Revenue and Benefit Service

North Tyneside Council

Quadrant East
Silverlink North
Cobalt Business Park
North Tyneside
NE27 0BY

Tel: 0345 2000 101

e-mail: [email protected]
www.northtyneside.gov.uk

Discretionary Housing Payment Application Form

Discretionary Housing Payments (DHP’s) can only be paid if you have circumstances, which
mean you need extra financial support to pay your housing costs. The fund is limited, not
everyone who applies will be awarded a Discretionary Housing Payment. It is paid as a short
term solution only.
To be considered you must be in receipt of either Housing Benefit or Universal Credit
including the Housing Element for the period you are claiming a DHP.
Discretionary Housing Payments cannot be paid for:
• Charges for water rates, gas, electric or an amount in your rent to reduce rent arrears.
• Periods of Sanctions & reductions in State Benefits or shortfalls due to an overpayment
being recovered.
• You must provide documents, which support your application such as utility bills, credit
card bills, receipts, loan agreements etc if you are asked to do so. These must be original
documents.
Important information – please read
• We can refer you to the Citizen’s Advice if we think they can help you. They are a free,
confidential and impartial service and are not part of the Council. They will ensure that
you are claiming everything you are entitled to, that you receive right advice about any
debt you may have as well as provide budgeting advice. This will help you manage the
shortfall in rent in the future.
• We will only refer you to CAB if you want us to. You can do this by ticking the box later in
this form; this will allow us to provide to them your name, address, contact details and
any relevant information relating to my application so they can contact you direct. You
can ask us to remove this consent by contacting the Council.
• If you have asked us to refer you to Citizens Advice, they may contact you before we
have made our decision on your DHP.
• If you do not ask us to refer you to Citizens Advice, please let us know the reasons so we
can understand why. There is a place to give your reasons on the last page of this form.
• If you are out of work or looking to increase your income, we would like to refer you to the
Employment and Skills Team who is another Council service. They will provide you with
one to one, professional support towards managing changes, gaining skills, job
searching and moving into employment. If you want us to do this, please tick the box
later in this form.

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If you are awarded a DHP:
• You will be expected to take steps to improve your financial circumstances so when your
award ends you are able to pay any shortfall between your rent and Housing Benefit
yourself without the need for a DHP. This could include seeking help from Citizens
Advice.
• You must tell us about any changes in your circumstances as it may affect the amount of
Housing Benefit and DHP that you receive. If you don’t, you may receive money that you
are not entitled to, and we can ask you to pay this back.
• If you are unhappy with our decision you can ask us to look at our decision again.
Officers who were not involved in the original decision will review the decision and inform
you of the outcome.
• The amount and length of the award depends on your circumstances. We will tell you
how long the DHP has been awarded for so you know when it will end and can budget
for it.

You can contact us for advice and information either;

Phone our contact centre on: Email us at:

Benefits and Council Tax 0345 2000 101 [email protected]
Opening hours: 7:30am to 8:00pm [email protected]

Alternatively, in person at our Customer Service Centres listed below;

Killingworth Customer Service Centre North Shields Customer Service Centre

White Swan Centre, North Shields Customer First Centre
Citadel East, Northumberland Square
Killingworth NE12 6SS North Shields NE30 1QU
Mon -Thurs 9.00am - 4.30pm Mon – Thurs 9.00am - 4:30pm
Fri 9.00am – 4:00pm Fri 9.00am – 4:00pm
Wallsend Customer Service Centre, Whitley Bay Customer Service Centre
16 The Forum York Road,
Wallsend NE28 8JR Whitley Bay NE26 1AB
Mon – Thurs 9.00am - 4:30pm Mon - Thurs – 9.00am – 4:30pm,
Fri 9.00am – 4:00pm Fri 9.00am – 4:00pm
If you are having financial difficulty and need independent debt advice, please contact
one of the free advice organisations listed below:
Citizens Advice Bureau
Telephone Advice Line 0300 3309 047 - or email www.ntcab.org.uk

• National Debt line 0808 808 4000 or email www.nationaldebtline.co.uk

• StepChange Debt Charity 0800 138 111 or email www.stepchange.org.uk
• Money Advice Service 0300 500 5000 or email www.moneyadviceservice.org.uk

Other useful contact telephone numbers:

North Tyneside Council Contact 0345 2000 101 or email
Centre [email protected]
Jobcentre Plus 0800 055 6688 or email www.jobcentreplus.gov.uk
Tax Credits Helpline 0844 856 4312 or email www.hmrc.gov.uk

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 Disability Living Allowance/ 08457 123 456 :or email DCPU.Customer-
Attendance Allowance Helpline [email protected]
Child Benefit Helpline 0845 302 1444 or email www.hmrc.gov.uk

To apply for a Discretionary Housing Payment, you must answer all questions. Use a
separate sheet if necessary.

