Welfare Benefits and Council Tax Support form Welfare Benefits and Council Tax Support form Any delay in returning this form could mean you lose benefit. (For office use) Date stamp

1

Welfare Benefits and Council Tax Support formAny delay in returning this form could mean you lose benefit.

(For office use)

Date stamp Case number

Council Tax account reference

For office use only

Please answer all questions and fill in the form in black ink. Please only write in the white areas. It will help us process your application more quickly if you give us full answers.

If you need help filling in this form or have any questions, see contact details listed on pages 27 and 28.

Please give us all the information and documents we ask for within one month of making your claim or you may lose benefit. If you cannot give us supporting information now, you must still fill in and return the form to us straight away. Normally, we only pay benefit from the Monday after we receive your claim.

This application will be used to work out any entitlement to Free School Meals.

Part 1 About you and your partner

Do you have a partner who normally lives with you? No

Yes If you have a partner, you must answer all the questions about them.

You Your partnerLast name

Other names

Title (Mr, Mrs, Ms and so on)

Address Do not tell us your partner’s address if it is the same as yours.

Postcode Postcode

Date of birth/ / / /

Letters Numbers Letter Letters Numbers LetterNational Insurance number

You can find this on payslips or letters from the Department for Work and Pensions or the tax office. We may not be able to proceed with your claim if we do not have your National Insurance number.

2

(Arabic)

(Bengali)

(Chinese)

(Hindi)

(Polish)

(Punjabi)

(Urdu)

(Somali)

If you need to contact us, but you don’t speak English, you can get help by phoning our call centre on 0151 606 2020 or visiting one of our One Stop Shops. Just tell us which language you speak and we can provide an interpreter on the phone.

This form is available in large print or Braille. If you need a copy in either, please tick. Braille Large print You can take your filled-in form to any of the offices mentioned on page 28. Or, if you are returning it by post, please send your filled-in form and documents to:

Benefit Service, Wirral Borough Council, PO Box No.2, Birkenhead, Wirral, Merseyside CH41 6BU. The cost may be more than a first-class stamp.

For enquiries about Council Tax, Housing Benefit or Council Tax Support and Free School Meals visit our website: www.wirral.gov.uk/benefits.

3

Part 1 About you and your partner – continuedPart 1 About you and your partner – continued

You Your partnerTell us any other names you have used.

Your daytime phone number It may help us to deal with your claim more quickly.

Your e-mail address

Are you: (Please tick the boxes that apply.)

an owner-occupier? living in a hostel? a joint tenant?

a private tenant? a boarder?a housing-association

tenant? a joint owner?If you are aged between 25 and 34 years, have you ever lived in a homeless hostel for any period of 3 months or more?

No Yes

If you have moved home in the last 12 months, tell us your last address and the date you moved.

Date: / / Postcode Postcode

Do you own this property? No Yes 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 from any other country?

No We will write to you about this.

No We will write to you about this.Yes Yes

If ‘Yes’, which country?

What date did you or your partner last arrive in the UK? / / / /

The UK is England, Northern Ireland, Scotland and Wales.Have you completed a Habitual Residency Test with the Department for Work and Pensions?

No Yes No Yes

If ‘Yes’ Please give details If ‘Yes’ Please give details

4

Part 1 About you and your partner – continued

You Your Partner

Have you or your partner claimed Housing Benefit or No Yes No Yes Council Tax Support before? When did you claim? When did they claim?

/ / / /

What address did you claim for? What address did you claim for?

Postcode Postcode

Are you or your partner in No Yes No Yes hospital at the moment? When did you go in? When did they go in?

/ / / /

When do you expect to come out? When do they expect to come out?

/ / / /

Does anyone get Carer’s No Yes No Yes Allowance for looking after you or you partner?

Please tick if you or your partner: You Your Partner

• are a student

• are a student nurse

• are an apprentice

• are on youth training

• are in legal custody

• are severely mentally impaired

• are receiving Disability Living Allowance (Care)

• are receiving Attendance Allowance

• have a long-term illness or disability and are not capable of work

• are registered blind

• are receiving Personal Independence Payment (Daily Living)

We will contact you if we need any more information.

Part 1 About you and your partner – continued

5

Part 2 About children who live with you

You may be able to get extra benefit for children you get Child Benefit for if they normally live with you and they are:• under 16;• aged 16 or 17 and registered for work or youth training; or• aged 16 or over, but still under 20 and in education doing a course not higher than GCE A-level, SCE Higher level

or GNVQ (advanced).Do you have any children?

No Go to Part 3.

Yes Tell us about the children who live with you. For more than four children, use a separate sheet of paper.

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

First child Second child Third child Fourth childLast name

Other names

Date of birth/ / / / / / / /

What is the child’s sex?

