Application for Direct Payment
Name and Address
Phone number
The Benefits Service normally has to make all payments of Local
Housing Allowance (LHA) directly to you. It is your responsibility to
make sure that you pay the right amount of rent to your Landlord at
the right time. We will only make payments to your landlord if we
think that you will have difficulty in managing your rent, if you are 8
weeks behind in your rent and your Landlord will accept payment.
The information you provide in this form will help the Benefits Service
to decide if they are able to pay your landlord. You may not need to
complete all the questions, as each application will be different, but
try to give as much information and proof as possible.
Filling in this form
This form can be filled in by the tenant or by someone on their behalf.
The tenant must always sign the form, and be fully aware that it may
lead to their benefit being paid directly to the landlord to help pay their
rent.
What should be sent with this form?
Written proof needs to be provided to support the details given in this
form. This can be from various sources dependant upon a person’s
individual circumstances.
When you have filled in this application
You should take this form and your documents to the One Stop Shop
at the Town Hall or post it Redditch Borough Council, The Benefit
Section, The Town Hall, Walter Stranz Square, Redditch, B98 8AH
You need to tell us why you have or would have problems
paying your own rent.
Do you have learning difficulties?
Do you have a physical disability or medical condition?
Do you have mental health problems?
Are you trying to cope with an addiction e.g. Alcoholism?
No
Do you have problems understanding English?
Do you have any debts other than rent e.g. loans,
credit cards?
Yes / No
Yes / No
Yes / No
Yes /
Yes / No
Yes / No
If you have answered yes to any of the above please now give as
much detail as you can and remember to provide proof so we
can deal with your application more quickly
About your rent
Do you currently have rent arrears?
If yes, how much are your arrears?
Yes / No
£
What period do your arrears cover?
from
to
Has your landlord taken any recovery action?
e.g. Notice of seeking possession or a Notice to quit
Have you had problems in the past with paying your rent?
If yes when was this and why did you have problems?
Yes / No
Yes / No
Other information
Do you currently receive support from an agency or organisation,
friend or family member?
If yes, do we have your permission to contact them?
Yes / No
Please tell us their:
Name:
Address:
Tel no:
Relationship to you:
PLEASE NOTE THAT IF A DECISION IS MADE TO PAY YOUR
LANDLORD DIRECTLY THE PAYMENT METHOD WILL BE
REVIEWED AT LEAST EVERY 12 MONTHS
.
How many months do you think that you will need payment to go
direct to your landlord?
Declaration
Part 1.
Did someone help you to complete this form?
Yes / No
If no, go to part 2.
If yes, that person must complete and sign this declaration.
 The information given is true and correct to the best of my
knowledge.
 I believe it to be in the best interest of the tenant to pay Local
Housing Allowance directly to the landlord.
What is your relationship to the person claiming e.g. friend, social worker
Signature of person completing form.
Date
Print name of person completing form.
Address of person completing the form.
Tel number
Your declaration
The information given is true and correct.
I am happy for my Local Housing Allowance to be paid direct to
my landlord to help pay my rent.
I will contact the Benefits Section should I feel I am able to
manage my own rent payments.
Redditch Borough Council can contact the person who helped
me complete this form to discuss this application.
I have read and understood this declaration.
Part 2.
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Your signature
Your partner’s signature (if you have one)
Date
Date