1 Start 2 Complete HHS Grant Application Form Name * Address * Contact telephone/mobile phone number * Email address * Do you receive housing benefit? * Yes No Do you receive the housing element within your Universal credit award? * Yes No Do you receive Discretionary Housing Payment * Yes No Do you have rent arrears? * Yes No NB if you have answered Yes. Please ensure that you provide evidence of this, such as a rent account statement or screen shot of your rent account detailing the last 6 months transactions. Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Please explain the reason for your application for an Exceptional Household Support Payment. (Please provide evidence to support your request) * Leave this field blank
