Housing Benefit claim form

Additional information about your rent

You should complete this form if you pay rent to someone other than Orkney Islands Council. It will give us extra information we need to know about the property you rent.

Part 1 About you

Last name

Other names

Address (this is the address that you want to claim for - including room number if relevant)

Postcode

Part 2 About your rent

When did you start renting your home? //___

How much is the rent for your home? £______

How often are you due to pay this rent?

(weekly/fortnightly/4 weekly/calendar monthly)

What sort of tenancy do you have?

(for example, assured, short assured, private residential agreement, or don't know)

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

If Yes, please tell us their names and their relationship to you?

How long is the tenancy for? From // To //

What is your landlord's name and address?

By landlord we mean the person or organisation who owns the property you live in.

Postcode

If your landlord has an agent, tell us their name and address

Postcode

You must provide proof of your rent and tenancy, such as a rent book, a tenancy agreement or a letter from your landlord. The proof must include:

• the full name and address of the landlord or agent
• the amount of rent you pay and how often it is due to be paid (weekly/fortnightly/monthly/4 weeks)
• the date the agreement started
• what is included in the rent

We must see original documents, not copies.

IMAGE: The first page shows the Orkney Islands Council crest and the Housing Benefit claim form title, followed by blank fields for the claimant’s name and address, rent and tenancy details, landlord and agent information, and a boxed notice listing the required proof of rent and tenancy.

Part 2 About your rent continued

Are you, your partner or any of your children related to your landlord or agent, or to your landlord's partner or the agent's partner? No ☐ Yes ☐

If Yes, what is the relationship?

Related includes related through marriage, even if the marriage has ended. Some examples are ex-wife, ex-husband, aunt, brother, daughter, father, grand-daughter, son-in-law or step-daughter.

Have you or your partner ever owned any part of the property? No ☐ Yes ☐

Do you or your partner live in the property as a condition of your work? No ☐ Yes ☐

Do you or your partner rent the property from a company of which you are a director or employee? No ☐ Yes ☐

Has your rent been registered as a fair rent by the rent officer? No ☐ Yes ☐

(this can only apply if your tenancy began before 2 January 1989)

Do you have any weeks when you do not have to pay rent? No ☐ Yes ☐

Part 3 Services included in your rent

Does your rent include money for:

If Yes, which meals are included?

Breakfast ☐    Lunch ☐    Evening Meal ☐

If Yes, what is this for?

IMAGE: The second page contains questions about family or business relationships with the landlord, property ownership, work-related occupancy, fair rent registration and rent-free weeks. It also provides checkboxes and amount fields for meals, heating, lighting, hot water, cooking fuel, laundry, gardening, chimney sweeping, personal care and support, cleaning, water authority charges and other charges.

Part 4 About where you live

How many floors are in the whole building?

Which floors do you live on? (for example, all, ground, first, etc)

How many rooms are in the building?

What rooms are they? (give number of each)

(For example, 3 Bedrooms, 1 Kitchen etc)

Which rooms are for the sole use of you and your household?

Which rooms do you share with other households?

(For example, None, 1 Kitchen, 1 Bathroom etc)

Who is responsible for decorating the property?

You ☐    Your Landlord ☐    Don't Know ☐

Is the property furnished:

Fully? ☐    Partly? ☐    Minimally? ☐    Unfurnished? ☐

Do you have the use of a garage? No ☐ Yes ☐

Does your home have central heating? No ☐ Yes ☐

What sort of building do you live in?

• Detached house ☐
• Flat in a house ☐
• Terraced bungalow ☐
• Semi-detached house ☐
• Flat over a business ☐
• Hotel or hostel ☐
• Bungalow ☐
• Flat in a block ☐
• Caravan ☐
• Semi-detached bungalow ☐
• Terraced house ☐
• Other ☐
• Bedsit or rooms ☐

If ticked, where in the building are the rooms?

Front ☐    Middle ☐    Back ☐

Part 5 How you will be paid

I would like my Housing Benefit to be paid

• Direct to my Landlord (Housing Association tenants only) ☐
• Directly into your bank account (please complete details below) ☐

Payments will be made every 2 weeks in arrears.

Name of your Bank / Building Society

Bank/Building Society Address

Postcode

Account number

Sort Code

Name of account holder(s)

Roll number (Building Societies only)

In most instances you will no longer be able to choose to have payments made direct to your landlord. There are some exceptions, for example, if you are a tenant of Orkney Housing Association (if payments are made direct to your landlord they will be made every 4 weeks in arrears.)

IMAGE: The third page asks about the building, floors, rooms, furnishings, decoration, garage, heating and building type. It then provides payment options for payment to the landlord or bank account, with blank fields for bank and account details.

Part 6 Sharing information with your landlord

Sharing information with your landlord or housing association could help us deal with your claim more quickly and reduce the risk of you falling behind with your rent because of your claim being delayed.

We need your permission before can discuss your claim with your landlord. If you would like to grant permission you should sign the authorisation below. This permission may be withdrawn at any time.

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

you have claimed or renewed your claim for Housing Benefit; we have made a decision on your claim, or we need more information to make a decision and what that information may be.

We will not give your landlord any information about:

your personal or household circumstances, or your financial circumstances.

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

Signature of person claiming

Part 7 Declaration

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

Signature of person claiming

Date __//__

If this form has been filled in by someone other than the person claiming:

Tell us why you are filling in this form

Name of the person who filled in the form

Signature of the person

Relationship to the person claiming

How information about you will be used

We need the information on this form in order to process your claim for Housing Benefit if you are not a Council Tenant and pay rent for you home. The Security Administration Act 1992, The Welfare Reform Act 2012 and the Local Government Finance Act 1992 is the legal basis for processing your personal information. The information may be shared as follows:

• Within the local authority, with other local authorities, Audit Scotland, the Department for Work and Pensions, the Scottish Government, Her Majesty’s Revenues and Customs to detect, investigate and prevent fraud.
• With the Department for Work and Pensions and Her Majesty’s Revenues and Customs, to verify and check accuracy of information provided, amending or supplementing such information.

For more information about how we process information, how long we retain the information, or the right to complain please contact us or visit the Council's website:

http://www.orkney.gov.uk/Online-Services/privacy.htm

If you are unable to access the Council's website you can request a paper copy from the Council. Users of smartphones can also scan the code below to access the information.

IMAGE: The fourth page contains the authorisation to share Housing Benefit claim progress with the landlord, the claimant’s declaration and signature fields, fields for a representative who completed the form, privacy and information-sharing notices, and a QR code for accessing further information about how the Council uses personal information.

Jun-18

Please return this form, along with proof of your rent, to the Benefits Section, Orkney Islands Council, Council Offices, Kirkwall, Orkney, KW15 1NY.

Telephone (01856) 873535 Ext 2116 or email: benefits@orkney.gov.uk