The child’s relationship to you

Usual address if different from yours

If this child was not on your last form, please give the date they moved in and their previous address.

/ / / / / / / /

Child Benefit number

Who gets the Child Benefit for them?What is the name of the school your child attends?

Free School MealsWe will use the information that you give us to work out if the children in your home qualify for free school meals. We will write to tell you about your entitlement.

Is the child registered blind or getting Disability Living Allowance or Personal Independence Payment?

No Yes No Yes No Yes No Yes

Do you pay any childminding costs for this child? For example, to a childminder, nursery or after-school club.

No Yes No Yes No Yes No Yes

Tell us the name and registration number of the minder.

How much do you pay a week?




£ £ £ £

We need to see proof.

Part 2 About children who live with you

6

Part 3 About other people who live with you

Do any other people normally live with you and your partner?By other people we mean people 16 and over, who nobody gets Child Benefit for.

No Go to Part 4.

Yes Tell us about all the adults, except your partner, who usually live with you.

Are any of the people who normally live with you married to each other or living together as if they are married?

No

Yes Tell us their names is the partner of

And is the partner of

Now tell us about all the people who normally live with you and your partner. If you want to tell us about more than three people, use a separate piece of paper.

If you are sending a separate sheet of paper, tick this box. First person Second person Third person

Last name

Other names

Date of birth/ / / / / /

National Insurance Number

Their relationship to you

Usual address if different from yours

For example, aunt, brother, daughter, father, grandson, grandmother, stepdaughter, joint tenant, joint owner or friend.If this person was not on your last form, please give the date they moved in and their previous address.

/ / / / / /

Do they get Income Support or income-based Jobseeker’s Allowance?

No Yes No Yes No Yes

We will contact the Department for Work and Pensions to confirm the information given.

Do they get Disability Living Allowance, Personal Independence Payment or Attendance Allowance, or are they registered blind?


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


Tell us which one.

Part 3 About other people who live with you

7

Part 3 About other people who live with you – continued

First person Second person Third personDo they pay rent to you or your partner? No Yes No Yes No Yes Are they severely mentally impaired? No Yes No Yes No Yes Are they in legal custody at the moment? No No No

Yes When are they expected to come out?



/ / / / / /Are they in hospital at the moment? No No No

Yes When did they go in? Yes

When did they go in? Yes

When did they go in?

/ / / / / /When are they expected to come out?

When are they expected to come out?

When are they expected to come out?

/ / / / / /Do they normally work for 16 hours or more a week? No No No

Yes Yes Yes Tell us their weekly earnings before deductions for things like tax and National Insurance

Tell us their weekly earnings before deductions for things like tax and National Insurance


£ £ £

We need to see proof of their earnings.Do they have any other income, benefits or allowances at all? No No No

Yes Yes Yes Tell us their weekly earnings before deductions for things like tax and National Insurance



£ £ £

We need to see proof of their income.

Part 4 About where you liveAre you the owner of this property?Tick ‘Yes’ even if you still have a mortgage.

No

Ye s When did you move in?

/ /Now go to Part 7.

Do you rent your home from a private landlord, registered social landlord, housing association or other?

No

Yes Please tell us which type

Have you or your partner applied or are receiving Universal Credit with housing costs included?

No Answer the next question

Yes Go to Part 7

Part 3 About other people who live with you – continued

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Part 4 About where you live – continued

Is your tenancy a Regulated Tenancy? No Yes (Tenancy started before January 1989)Have you succeeded a Regulated Tenancy? No

Ye s When did you succeed the tenancy? / /

When did you move in? / /

What sort of building do you live in? Detached house Flat in a house Hotel

Semi-detached house Flat in a block Board and lodgings

Terraced house Flat over a shopCaravan, mobile home or houseboat

Maisonette Bedsit or roomsResidential nursing home

Semi-detached bungalow Detached bungalow HostelResidential care home Other

Is there more than one floor?(Including the ground floor.) No

Ye s How many floors are there?Which floors do you live on?

For example, basement, ground floor, first floor.

Do you and your household live in only that part of the building?

No Ye s Where in the building do you live?

At the front

In the middle

At the back

How many rooms are there in the building?

In the whole building?

Just for you and your household?

That you share with other people?

Living rooms

Dining rooms

Bedsitting rooms

Bedrooms

BathroomsToilets (separate from the bathroom)

Kitchens

Other rooms

A bedroom used for a foster childA bedroom only used by a carer who does not live with you.


9


Do you use a separate bedroom for a disabled child? No

Ye s If ‘Yes’ give details

Do you use your home for business purposes? No Yes Do you 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.

No

Yes What is the address?

Postcode

How much rent do you pay for this home?

£

Part 5 About rent Do you pay rent?Tick ‘Yes’, even if you currently receive help with your rent.

No Go to Part 7.

