This form is used to fully review your entitlement to Housing Benefit and/or Council Tax Support/Reduction.

There may have been changes to your household, income, capital or general circumstances that we were not aware of that may have an effect on your entitlement.

Please complete this form fully and upload/attach any relevant evidence you are directed to provide.

Section 1

About yourself
Are you the claimant?

Your property address
Your contact information
Do you have authority to act on the claimant's behalf?

If you are not an existing Power of Attorney or Appointee or we have not previously seen written authority to act on the person's behalf. Please obtain written authority and upload evidence within the evidence upload section shown at the end of the form

Section 2

Claimant information

Check and update information about you, and your contact details as well as special circumstances such as fostering, caring for others, being cared for, disability, blindness, being a student or being absent from home.


Claimant property address
Property address

Claimant contact information
I am a student:

You will be requested to upload your latest student finance award notification(grant/loan/bursary details) and your latest course enrolment notification from the college/university within the evidence upload section shown at the end of the form
I am registered blind:

I am a carer for someone:

Someone receives Carer's Allowance for looking after me:

I require and receive overnight care:

I am a foster carer and require an additional room for a foster child:

I am currently absent from home:

Section 3

Other people who live with you
Do you have a partner?

Partner information

Partner previous address


My partner is a student:

You will be requested to upload their latest student finance award notification(grant/loan/bursary details) and your latest course enrolment notification from the college/university within the evidence upload section shown at the end of the form
My partner is incapable of work or treated as incapable of work:

My partner is registered blind:

My partner is a carer for someone:

Someone receives Carer's Allowance for looking after your partner:

My partner requires overnight care:

My partner is a foster carer and require an additional room for a foster child:

My partner is currently absent from home:

Is there an intention for your partner to return home?

For any new partner you have included since your new claim, your last review or that has joined the household and that we were not aware of prior to completion of this form please upload proof of identification such as; passport or driving license within the evidence upload section shown at the end of the form

Do any children that you receive child benefit for live with you?

Dependant children information
Child 1
Is this child registered blind?

Are they disabled and receiving disability living allowance or personal independence payments?

Do they need their own room because they are disabled?

Remove child
Add another child
For any new dependant children you have included since your new claim, your last review or that has joined the household and that we were not aware of prior to completion of this form please upload proof of identification such as passport or birth certificate and proof of Child Benefit award within the evidence upload section shown at the end of the form

Non-dependants are adults living with you such as grown up children, parents or friends.

Do you have any non-dependents living with you?

Non-dependants information
Non-dependant 1
Are they a full time student or on a Youth Training Scheme or Apprenticeship?

Are they in prison or have been in hospital for more than 52 weeks?

Are they a member of the armed forces away on operations and will require a room on their return?

Is this non-dependant part a non-dependant couple? If you have more than one non-dependent living with you, indicate if any of these people are a couple:

Does the Non-Dependant named, have any dependent children living in your household:

Remove non-dependant
Add another non-dependant
For any new non-dependants you have included since your new claim, your last review or that has joined the household and that we were not aware of prior to completion of this form please upload proof of identification such as passport or driving license within the evidence upload section shown at the end of the form

Do you have any boarders (pays board to you and includes provision of meals), joint tenants (pays rent to landlord) or sub-tenants (pays rent to you - no meals provided) in the household?

Boarders, joint tenants or sub-tenants information
Boarder, joint tenant or sub-tenant 1
£
£
%
Remove person
Add another person

Section 4

Your income

Please include all employment income for yourself (and your partner if applicable)

Do you receive income from earnings?

Earned income information
Earned Income 1
£
£
£
£
£

We will require additional details of your self employed earnings if you have recently started being self-employed or we have not reviewed your Self-employed earnings or the Self employed earnings we are currently using to assess your claim are not reflective of your current earnings

Please upload your accounts (audited or otherwise) for the last financial year if you have not already provided or fully complete our Self Employed earnings form within the evidence upload section shown at the end of the form

Remove earned income
Add another earned income

Do you or your partner receive any income other than from employment?

Other income information
Other Income 1
£
Remove income
Add another income

Non-dependant income information
Do any of the non-dependants receive an income?

Non-dependant income 1
£
Remove income
Add another income

Do any of the non dependants have no current income?

You will be requested to upload proof of income for any/all non-dependants in the household, this can be current Benefit award notifications, proof of earnings or a statement of nil income within the evidence upload section shown at the end of the form

Section 5

Capital and savings
Do you have any Capital or Savings, totalling over £6,000?
(Savings in Bank/Building Society Accounts; Capital in Bonds, National Savings Certificates, Stocks or Shares; Cash or a Second Property)

Capital and savings 1
£
Remove capital/savings
Add another capital/savings
You will be requested to upload 2 months recent bank statements for all your and your partners accounts, including any accounts where wages or other incomes are paid into within the evidence upload section shown at the end of the form

Section 6

Expenses

Are any of the following statements true?

I pay Child Care Costs to a registered child care provider:

£
You will be requested to upload proof of your child care costs such as an invoice/bill or letter from your child care provider within the evidence upload section shown at the end of the form
I pay contributions to a private or personal pension:

£
I pay parental contributions to student fees and expenses:

£

Section 7

Your home
£
Are services such as heating or hot water included in your rent?

Service 1
£
Remove service
Add another service

Are you in arrears with your rent by more than 8 weeks and Housing Benefit payments are currently not going directly to your landlord?

You will be requested to upload your current rent statement or a letter from your landlord confirming your arrears within the evidence upload section shown at the end of the form
Landlord details
Landlord's address
Can we (the local authority) discuss your claim with your landlord?

If there have been changes to your claim (landlord change, amount of rent change etc.) since we last reviewed your claim please upload your current tenancy agreement or rent proof document within the evidence upload section shown at the end of the form

Other changes

Please use this section to report any other changes you may think are relevant to your Housing Benefit claim

Section 8

Declaration

This authority may make enquiries about the information needed to support the application and to prevent fraud. If you receive Housing Benefit or Council Tax Reduction by providing incorrect details or not giving us full details or providing false information you could be prosecuted. This declaration is legally binding. Please read all the points carefully and make sure you understand them before submitting this claim checker.

  • I declare that the information I have given on this form is correct and complete.
  • I understand that I must promptly tell the authority of any further information which may affect the outcome of my application which I become aware of after it has been made.
  • I understand that authority may check the information I have given with other sources.
  • I understand the authority may use any information I have provided in connection with this and any other claim for Welfare benefits that I have made or may make.
  • I understand the authority may share information with other government organisations, if the law allows this.
  • I understand that I must tell the authority straight away if I have a change of circumstances which may affect my application.

Data Privacy

This application and all documents related to this application will be treated in line with the General Data Protection Regulation and Data Protection Act 2018 and may be shared within the authority and with other authorities. Any data deemed to be 'sensitive personal data' under the Act will only be disclosed to third parties as necessary for the operation and administration of the scheme and to other organisations where necessary to establish entitlement or otherwise as required by law. If you have any questions or concerns about the way we process your personal data, please go to www.redcar-cleveland.gov.uk/site-terms/Pages/privacy.aspx.