If you are claiming for removal costs only please complete your personal
details at Q1 and removal costs at Q2A, then please sign the declaration on
page 8

1.
CUSTOMER NAME:
HOUSING BENEFIT NUMBER:
ADDRESS:

POSTCODE:
TELEPHONE NUMBER:
N.I.NUMBER:
1A. Please give details of your special circumstances and why you require a DHP.
Please include details of any disabilities you or any other member of your household have.
Please also state if your property has been adapted for your needs and if so please list these
below.

2. Please state the amount and period you would require a DHP for. Please also give
details of how you have previously been able to meet the shortfall in your rent payment.

If you do not want to claim a DHP for removal costs, please go straight to question 3.
2A. DHP for removal costs only. Please state name of company used and amount paid.
Your receipt of payment is required

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3. Do you have a legal arrangement for overnight custody of your children? If yes give
details of how often you have your children. Please note we will require sight of the Court
Order or a Solicitor’s letter confirming this.

4. As a DHP is only for a short period please explain how you intend to meet your
shortfall in the future. Please give details of what action you have taken so far and the
action you intend to take in the future e.g. reduce your expenses, look for cheaper
accommodation, request help from family or other household members, negotiate a lower
rent with your landlord, seek employment or increase your hours of work.

5. If you have previously been in receipt of a DHP, please tell us what steps you have
taken to improve your circumstances. Please provide evidence to support this.

6. Have you, or do you intend to contact The Citizens Advice Bureau or, any other
voluntary organisation, to make sure you are claiming all of the Welfare Benefits you
are entitled to or for Debt advice? If yes, please give details.

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7. If your accommodation is larger than you need, please tell us why you need to live
there. Also advise if you have looked for a smaller property. If not, please tell us
why.

8. Do you give us permission to contact your landlord and try to negotiate the level of
rent? Yes No

If you do not claim Universal Credit, please go to Question 10.

9. Universal Credit claimants please complete and provide the following:

• your Secretary of State decision letter

• proof of rent e.g. your tenancy agreement
• if you are a private tenant please confirm below whose bank account you wish your
award to be paid into
• please provide below the bank sort code and account number you wish your award to
be paid into
• please confirm below your landlord’s name and address

If you are liable for Council Tax and have not made a claim for Council Tax Support
please make an on-line claim by visiting www.northtyneside.gov.uk/benefits

List of all members of your household

Name Relationship to you Date of birth

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The name on the bank account you wish your award to be paid into

Bank sort code and account number

Your landlord’s name and address

10. Income - Please give details of all income for yourself and your partner. We
need to know about wages (gross and net) and whether they vary, all welfare benefits,
pensions, board, money from lodgers, maintenance payments or any other income from
any other source.

Weekly Income (Source e.g. wages/State Benefits) Weekly Income Amount.

Please give details of all capital for yourself and your partner.
Capital (Bank, Building Society, ISA, Premium Bonds)

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Please give details below for each employed household member.

Name of household Employer’s Name and Address Average gross weekly

member wage

Please give details of any other income e.g. maintenance, fostering allowance, payments
from boarders, money received from non-dependants.

11. Expenditure – please provide weekly amounts

Rent £ Travelling Expenses £

Council Tax £ Motor Vehicle / Petrol £
TV Licence £ Tax, Insurance & Maintenance £
of Motor Vehicle
Water Rates £ Bank / Building Society Loans* £
Housekeeping £ Other Loans* £
(food, toiletries etc)
Gas £ Mail Order / Catalogue* £
Electricity £ HP / Credit Agreements* £
Telephone £ Social Fund Loan Repayments* £
Multimedia Package £ Fines* £
(Sky/Virgin)
Child Maintenance Payments £ Other (please specify) £

Total Weekly Income £ Total Weekly Expenses £

*For loans, catalogue and credit agreements etc, please also tell us when it is
expected to end and to whom it is payable. We may require proof of these.

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Please give details of any additional expenditure (including arrears and payment
arrangements). Use a separate sheet if necessary.

If you have arrears, please tick here to allow us to confirm these details with
your landlord.

I would like to be referred to Citizens Advice. Please Tick

I give consent for my details to be shared with CAB and for CAB to store my data and
to use this to contact me so they can provide me with assistance.

If you do not want to be referred to Citizens Advice for help, please let us know your
reasons.

For claimants requesting Employment and Skills support – I would like to be referred
to the Employment and Skills Team for help. Please Tick
Declaration - I understand that:
• If any of the information I have provided with regard to my DHP claim is not
accurate, the Council may take steps to recover any DHP that I am not entitled to.
• I have a duty to inform North Tyneside Council immediately if there is any change in
my circumstances that may affect any award of DHP.
• I will be expected to repay any amount of DHP I am overpaid.
• I am aware that I will be referred to Citizens Advice if I have asked for this. I
understand that the Council will share my name, address, contact details and any
relevant details with them so they can contact me. I know that I can remove my
consent to be referred to CAB by notifying the Council.
• I am aware that I may be referred to the Education to Employment Team if have
asked for this.

Signature: Date:
If someone else has completed this form on your behalf, please give their name and
relationship to you.