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					                        Discretionary Housing Payment
From 2 July 2001 Hillingdon Council is allowed to make Discretionary Housing
Payments. These are not classed as payments of Housing Benefit and Council
Tax Benefit. However, the Housing Benefit and Council Tax Benefit section will
administer the scheme.
Hillingdon Council is limited by central Government in the total amount that it can
pay in Discretionary Housing Payments in any financial year. Therefore, unless
you can show an above average need for further financial help with your housing
costs you will not receive this extra payment.
Discretionary Housing payments are made on a short term basis to allow you time
to move or reassess your finances. It will not be awarded indefinitely. The decision
is at the discretion of the Housing Benefit team only. A decision can not be
confirmed until the completed application form has been received and assessed.
It can only be paid in respect of your rent if you receive Housing Benefit. It can only
be paid in respect of your Council Tax if you receive Council Tax Benefit.
In order to apply for a Discretionary Housing Payment, Hillingdon Council requires
you to complete the enclosed application form.
In support of your application for a DISCRETIONARY HOUSING PAYMENT YOU
original documentation will be accepted. If you bring your documents into our
reception at the Civic Centre or the Hayes One Stop, we will give you a receipt and
photocopy them for you.
If you are in receipt of either of the above benefits please provide the following:
 Proof of rent arrears or council tax arrears.
 You need to provide proof of all money you and your partner have. Please send
    your last three months bank, building society and Post Office account
 Please send original proof of all Premium Bonds, National Savings Income
    Bonds Stocks and Shares, Unit trusts, PEP’s, ISA’s, TESSA’s.
 Please provide details of any property that you own.
 Please provide details of any money that you are owed.
 Please provide original proof of any savings held by someone else on your
 Proof of outstanding debts or bills.
 Any other income or savings that has not been accounted for in the list above.
 Letter from doctor, hospital, social/welfare agency
Once a decision is made you will be notified in writing with reasons for the decision.
If successful you will also be told of the amount and the period of payment.
You must notify the Housing Benefit and Council Tax Benefit section of any change
in circumstances, which may affect the level or amount of Discretionary Housing
Payment. This includes any changes in circumstances, which occur between
completing this form and the decision being made, and after a decision to award,
and Discretionary Housing Payment is made.
Payment will be with your Housing Benefit payment for Private and Housing
Association tenants, direct onto your rent account for Council Tenants and direct
onto the Council Tax account in respect of Council Tax claims.
In most cases, if you are overpaid Discretionary Housing Payment then you must
repay it.

For further information please contact the Housing Benefit and Council Tax Benefit

Telephone Number: 01895 556666

Post: Housing Services/Benefits, P.O. Box 458, Uxbridge, UB8 1HN

Visitors: Please go to main reception at the front of the Civic Centre in High Street,
Uxbridge or the Hayes One Stop


Help in completing this form can also be sought from Hillingdon Citizens Advice
Bureau Service. Their advice and information telephone line is 0870 1264021.

Please note that a Discretionary Housing Payment cannot be paid in the following

1. If you are not entitled to Housing Benefit you cannot get a Discretionary Housing
   Payment to help with your rent.
2. If you are not entitled to Council Tax Benefit you cannot get a Discretionary
   Housing Payment to help with your council tax.
3. We cannot give a Discretionary Housing Payment for things included in your rent
   that Housing Benefit could not pay for. This means a Discretionary Housing
   Payment cannot pay for things like heating charges and hot water charges.
4. We cannot consider your request until your Housing and/or Council Tax Benefit
   claim has been fully assessed. This includes where your Housing Benefit claim
   has only partially assessed because the benefit office is waiting for a rent
   assessment from the Rent Service.
5. Discretionary Housing Payment’s are paid for a limited period only. If you
   reapply we cannot guarantee that you will continue to receive a Discretionary
   Housing Payment.
                    Application for Discretionary Housing Payment

Please answer the questions below as fully as possible.

