Application for a discretionary housing payment

If you wish to be considered for a discretionary housing payment, please complete the following form.

Personal details
Claim details

Please complete the following questions so we can assess your entitlement to these payments.

Household income

Please now complete your household income details.

Household expenses

Please now complete your household expense details. If any of your expenses are unusually high, please state why.

Declaration - please read carefully.

The Council can prosecute anybody who gives false information or documents about their claim for a Discretionary Housing Payment, or anybody who keeps claiming after their circumstances have changed in a way that would affect whether they would receive a Discretionary Housing Payment.

  • This is my claim for a Discretionary Housing Payment.
  • I will tell you if the information on any letter you send me is incorrect.
  • The information I have given is true and complete.
  • You can check any information relevant to my application. This includes sending a Certificate of earnings direct to my employer if required.
  • I am not claiming a Discretionary Housing Payment for any other address.
  • I understand that you may contact the Home Office, Benefits Agency or Employment Service to check the information I have given on the form and to get other information.
  • I will write to you straight away if there are any changes in my circumstances so that you can work out my Discretionary Housing Payment again. If I do not, and get too large an award, an award the Council can ask me to pay it back. I may also be prosecuted under the Social Security Administration (Fraud) Act 1997.