?

page 21

How many floors are there? Do you and your household occupy only part of the building you have ticked? No Yes As you look at the building from the street, where in the building do you live? At the left At the front Which floors do you live on? For example, ground floor, first floor. How many rooms are there in the building? Just for you and your household That you share with other people At the right In the middle At the back

Living rooms Bedsitting rooms Bedrooms Bathrooms or shower rooms Toilets Kitchens Other rooms

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15-May-13

Part 12 About rent
Who has to pay the Council Tax bill for your home? Tick the box that applies. You or your partner Your landlord Someone else 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? No Yes No Yes 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. 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. Go to Part 13. Answer the next question. Answer the questions below. Go to Part 13. Tell us who it is.

page 22

No Is your landlord or agent, or your landlord or the agent’s partner either Yes What is the relationship? ● 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? 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?

is my landlord’s or agent’s

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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. £ every to

page 23

No Yes Tell us the details below.

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?

£

every

No Yes Send us proof of the date it changed and how much it changed.

When is the next rent increase due? 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
Has your rent been registered as a fair rent by a rent officer? Do you have any weeks when you do not have to pay rent? Are you behind with your rent? No Yes No Yes No Yes By how many weeks? How many weeks in a year? Please send us the notice of registration form RO5.

page 24

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? Which meals? Water authority charges Heating Lighting Hot water Electricity Fuel for cooking Laundry Cleaning rooms or windows Gardening Garage or parking space How much? How much? How much? How much? How much? How much? How much? How much? How much? How much? £ Breakfast £ £ £ £ £ £ £ £ £ £ every Lunch every every every every every every every every every every No Yes Evening meal

Do you have to rent the garage as part of your tenancy agreement? Personal care and support How much? £ every

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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? No Yes How much? What for? £ every

page 25

No Yes

Go to Part 13 Tell us about it below.

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?

Have you sublet your home?

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.

page 26 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.

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.

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.

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.

You must tick one of these boxes.
Tick this box if you would like to be paid into an account 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. 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. Go to Part 14. Go to Part 14.

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15-May-13

Part 13 How we pay you About the account you want to use
● ●

page 27

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.

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
Please use this space to tell us anything else you think we should know about. Use a separate sheet of paper and attach it to this form if you need to. If you are sending any separate sheets of paper with this form, tell us how many.

page 28

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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

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 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 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 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 private rent and tenancy
Such as a rent book, rent receipts, a tenancy agreement or a letter from your landlord.



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 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.

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15-May-13

Part 16 Backdating
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 circumstances different to those you have told 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? No Yes Please tell us about it below.

page 30

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. 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.

Signature of person claiming

Please remember to sign the form in pen after printing.

Partner’s signature

Please remember to sign the form in pen after printing.

Date

Date

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15-May-13

Part 17 Declaration continued
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
Please remember to sign the form in pen after printing.

page 31

Part 18 What to do next
You should now have: filled in and signed the claim form for Housing Benefit, 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 www.gov.uk/find-your-local-council If you are going to send proof at a later date, you should also send this to us.

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15-May-13

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. 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.

HCTB1 tear-off

1

I give my local council permission to share information about the progress of my Housing Benefit claim with my landlord or their representative.

Signature

Please remember to sign the form in pen after printing.

Address

Full name (in CAPITAL LETTERS) Date

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15-May-13

Paying benefit to your landlord
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.

HCTB1 tear-off

2

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

Please remember to sign the form in pen after printing.

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

Please remember to sign the form in pen after printing.

Date

Full name (in CAPITAL LETTERS)

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15-May-13

Questionnaire
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.

HCTB1 tear-off

3

A

Please indicate which background you feel you belong to: Asian Bangladeshi Indian Pakistani Other Asian background Please specify 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

Any other ethnic background Any other ethnic background Please specify

B

Please indicate your nationality: British or mixed British Scottish English Welsh Irish
HCTB1_042013_004_001

Any other nationality

Please specify

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