Yes Answer the following questions.When did you start renting your home? / /What sort of tenancy do you have?For example, shorthold.How long is the tenancy for?

/ /to

/ /

Please tick to show if the property is let as: Furnished Partially furnished Minimally furnished

UnfurnishedHow much rent do you pay?You can get this information from your landlord or tenancy agreement.

£ every week every fortnight

every four weeks every month

Does anyone else share the rent with you and your partner? No Yes

Tell us their names and what share of the rent they pay (for example, half).


10

Part 5 About rent – continuedPart 5 About rent – continued

Has your rent changed in the last 12 months? No Yes

Send us proof of the date and amount if you have not done so already.

When is the next rent increase due? / /Are you a tenant of a ‘housing co-ownership’ property? No Yes You will not be entitled to help with your rent payments.Are you a tenant of a ‘shared ownership’ property? No Yes

We must see proof of your rent and tenancy before we can decide how much benefit or support you can get. Read the checklist in Part 14 to see what you can use as proof.

Has your rent been registered as a fair rent by the rent officer? No Yes Do you have any weeks when you do not have to pay rent? No Yes How many?

Are you behind with your rent?No Yes

How much do you owe?

£

We need to see proof.Are any of your Social Security benefits being reduced to pay back the rent you owe?

No Yes

Who pays the Council Tax on your home? You and your partner Your landlord

Someone else – tell us who pays the Council Tax

Are you living away from home at the moment? No Yes Tell us why you are not living at home

When did you last live at home?

/ /

When do you expect to go back home?

/ /

Tell us the address of where you are living at the moment.

Postcode

If your home has been sublet, tell us who lives there now.

11

Part 5 About rent – continuedPart 5 About rent – continued

Does your rent include money for the following?

Meals No Yes How much?£

Which meals are included?

Heating No Yes How much?£

Lighting No Yes How much?£

Hot water No Yes How much?£

Fuel for cooking No Yes How much?£

Laundry No Yes How much?£

Cleaning rooms or windows No Yes How much?£

Gardening No Yes How much?£

Garage or parking space No Yes How much?£

Do you have to rent the garage as part of your tenancy agreement? No

Yes

General counselling and support No Yes How much?£

Council Tax No Yes How much?£

Do you pay any service charges separate from your rent? For example, for cleaning or lighting in shared areas, an alarm system, a warden or lift maintenance.

No Yes How much?£

What for?

Do you pay water charges direct to the water authority? No Yes Does your property have central heating? No Yes Who is responsible for decorating? Inside You Your landlord

Outside You Your landlord What is your landlord’s name and address? By landlord we mean the person or organisation who owns the property you live in.

Postcode

Phone numberIf your landlord has an agent, you must supply your landlord’s name as well as the agent’s details to avoid delays in processing your claim. By agent we mean the person or organisation you actually pay your rent to.

Postcode

Phone number

12

Part 5 – continued and How do you want to be paid?Part 5 – continued and How do you want to be paid?

Are you, your partner or any child you are claiming for related to your landlord, your landlord’s partner, your agent or your agent’s partner?Related includes related through marriage, even if the marriage has ended.

No Yes If you ticked ‘Yes’, please tell us who the relationship is between and the nature of that relationship.

Have you previously owned the property where you now live?You will need to provide evidence of the sale including any capital that you may have made, and reasons for selling.

No

Yes When did you sell it?

/ / (We will write to you about this.)

We can pay your money:• straight into a bank or building society account;• direct to your landlord usually for up to eight weeks (this is to give you time to open your own bank or building society account);• direct to your landlord if your landlord is a housing association or registered social landlord; • direct to your landlord if the rent has been reduced in line with Local Housing Allowance rates, to help keep or renew

your tenancy; or• direct to your private landlord, but only if there is a reason why you cannot manage your own rent

payments. If you think this applies to you, please tick this box. We may write to you for more information.

My landlord is a housing association or registered social landlord and I want my Housing Benefit to be paid direct to them.

We will contact your landlord for their bank details.

Do you have a bank or building society account? No

We will contact you. We may also contact your landlord. If you do not want us to contact your landord, tick this box.

Yes I want my benefit to be paid into my bank or building society account. Tell us the following details.Name of bank or building society

Address

Postcode

Whose name is the account in?

Account number

Sort code

If your landlord is a housing association or registered social landlord and you want us to pay your benefit straight to them, you must sign this declaration.Please pay my Housing Benefit straight to my landlord. I understand that:• I must always tell you about any change in my circumstances;• If I do not tell you about any change of circumstances and you pay me too much benefit because of this, I will have to

pay back the extra benefit; and• I may be prosecuted if I do not tell you about any change of circumstances.

Signature Date / /

13

Part 6 Sharing information with your landlord

Sharing information with your landlord could help us to 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.

In some cases we can share certain information with third parties without your permission where government legislation allows us to do this.

By law, we must tell your landlord about certain decisions we make on your claim, for example, when we decide to pay your benefit to your landlord.

In certain circumstances your first payment may be by cheque, made payable to your landlord, or to your landlord’s bank account.

If you give us permission to share information with your landlord, we would be able to tell your landlord whether:

• you have claimed Housing Benefit;

• 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 information about 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.

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

Signature

Full name (in CAPITAL LETTERS)

Date / /

Part 6 Sharing information with your landlord

14

Part 7 About being self-employedPart 7 About being self-employed

Are you or your partner self-employed? No Go to Part 8.

Yes 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, you will need to fill in a self-employed declaration form. You can get one from our website at www.wirral.gov.uk

You Your partnerWhat kind of work do you do?

When did the business start?/ / / /

What is the business address?

Postcode Postcode

Do you own the property from which you run the business? No Yes No Yes Are there any other partners in the business? No No

Yes Tell us their name and address and supply a deed of partnership.

Yes Tell us their name and address and supply a deed of partnership.

Postcode Postcode

How many hours a week do you work?Do you get a Business Start-Up Allowance? No No

Yes How much? Yes How much?

£ £

Ho w often How often

Every Every

Do you pay into a private pension scheme? No No


£ £


Every Every

We must see proof of any earnings before we can decide how much benefit or support you can get. Read the checklist in Part 14 to see what you can use as proof.

15

Part 8 About working for an employer

Do you or your partner work for an employer? No Go to Part 9.

Yes Answer the questions on this page. If you work for more than one employer, tell us about all the employers on another piece of paper and send it with this form.

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

What kind of work do you do?

What is your employer’s name and address?

Postcode Postcode

Payroll office phone number

When did you start this job?/ / / /

Are you employed for a limited period? No No

Yes When will you finish? Yes When will you finish?

/ / / /What is your payroll, employee or staff number?Do you expect this job to last for more than five weeks? No Yes No Yes How often do you get paid?

Every Every

How much do you get paid (before deductions)? £ £

When was your last pay rise?/ / / /

When is your next pay rise?/ / / /

How many hours a week do you work?Give details of any regular overtime, bonuses, commission or tips.

Are you getting Statutory Sick Pay (SSP) or Statutory Maternity Pay (SMP) from your employer at the moment?

No Yes No Yes

Are you getting any other sick pay or maternity pay from your employer at the moment?

No Yes No Yes

Part 8 About working for an employer

16

Part 8 About working for an employer – continuedPart 8 About working for an employer – continued

How are your wages paid? For example, into your bank account.Do you pay into a private or company pension scheme? No No


£ £


Every Every

If you do not have any wage slips.Please tick the box and sign here if we can contact your employer direct for payment details.If you are a person from overseas have you registered on the Accession State Worker Registration Scheme?

No

Yes If ‘Yes’ please provide your certificate. You still need to do this if you are self-employed.

We must see proof of any earnings before we can decide how much benefit or support you can get. Read the checklist in Part 14 to see what you can use as proof. If you get tips or bonuses, tell us about these in Part 8.

Part 9 About any other workDo 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.

No Go to Part 10.

Yes Answer the following questions.


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

Postcode Postcode

When did you start this work?/ / / /

How many hours a week do you normally work?Do you get paid?If you only get expenses or tips, still tick ‘Yes’ and give details.

No No


£ £


Every Every


17

How are your wages paid? For example, into your bank account.Do you pay into a private or company pension scheme? No No


£ £


Every Every

If you do not have any wage slips.Please tick the box and sign here if we can contact your employer direct for payment details.If you are a person from overseas have you registered on the Accession State Worker Registration Scheme?

No

Yes If ‘Yes’ please provide your certificate. You still need to do this if you are self-employed.

We must see proof of any earnings before we can decide how much benefit or support you can get. Read the checklist in Part 14 to see what you can use as proof. If you get tips or bonuses, tell us about these in Part 8.

Part 9 About any other workDo 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.

No Go to Part 10.



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

Postcode Postcode

When did you start this work?/ / / /

How many hours a week do you normally work?Do you get paid?If you only get expenses or tips, still tick ‘Yes’ and give details.

No No


£ £


Every Every


Part 10 About benefitsPart 10 About benefits

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

No

Yes Answer all the questions in this part.

You Your partnerAre you or your partner getting Income Support? No No

Yes When did you start getting it? Yes When did they start getting it?

/ / / /Are you or your partner getting Universal Credit? No No


/ / / /Are you or your partner getting income-based Jobseeker’s Allowance?

No No


/ / / /Are you or your partner waiting to hear about a claim for Income Support?

No No

Yes When did you claim? Yes When did they claim?

/ / / /Are you or your partner waiting to hear about a claim for income-based Jobseeker’s Allowance?

