Housing benefit supported accommodation individual needs

1Using the form

2Declaration

3About you

4About the tenant

5About the tenant's circumstances

6About support cover

7About the property

8About the payment

Use this form to let us know specific information required by the Department for Work and Pensions in line with their current guidance.

In addition to an application for Housing Benefit this form is used to establish if the tenant needs accommodation with support, and it is being provided.

The form must be completed, with all questions answered, by the care provider so we can calculate the correct level of Housing Benefit the tenant is entitled to.

This form will ask you to provide

Your details
Tenant details, including National Insurance and Housing Benefit reference number
Designated social or support worker details, if applicable
Information about the tenant's individual circumstances, including a signed copy of the care plan or another similar document
Details of any support the tenant receives
Accommodation and room details

Please have this information ready as pages time-out after one hour.

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Privacy Statement

To provide this service Thanet District Council will collect and process personal information. We may check some of the information with other sources (e.g. government departments and other councils) to verify your identity and ensure that the information you have provided is accurate.

Your personal information is being processed because it is necessary for compliance with a legal obligation or for the performance of a task carried out in the public interest.

Please refer to our Corporate Privacy Notice for further details on how we process your personal information and your rights. This is also available in other formats (e.g. print).

Declaration

Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form:

I confirm the details I will give are correct and that the documents I will upload as proof are original copies and have not been edited in any way.
I confirm that I will notify you of any relevant changes straight away.
I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me.
I understand my data may be shared with other departments as permitted by law.

Declaration(Required)

I understand and accept the above declaration

About you

Your name(Required)

Job title/position(Required)

Company or organisation name(Required)

Address(Required)

Postcode(Required)

Email address(Required)

Enter Email Confirm Email

Contact phone number(Required)

About the tenant

Tenant's name(Required)

Tenant's date of birth(Required)

National Insurance number(Required)

Tenant's Housing Benefit reference number(Required)

Tenant's address(Required)

Tenant's postcode(Required)

Tenant's contact phone number(Required)

Is the tenant capable of dealing with a phone call from us to gather more information about their case?(Required)

Yes

Does the tenant have a designated social or support worker?(Required)

Yes

About the social or support working

Full name of social or support worker(Required)

Company name(Required)

Company address including postcode(Required)

Email address of social or support worker(Required)

Enter Email Confirm Email

Contact phone number of social or support worker(Required)

About the tenant's individual circumstances

Please select all that apply to your tenant(Required)

Receives the limited capability for work element within their Universal Credit award

In receipt of Employment and Support Allowance

Receives national insurance credits due to incapacity

Currently entitled to Statutory Sick Pay

A pregnant woman, or one who has recently had a baby, and she is within a period beginning on the first day of the sixth week before the expected week of childbirth, or beginning with the actual date of childbirth if that is earlier, and ending with the 14th day after the date she has had the baby

None of the above

Are you assisting them to claim any additional benefits?(Required)

Yes

Please provide details of any additional benefits you are assisting them to claim(Required)

Has the tenant been subject to a care order or “looked after” under the Children Act 1989?(Required)

Yes

Was the tenant a former resident of a specialist hostel for homeless persons for at least three months?(Required)

Yes

How was it determined that the tenant needs the support attached to this accommodation prior to moving in?(Required)

Explain in detail what care, support or supervision will be provided to this tenant based on their individual circumstances and not the schemes aims and objectives.(Required)

Does the tenant have a care plan or something similar in place?(Required)

Yes

Please upload a signed copy of the care plan, if there is one, or another similar document(Required)

Drop files here or

Max. file size: 4 MB, Max. files: 2.

You can redact personal information as we mainly need to know about the provided care

About support cover

Please tell us the level of support this tenant receives, use n/a if not applicable

24 hour sleep in support(Required)

By you or your company

By others, if known

Intensive high-level support(Required)

By you or your company

By others, if known

Life skills(Required)

By you or your company

By others, if known

Sheltered housing(Required)

By you or your company

By others, if known

Floating support for general needs(Required)

By you or your company

By others, if known

Other level of support(Required)

By you or your company

By others, if known

If other level of support, please provide details

The type of support you provide, use n/a if not applicable

Office hours(Required)

Visiting support

On site support

Emergency call out

Evenings(Required)

Visiting support

On site support

Emergency call out

Weekends(Required)

Visiting support

On site support

Emergency call out

24 hours(Required)

Visiting support

On site support

Emergency call out

Sleep in(Required)

Visiting support

On site support

Emergency call out

Additional details for the type of support you provide, if applicable

How many hours support and or care does the tenant receive in a typical week from you.(Required)

Face to face contact

Telephone contact

Other contact

About the property

What type of accommodation does the tenant rent?(Required)

Please provide details of other type of accommodation(Required)