Application for direct payment to landlord
Tenant's details
Housing benefit claim reference number
Name
Tenant's address (including room or flat number and postcode)
Email
Contact number
Reason(s) that may cause problems paying the rent
Select any of the reasons that may cause problems paying the rent (select all that apply)
Learning disabilities
Physical disabilities or medical conditions
Mental health problems
An addiction eg. alcoholism, substance misuse, gambling
Difficulty in managing your affairs because you need assistance with understanding English
Recent changes that may mean you need additional support, or anticipate any in the near future?
Details of the reason that may cause problems paying your rent
Are there any rent arrears?
Yes
No
Details of rent arrears
Amount £
Period from
to
Are they as a result of not making up the difference between your benefit and your rent?
Yes
No
Has the landlord taken any action to recover the rent? eg., court action, notice of seeking possession, a letter to quit, payment plan?
Yes
No
Details of rent arrears and any action taken by the landlord
Upload any evidence of rent arrears and any action taken by your landlord to recover the rent
Have you tried to re-negotiate with the landlord about reducing the rent?
Yes
No
Details
Have you had any previous problems in maintaining rent payments?
Yes
No
Details
Do you have multiple debts and need assistance to resolve them?
Yes
No
Details
Do you currently receive any ongoing support from an agency that can help you organise your rent payments?
Yes
No
Details
Can anyone else support you in managing your financial affairs?
Yes
No
Please give details of help required.
Are you having deductions from your income to repay debts?
Yes
No
Details
How long might you need to make payments direct to the landlord
26 weeks
52 weeks
If you require a shorter or longer period of time, please specify the period and tell us why?
Declaration
Are you the tenant?
Yes
No
Tenants declaration
How we collect and use information
This Authority is under a duty to protect the public funds it administers. We may check information that you provide, or information provided by a third party, with other information we hold to check its accuracy; to prevent or detect crime; and to protect public funds in other ways, as permitted by law. We may also share this information with other Council departments or bodies administering public funds for these purposes. We may also use this information to put you in touch with council services that may be able to help you. We will not disclose information about you to anyone, unless the law permits us to.
Folkestone & Hythe District Council is the data controller for the purposes of the Data Protection Act 1998. If you want to know more about what information we have about you, or the way we use that information, you can ask.
I confirm that the information given is true and correct
I agree for my LHA to be paid directly to my landlord
I will contact the council should I feel that I am able to receive my benefit directly
Full name
Date
Partner's name (if applicable)
Date
Details of person completing the form on behalf of the tenant
Name of person completing this form
Address
Contact number
Email address
Declaration
How we collect and use information
This Authority is under a duty to protect the public funds it administers. We may check information that you provide, or information provided by a third party, with other information we hold to check its accuracy; to prevent or detect crime; and to protect public funds in other ways, as permitted by law. We may also share this information with other Council departments or bodies administering public funds for these purposes. We may also use this information to put you in touch with council services that may be able to help you. We will not disclose information about you to anyone, unless the law permits us to.
Folkestone & Hythe District Council is the data controller for the purposes of the Data Protection Act 1998. If you want to know more about what information we have about you, or the way we use that information, you can ask.
I confirm that the information given is true and correct
I believe it to be in the best interest of the tenant to pay LHA directly to their landlord
I have read and understood the declaration
Your name
Date
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