 My full name is:

 My address is:


 Home telephone number:
 Mobile telephone number:
 Email address:

 My Housing Benefit/Council Tax Benefit reference number is


I wish to apply for Discretionary Housing Payment for my: (please tick box)

 Rent                           Council Tax                      Both

 The date I would like it to start is:

How much do you still have to pay once Housing/Council Tax Benefit is awarded
each week?

Rent                  £              Council Tax          £

How much can you afford to pay each week?

Rent                  £              Council Tax          £
If the start date is before today, please advise why you did not apply for
Discretionary Housing Payment earlier:

All customers must complete this section

If you have to pay the shortfall in rent or council tax yourself, what difficulties will this
cause you?

Do you have any other financial resources that you could rely on i.e. family or friends?
If yes, please give details.

 Are your circumstances likely to change in the future? If so, please give details.

Private tenants please complete sections 3 to 10
All other claimants please complete sections 6 to 10


Did you find this accommodation through an agency?                Yes                   No

 If no, how did you find it?

Was anywhere cheaper offered to you?                              Yes                   No
 If yes, why did you not take it?

Did you pay a deposit before you moved in?                      Yes             No

If yes, will you get your deposit back?                         Yes             No

If no, please state why?

What was your previous address?

Did you own the property you previously occupied?               Yes             No

If yes, please provide evidence of sale.

How much was your rent at your last address?                £            per week/month

How much was met by Housing Benefit?                        £            per week/month

If you did not pay rent please explain on what basis you were living there (e.g. living
with friends).

 Why did you move from that address?

 Please attach a copy of any notice to quit the property.
 If you did not previously live in the London Borough of Hillingdon, why did you move
 to this borough?

Before moving to your present address did you contact the Rent Service or the Council
and ask how much Housing Benefit you might get? If you did, please say what the
reply was.

 If you did not make any enquiries either with the Council or anyone else please
 explain how you expected the rent to be paid?


Have you attempted to re-negotiate your rent with your landlord? If so, what was the

Would you like the council’s Housing Advice section to try and re-negotiate the rent
with your landlord? If no, state why

 Do you think your landlord would be agreeable to reducing the rent to an amount you
 could afford if Housing Benefit were paid directly to your landlord?

   Yes                 No
Have you tried finding cheaper accommodation?               Yes                 No

 If yes, please provide full details.

 If no, please say why.

 When does your tenancy end?

If you have to leave your present accommodation, how much notice do you have to

 Are you in arrears with your rent?                         Yes                 No

 If yes, by how much

 Have you had a Notice to Quit?                             Yes                 No

Please provide proof of arrears and your Notice to Quit (original documents, not
copies please).

If your rent is not in arrears please explain how you have managed to pay the rent?

Have you registered on a council house waiting list or with a Housing Association?

    Yes                   No

 Has someone you lived with recently died?                       Yes              No

If yes, please tell us your relationship to the person who died and the date they died.


 Date they died
 Could you live with family or friends?                          Yes              No

 If no, please state why


 All customers must complete this section

 Outgoings             £ per       £ per         Income                £ per       £ per
                       week        month                               week        month
 Rent                                            State Pensions
 Council Tax                                     Work Pensions
 Water Rates                                     State Pensions
 Food                                            Work Pensions
 Private pension                                 Disability Benefits
 Travel/car                                      Child Benefit
 Gas                                             Main earnings
 Electricity                                     Main earnings
 Telephone                                       2nd earnings
 Mortgage                                        2nd earnings
 Clothes                                         Tips/gratuities
 Insurance –                                     Working Tax
 Buildings/contents                              Credit
 Other                                           Child Tax Credit
 (Please detail)
 Other                                           Maintenance
 (Please detail)
 Other                                          Child Support
 (Please detail)
                                                (Please detail)
                                                (Please detail)
 Total:                                         Total:

Total Savings                  £

Do you have any savings or property abroad?                       Yes          No
(Including holiday homes or timeshares)

If yes, please give details.

Have any of your other benefits been reduced as a                 Yes          No
result of a sanction or a reduced benefit direction?