No No

Yes When did you claim? Yes When did they claim?

/ / / /Are you or your partner getting any benefits or allowances, or waiting to hear about benefits you have claimed?

No

Yes Fill in the table on the next page and tell us about any benefits or allowances you or your partner are getting now or have claimed. Please tick each benefit or allowance as either ‘Yes’ or ‘No’.

Are you or your partner getting Child Benefit, Child Tax Credit or Working Tax Credit for any children who live outside the UK (The UK is England, Northern Ireland, Scotland and Wales)

No How much ?

Yes If ‘Yes’, please provide proof. £

18

Part 10 About benefits – continuedPart 10 About benefits – continued

Read the list of benefits below and tell us about any you or your partner are getting now or have claimed.You

If ‘Yes’, tell us the amount you receive each week.

Your partnerIf ‘Yes’, tell us the amount you receive

each week.No Yes No Yes

Attendance Allowance £ £

Bereavement Allowance £ £

Carer’s Allowance £ £

Still tick ‘Yes’ even if you don’t get this because you are getting another higher social security benefit instead.Child Tax

Credit £ £

Contribution-based Jobseeker’s Allowance £ £

Disability Living Allowance (Care) Low £ £

Middle £ £

High £ £

Disability Living Allowance (Mobility) Low £ £

High £ £

Fostering Allowance £ £

Guardian’s Allowance £ £

Incapacity Benefit or Employment and Support Allowance £ £

Industrial Death Benefit £ £

Industrial Injuries Disablement Allowance £ £

Maternity Allowance £ £

Pension Credit Guaranteed Credit £ £

Personal Independence Payment Daily Living – Standard/Enhanced

(Delete as appropriate)£ £

Personal Independence Payment Mobility – Standard/Enhanced

(Delete as appropriate)£ £

Savings Credit £ £

Reduced Earning Allowance £ £

Retirement Pension £ £

Severe Disablement Allowance £ £

Statutory Sick Pay or Statutory Maternity Pay £ £

War Disablement Benefit, War Pension or War Widow’s Pension £ £

Widow’s or Widower’s Benefit £ £

Working Tax Credit £ £

19

Part 10 About benefits – continued

If you or your partner are getting or have claimed any benefit or allowance that is not listed, tell us about it below.

You Your partnerThe name of the benefit

Waiting to hear

Getting now

Waiting to hear

Getting now

How much?£ £

Ho w often?Every Every

Part 11 About other money coming in

Do you or your partner, or any children you are claiming for, have any other money coming in? (Include all income, benefits, allowances and student income you have not already told us about.) This includes occupational pensions, any medically discharged occupational pension from the Armed Forces, pensions for a partner who has died, maintenance or child support for you, your partner or any of the children you have told us about on this form, and any cash payments. Also tell us about any money you get from people living in your house as boarders, lodgers or subtenants. You do not need to tell us about payments from the Independent Living Fund, the Eileen Trust or the MacFarlane Trust.

No Go to Part 12.


Other money 1What is the money for?

Who gets it?

How much do they get?£ How often? Every

When did they start getting this income? / / How is it paid

(for example, bank, building society account or cash?)


Who gets it?





Who gets it?




Part 10 About benefits – continued

20

Part 11 About other money coming inPart 11 About other money coming in

Does anyone owe money to you or your partner? No

Yes What for?

How much?

£ How is it paid


Is any of your income likely to increase? No

Yes If ‘Yes’, from what date?

/ /What is the income?

£

We must see proof of any money coming in before we can decide how much benefit or support you can get. Read the checklist in Part 14 to see what you can use as proof.

Part 12 About current bank accounts, capital, savings and investments

Do you or your partner have any capital, savings or investments? This includes: current accounts; savings accounts; building society accounts; Post Office accounts; Premium Bonds; stocks and shares; and money and assets overseas.

No

Yes Answer all the questions in this part. We must see proof of all the capital, savings and investments. Read the checklist in Part 14 to see what you can use as proof.

Do you or your partner have any bank accounts? (This includes online bank accounts such as PayPal)

No

Yes Tell us about all bank accounts. If there are more than two bank accounts, tell us about the others on a separate piece of paper and send it with this form.

If you are sending a separate sheet of paper, tick this box. Name of bank Account number

Whose name is the account in? How much is in the account?

£ If there is nothing in the account, please put nil.

Name of bank Account number


£ If there is nothing in the account, please put nil.

21

Part 12 About current bank accounts, capital, savings and investments continuedPart 12 About current bank accounts, capital, savings and investments continued

Do you or your partner have any building society accounts? No

Yes Tell us about all building society accounts. If you have more than two building society accounts, tell us about the others on a separate piece of paper and send it with this form.

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

Name of building society Account number


£If there is nothing in the account, please put nil.

Name of building society Account number


£If there is nothing in the account, please put nil.

Do you or your partner have any other capital, savings, shares or investments? Tell us about any TESSAs, ISAs,TOISAs or compensation and so on.

No

Yes Tell us about this.

Do you or your partner own or partly own any land or property other than the home you live in, either in the UK or abroad?Tick ‘Yes’ even if you have a mortgage or loan on the property, land or timeshare.

No

Yes What is the address?.

Postcode

If you have a mortgage or loan on the property, other than the home you live in, how much is left to repay?

£

How much is the property worth? £

Do you or your partner have any capital from the sale of any other property you may have previously owned? (You will need to provide proof of this.)

No Yes

Have either you or your partner received a Far Eastern Prisoner of War payment?

No

Yes Please tell us how much the payment was for.

£

22

Part 13 Backdating

Please tell us why you did not make your claim for Housing Benefit earlier. We do not backdate Council Tax Support.

Use a separate sheet and attach it to the form if you need to. You must provide evidence to support your request. This must cover the period you are asking for. Give medical evidence if this applies.

What date do you want your benefit to start from? / /

Part 14 Checklist

Please tick to tell us what proof you have provided with this form. We must see original documents, not copies.

If you do not provide all the proof we need, we might not be able to pay you any benefit or support. We need the same proof for your partner, if you have one, and for any other adults living in your home.

If you cannot provide the proof we need at the moment, take the form to your nearest One Stop Shop (see page 27 for details) and they will tell you what proof you need. We can start to process your claim, but we will not be able to pay you any benefit or support until we have all the proof.

Please do not send valuable documents through the post. Take them to any of our One Stop Shops. We will take the details we need and give you the documents back straightaway. If you cannot get to one of our offices, phone us for more advice (see page 28 for details).

Proof of identity – you do not have to give this if you have claimed beforeSuch as a birth certificate, marriage certificate, passport, National Insurance number card, medical card, driving licence, UK residence permit, EEC identity card or recent gas or electricity bill.

Proof of savings and investmentsSuch as all your bank, building society or post office books, or certificates for premium bonds, bank statements showing transactions for the last two full months (we do not accept mini statements), NationalSavings Certificates, ISAs, stocks, shares and unit trusts. We need to see proof of any interest or dividends you get on investments and savings.

Proof of earningsThis 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. We can contact your employer if you do not have these payslips but this may cause delays in processing your application. If you or your partner are self-employed, we need to see your accounts for the last financial year. If you do not have accounts or you have been trading for less than six months, please fill in a self-employed earnings declaration form available from our website (you may be asked to supply your day books or accounts at a later date).

Proof of other incomeSuch as pension slips from a former employer. We need to see proof of any money people pay you for board and lodgings.

Proof of benefits, allowances or pensionsSuch as award notices or letters from the Department for Work and Pensions confirming how much you get. If you do not have proof, let us know straightaway.

Proof of private rent and tenancySuch as an up-to-date rent book, a tenancy agreement or a letter from your landlord.

Proof of other money paid outSuch as letters about student grants or receipts from registered child carers.

Part 13 Backdating

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Part 15 Equal opportunities

We have an equal opportunities policy. It helps to make sure that all our customers have equal access to our services. To help us continue to carry out this policy and improve our service, please fill in the section below. You do not have to fill in this section and this will not affect your claim for benefit or support. All the information you provide will be treated as confidential.

I am Male Female A British or Irish

British Irish Any other white background (please say what)

B Asian or Asian BritishIndian Pakistani Bangladeshi Kashmiri

Any other Asian background (please say what)

C British or Black BritishCaribbean African

Any other black background (please say what)

D Mixed White and black Caribbean

White and black African

White and Asian

Any other mixed background (please say what)

E Chinese F Gypsy and

Traveller G Asylum

seeker H Refugee I Other ethnic group (please say what)

Part 16 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, they must sign this declaration as well.

Please read this declaration carefully before you sign and date it.

I understand the following.

• If I give incorrect or incomplete information, you may take action against me.

• You may use any information I have provided in connection with this and any other claim for social security benefits thatI have made or may make. You may give some information to other government organisations, if the law allows this.

• I know I must let you know straightaway about any change in my circumstances that might affect my claim.I understand that if I have knowingly provided false or incomplete information and don’t tell you about changesin my circumstances, you may take action against me.

I declare the information I have given on this form is correct and complete.

Your signature

Date/ /

Your partner’s signature

Date/ /

Part 15 Equal opportunities

24

Part 16 Declaration – continued

• If my rent includes costs for general counselling and support services, I agree for details of my entitlement to HousingBenefit to be passed to the council’s Supporting People Team, to make sure these costs are paid.

Your signature

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 formSignature of the person

Relationship to the person claimingDate

/ /

Important information – authority to discuss your claim with someone else.

If you contact us at any time about your claim, we will ask you to identify yourself. This is because, under the Data Protection Act 1984, we must not discuss your claim with anyone else.

If you would rather somebody else contacts us on your behalf, such as a family member or neighbour, you should fill in the details below giving your permission.

You can withdraw your permission at any time. To do this, you should write to us to let us know.

Authorisation to discuss my claim

I give permission for the person named below to discuss my claim for Housing or Council Tax Support and authorise the Housing Benefit Section to release any relevant details of my claim to that person.

Name (of this person)

Address (of this person)

Your signature

Part 16 Declaration – continued

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• If your Housing Benefit does not cover your full rent, it may be possible, in exceptional circumstances, to increaseyour entitlement. Please ask for a discretionary housing payment form.

• If you have been receiving Income Support or income-based Jobseeker’s Allowance and you have started work,you may be entitled to four weeks’ extra benefit. You can apply for this in writing or by phone.

• We will probably visit you to confirm the details you have given on this form and to check that you are receiving allthe benefits that you are entitled to.

• You may be entitled to a reduction in the amount of Council Tax you pay. Please refer to the back of your CouncilTax bill for further details. If you feel you may qualify for a reduction, you should contact our helpline for advice orvisit one of our offices listed on page 27.

Discretionary Housing Payments

The Government provides a limited amount of money for Discretionary Housing Payments every year and this money can be used to help people with their rent.

You are eligible to claim if you are receiving some Housing Benefit, or the housing element in Universal Credit and:

• there is a shortfall between your Housing Benefit, or the housing element in Universal Credit and your rent and,

• the amount of Discretionary Housing Payment paid, when added to your Housing Benefit, or the housing elementin Universal Credit entitlement is not more than your rent and,

• you cannot afford to pay the shortfall out of your existing budget.

Discretionary Housing Payments are only for helping with short-term problems, and are not meant to cover long-term situations with your rent.

How much you get depends on your circumstances. We look at each case individually and we pay it for different periods of time. However, there is no guarantee that you will actually get a payment.

In some cases we can award a Discretionary Housing Payment to help with your moving costs.

You must apply in writing. You can get Discretionary Housing Payment application forms from our One Stop Shops or from our website.

Local Housing Allowance

Remember to check the Local Housing Allowance rates before you move address and take up a new tenancy. The Local Housing Allowance rates are available on our website at www.wirral.gov.uk and are also displayed in all of our one stop shops.

A single person under the age of 35 will have their Housing Benefit restricted to the shared accommodation rate regardless of whether they live in self-contained accommodation.

In some cases, a single person under the age of 35 may be entitled to an exemption to the shared accommodation rate restriction. This exemption will make a difference to the way housing benefit is calculated and could mean that a higher rate of housing benefit is awarded. Contact us to find out more.

Housing Options Team

The Housing Options Team can give you free, confidential help and advice on all housing matters. If you are experiencing a problem with your housing we want to see you as soon as you think you may be in difficulty.

To access the Housing Options service you must go to any One Stop Shop where Advisors can offer you advice and assistance. They can also make a referral to Housing Options who will arrange an appointment for you to see a Housing Advisor or Homelessness Officer if required. Further information can be found on the Council website www.wirral.gov.uk

Other informationOther information

26

Most of the social housing lettings in Wirral take place through Property Pool Plus (previously known as Wirralhomes),the Choice Based Lettings service. Properties are advertised on the website www.propertypoolplus.org.uk and at One Stop Shops every week and if you are interested in one you need to make a bid. To make a bid you will first need to register with the service via the website or at a One Stop Shop. Property Pool Plus also advertises Available Now social housing and accredited Private Sector properties; for these property types, you need to contact the landlord direct.

How we collect and use information

Wirral Council will use the information you give on this form and any supporting evidence you send us, to process your claim for Housing Benefit, Council Tax Support and Education Welfare Benefit. Any information you give which identifies a living individual such as yourself, or another person, is classed as Personal Data and subject to the 8 principles of The Data Protection Act 1998.

Wirral Council is a Data Controller under The Data Protection Act 1998. We are notified with the Information Commissioner and we only process Personal Data within the strict confined of The Data Protection Act 1998. If you would like to know more about how we process Personal Data, please see our website at http://www.wirral.gov.uk/my-services/council-and-democracy/freedom-information-and-data-protection/data-protection-act

If you do not have access to the Internet, you can use Internet provision at our One Stop Shop or any of our libraries. Alternatively, you can write for more information to:The Information Manager, Wallasey Town Hall, Brighton Street, Wallasey, Wirral, Merseyside CH44 8ED.

To make sure you get all the financial help you are entitled to and help reduce the number of times you have to give the same information to us, we will share your information with other relevant service areas and external organisations, such as the Department for Work and Pensions, HM Revenue & Customs and Credit Reference agencies. This sharing of information, helps us improve the quality of service we can offer you, guard against fraud and make sure you receive the correct amount of benefits and support you are entitled to.

Sometimes we may need to check or cross reference information you have given us. We may also give or receive information about you from third parties in order to:• make sure the information is correct;• prevent or detect crime; and• protect public funds.

The third parties include government departments, other local authorities and private-sector organisations such as banks. Please be advised that the Council will not share your information with any third parties unless we have a lawful basis to do so. If you do not have a bank account, we will arrange for you to receive your payment from the Post Office, this means we need to share your details with the relevant third parties involved in processing your payment.

Property Pool PlusProperty Pool Plus

27

What to do with the form when you have filled it inWhat to do with the form when you have filled it in

Housing Benefit and Council Tax Support enquiries at the following offices with appointments only. Counter enquiries: Monday to Friday, 9am to 5pm unless it says otherwise. To make an appointment at stated sites ring 0151 606 2220.

Bebington One Stop Shop Pennant House, The Village, Bebington, Wirral, CH63 7PL (Open Monday, Tuesday, Thursday and Friday 9am to 5pm, Wednesday 9am to 4pm)

Birkenhead One Stop Shop Conway Centre, Conway Street, Birkenhead CH41 6JD (Open Monday to Friday 9am to 5pm, Saturday 9am to 12.30pm – Drop in service)

Eastham Library/One Stop Shop, Mill Park Drive, Eastham, Wirral, CH62 9AL (Open Monday, Tuesday, Thursday and Friday 9am to 5pm, Wednesday 10am to 5pm)

Heswall Library/One Stop Shop Telegraph Road, Heswall, CH60 0AF (Open Monday, Tuesday, Thursday and Friday 9am to 5pm, Wednesday 10am to 5pm)

Moreton Library/One Stop Shop Pasture Road, Moreton, CH46 8SA (Open Monday, Tuesday, Thursday and Friday 9am to 5pm, Wednesday 10am to 5pm)

New Brighton One Stop Shop Community Centre,1a Hope Street, New Brighton, CH45 2LN (Open Monday to Friday 11am to 3pm)

Rock Ferry One Stop Shop 257 Old Chester Road, Birkenhead, CH42 3TD (Open Monday, Tuesday, Thursday and Friday 9am to 5pm, Wednesday 10am to 5pm)

Seacombe One Stop Shop The Dave Jackson Suite, Town Hall, Wallasey, CH44 8ED (Open Monday, Tuesday, Thursday and Friday 9am to 5pm, Wednesday 10am to 5pm – Drop in service)

West Kirby One Stop Shop The Concourse, West Kirby, CH48 4HZ (Open Monday, Tuesday, Thursday and Friday 9am to 5pm, Wednesday 10am to 5pm)

Tenants of the following housing associations can go to the offices below to give in forms or tell us about changes in their circumstances.

Magenta Living:

Partnership Building, Hamilton Street, Birkenhead, Wirral, CH41 5AA

Beechwood and Ballantyne Community Housing Association:

Manor House, Beechwood Drive, Beechwood, Prenton, CH43 7ZU

Wirral Methodist Housing Association:42 Hamilton Street, Birkenhead, CH41 5AE

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The One Stop Shops offer the following services in their public areas.

Wheelchair access. Toilets with access for disabled people.

Car parking spaces for disabled people (blue badge holders). Rooms for you to change your baby’s nappy in.

A variety of information leaflets. A children’s play area (unsupervised).

Induction loops to help you if you are hard of hearing. Private interview rooms.

You can write to us at: Benefits Service, PO Box 2, Wirral Borough Council, Birkenhead, Wirral CH41 6BU.

Helpline: 0151 606 2002 for Council Tax, Housing Benefit and Council Tax Support and free school meals enquiries.

Monday to Thursday: 8am to 6.30pm • Friday: 8am to 5pm • Saturday: 9am to 12.30pm

E-mail: [email protected] • [email protected] • [email protected]

Website: www.wirral.gov.uk

To report suspected Benefit Fraud call free on 0800 731 5783 or text us on 07786 202 304, starting your message with ‘Fraud’.

Citizens Advice Wirral

You can get help to fill in your form from Citizens Advice Wirral. They can also give you

help and advice if you are struggling to manage money or debts.

Phone 0344 477 2121 or visit one of their offices:

Birkenhead: 50 Argyle Street, Birkenhead CH41 6AF

Heswall: Hillcroft, Rocky Lane, Heswall CH60 0BY

Wallasey: 237-243 Liscard Road, Wallasey CH44 5TH

Issued July 2016

Documents

Welfare Benefits and Council Tax Support form Welfare Benefits and Council Tax Support form Any delay in returning this form could mean you lose benefit. (For office use) Date stamp