Discretionary Housing Payment Application

* Mandatory question please answer

Do you receive Housing Benefit payments from Northampton Borough Council, or the housing element of Universal Credit ? *

Section 2 of 5 - Current Housing Situation:

When does your tenancy end ? * Please give details of how much notice you need to give your landlord to end your tenancy. *

Have you tried to negotiate a lower rent with your landlord ? *

Are you on the Northampton Borough Council housing register ? *

Does your rent include any service charges ? *

Are you prepared to move home ? *

Are you in rent arrears ? *

Section 3 of 5 - Financial Circumstances:

Please indicate what INCOME you/partner receive and complete the relevant details.

Wages: *

JSA / ESA / IS/ Universal Credit: *

Child Tax Credit: *

Working Tax Credit: *

State Retirement Pension: *

Private or Occupational Pension: *

Pension Credit: *

Child Benefit: *

Incapacity Benefit: *

Disability Living Allowance: *

Personal Independence Payments: *

Child Support: *

Non-dependants Contribution: *

Other (Please Specify): *

Section 3 of 5 - Financial Circumstances:

Please indicate all household EXPENDITURE there is and complete the relevant details, keeping arrears separate. (PART 1 of 3)

Rent: *

Council Tax: *

Water: *

Gas: *

Electric: *

Other Fuel: *

Phone (Landline): *

Phone (Mobile): *

Broadband/Internet: *

TV (Digital/Cable): *

TV Licence: *

Section 3 of 5 - Financial Circumstances:

Please indicate all household EXPENDITURE there is and complete the relevant details, keeping arrears separate. (PART 2 of 3)

Motor Vehicle: *

Other Travel Expenses: *

Personal Insurance: *

Home Insurance: *

Child Support Payments: *

Court Fines: *

Credit Card Payments: *

Hire Purchase Payments: *

Loan Repayments: *

Catalogue Payments: *

Pension Contributions: *

Section 3 of 5 - Financial Circumstances:

Please indicate all household EXPENDITURE there is and complete the relevant details, keeping arrears separate. (PART 3 of 3)

Child Care: *

School Dinners: *

School Clubs/Expenses: *

Clothing (including school uniforms): *

Food: *

Toiletries: *

Other Household Items: *

Pet Food: *

Newspapers/Magazines: *

Alcohol: *

Entertainment: *

Cigarettes/Tobacco: *

Other (Please Specify): *

Amount (You):	Frequency:		Amount (Partner):	Frequency:

Amount (You):	Frequency:		Amount (Partner):	Frequency:

Amount (You):	Frequency:		Amount (Partner):	Frequency:

Amount (You):	Frequency:		Amount (Partner):	Frequency:

Amount (You):	Frequency:		Amount (Partner):	Frequency:

Discretionary Housing Payment Application

Personal Information:

Section 1 of 5 - Personal Circumstances:

Section 2 of 5 - Current Housing Situation:

Section 3 of 5 - Financial Circumstances:

Section 3 of 5 - Financial Circumstances:

Section 3 of 5 - Financial Circumstances:

Section 3 of 5 - Financial Circumstances:

Section 4 of 5 - Additional Information:

Section 5 of 5 - Declaration:

Processing:

Confirmation: Application received

Error:

Contact the Council

Service Charge:	Amount:	Frequency:

Description:	Who:	Amount:	Frequency:

Discretionary Housing Payment Application

Personal Information:

Section 1 of 5 - Personal Circumstances:

Section 2 of 5 - Current Housing Situation:

Section 3 of 5 - Financial Circumstances:

Section 3 of 5 - Financial Circumstances:

Section 3 of 5 - Financial Circumstances:

Section 3 of 5 - Financial Circumstances:

Section 4 of 5 - Additional Information:

Section 5 of 5 - Declaration:

Processing:

Confirmation: Application received

Error:

Contact the Council

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