 If yes,
Please state your normal           £           And the amount of the       £
entitlement                                    reduction.

Do you have any debts?                                            Yes          No

If yes, please state what for and for how long you have had the debts and when the
repayments period is due to end.

 What steps have you taken to improve your financial situation? Please provide

 If you have children living with you for some of the time, please give details of when
 they stay (if Social Services are involved please give as much detail as possible).

Are you expecting an increase in the number of people living in your property in the
near future? e.g. is anyone in the household expecting a child/adopting a child, or is
someone else coming to live with you?

Are there medical reasons as to why you or your partner or any members of the
household, including children, need a separate bedroom? Please provide details and
original documentary evidence of the medical condition.

 Do you or your partner have a carer (other than your partner) who stays overnight in
 your home?
                                                           Yes                No

 If ‘Yes’, how often do they stay?

 Is overnight care provided by a carer who doesn’t normally live in your home?

                                                            Yes                 No

 Do you have a spare bedroom that the carer uses to sleep in overnight?

                                                            Yes                 No

 Who needs the overnight care?

 Do you or any member of your family living with you have any special needs which
 require you to spend more money than normal e.g. special dietary needs or medical
                                                       Yes                No
 If Yes, please complete the box on the next page
Special Need                                    Weekly Cost

How much do you spend on prescription charges each week?

What impact does it have on your housing situation?

Do you or any member of your family receive Disability Living Allowance?

                                                            Yes             No

If yes, the name of the person Disability Living Allowance is paid for is

Please advise how this money is spent on meeting the special needs of that person.

Do you, or any member of your family who lives with you, have any health problems,
which mean you need to live in your accommodation, or might be made worse if you
had to move?                                              Yes                No

If yes please give details

Has your home been adapted or modified for the needs of you or any member of your
family who lives with you?                                Yes               No

If yes, please give details

Most non-dependants who are aged 18 or over will usually be expected to make some
contribution towards the household costs. We take this into account by making a
deduction from your Housing and Council Tax Benefit.

The amount of the deduction is set each year and depends on the income and
circumstances of the non-dependant. The Housing and Council Tax Benefit rules do
not allow us to ignore the deduction or to alter the amount.

Please explain why your non-dependant cannot afford to pay the amount of the non-
dependant deduction.

Please explain what financial help your non-dependant gives you. For example does
he or she help with any of the bills, or pay for any of the food?


 Have you lived in the London Borough of Hillingdon               Yes          No

If yes, please give details:
Address                                          Period of residence

Do you have any other links with the London Borough of Hillingdon? Examples
include family live in the borough, work in the borough, children attend local schools?

                                                            Yes               No
  If yes please provide full details:

Personal statement - Please use this space to say why you believe you need a
Discretionary Housing Payment, or to say anything else to support your application.
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
    sections of the council, the rent officer, other councils and benefit authorities.

   I/we understand that I/we must tell the Benefits Service in writing about any changes in
    my/our circumstances that may affect my Housing Benefit or Council Tax Benefit,
    o   If I/we start or stop claiming Income Support, Jobseekers Allowance, Employment and
        Support Allowance or the Guarantee element of Pension Credit;
    o If I/we start or stop work or get a pay rise or an increase in pension;
    o If I/we start or stop receiving another benefit or tax credit (for example, Working Tax
       Credit or Incapacity Benefit); or
    o If someone else moves into or out of my/our home or one of my/our children leaves

   I/we understand that I/we have to tell the Benefit Service about any changes to my/our
    Income Support, Pension Credit or Jobseekers Allowance. I/we understand that the
    Benefit Agency, Pension Service or Job Centre Plus are not responsible for giving this
    information and that I/we must tell Hillingdon Benefits Service myself.

   I/we understand that the Benefit 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/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

   I/we have read and understood this declaration.
Please sign here:

Your signature                                            Claimant          Date

Your partner’s                                                              Date

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

Name of the Person who filled in the form:
Relationship to the person claiming: