APPLICATION FOR A DISCRETIONARY HOUSING PAYMEMT (DHP)
Name
Claim reference number*
Address
Postcode
Telephone number - home
Mobile
E-mail address
*This is the 5 digit number at the top of your benefit decision notices
Please ensure that we have your current telephone number(s) and e-mail address, if you
have one, as if we need to contact you about your application, we will phone first, and then
e-mail.
About DHPs
A DHP is a payment made in addition to housing benefit or universal credit where the
applicant needs financial assistance with housing costs. There is limited funding available
for DHPs and an award will only be made where the applicant satisfies the criteria as laid
down in Lichfield District Council’s Discretionary Housing Payments policy. A copy of this
policy is on the website at www.lichfielddc.gov.uk/DHP
If you wish to apply for a DHP, please complete every section on this form in full. You
should read the guide enclosed as you complete each section.
If the form is incomplete we will not be able to process your application.
Section 1
Self help
A DHP is, in most cases, only a temporary measure and it is vital that you find a more permanent
and sustainable solution to your housing costs. Listed below are some alternative solutions that
you need to have considered. If you cannot do any of the suggested solutions, please tell us why.
Please complete all of the boxes; answer ‘yes’ or ‘no’ to each question and also put the reason
for your answer. For example
Option
Can you move house?
Yes/No
yes
Do you have anyone living with you that could
contribute to your household?
No
Additional information/reasons
I have registered with Uchoose and have
contacted estate agents to get a smaller
property.
There are no other adults living in the
household.
Please remember to refer to the guide with this application – it is there to help you.
A Have you considered moving house?
If you have answered ‘yes’, please tell us
what you have done to find another
property.
If you have answered ‘no’ please tell us
why you could not move house.
B If you are in private rented
accommodation, have you asked your
landlord to consider reducing your rent?
If you have answered ‘yes’ please tell us
what the outcome was.
If you have answered ‘no’, please tell us
why you have not approached your
landlord.
C Do you have anyone living with you that
could contribute to the household?
If you have answered ‘yes’ and they are
not contributing anything, please tell us
why.
.
D Can you take in a lodger? (Subject to
the landlord’s permission)
If you have answered ‘yes’ please tell us
what you propose to do.
If you have answered ‘no’ please tell us
why you cannot consider this.
E If working, can you increase your
hours?
F If you and/or your partner are of working
age, able to work but not working, are you
looking for employment?
If you have answered ‘yes’ please tell us
what you are doing to find employment.
If you have answered ‘no’, please tell us
why.
G If you have outstanding debts or have
difficulty budgeting, have you sought
professional advice?
If you have answered ‘yes’ please tell us
when and who you saw for advice.
If you have answered ‘no’ please tell us
why you have not sought advice.
If you have answered ‘no’ to all of the above questions and have not provided compelling reasons
why they are not suitable options, it is unlikely that you will be awarded a DHP.
We may ask for evidence to support some of your answers.
Section 2
Eligibility criteria
We will be giving priority to applications in the following circumstances. Please tick one box in the
‘applicant’ side of the table below that best describes you. Then please consider the circumstances
on the right hand side of the table below and tick up to 2 boxes that best describes you. Please do
not tick any more boxes than requested – we cannot take them into account.
If none of these circumstances apply to you please go to Section 3.
Please remember to refer to the guide with this application – it is there to help you.
Applicant – tick one box only
A household member has a disability.
A household member is receiving care.
A household member is vulnerable.
√
Additional information
If you need more space for your answers
please use section 4
Disability living allowance (DLA) must be paid, at
any rate and for care and/or mobility. For anyone
of pensionable age, attendance allowance (AA)
must be paid. Please do not tick this box if you are
not getting DLA or AA.
Carers allowance must be paid to someone
providing the care. Please do not tick this box if
no-one is getting carers allowance.
Please describe the nature of the vulnerability.
A member of the household is a frail
elderly person who would find it difficult
to move.
Please tell us why you need to remain in your
current property.
There are children in the household who
are of school age.
There are children in the household who
are pre school age.
Single/couples without children.
We will have this information.
We will have this information.
We will have this information.
Circumstance – tick up to 2 boxes
The property is significantly adapted for
disablement needs of someone in the
household.
√
Additional information
If you need more space for your answers
please use section 4
Please describe the adaptations that have been
carried out.
The applicant has received formal notice
from the landlord to leave the property
and is therefore potentially homeless.
The current property is required to
maintain employment i.e. it is close to
your place of work.
We will need to see a copy of the notice.
The applicant is fleeing domestic
violence.
Please tell us briefly about your circumstances.
A member of the household is on the
child protection register.
Access to specific services, for example
hospitals, support services or a day
centre is required.
We will need to see evidence of this.
Please tell us how far your work place is from
where you live and how you get there for example
it may be within walking distance or a short bus
ride away.
Please tell us what services you use.
How far away are the services you use? For
example “2 miles”
How do you get there? For example car, bus.
A member of the household is providing
care, for which carers allowance is paid.
The applicant is in supported or
temporary accommodation.
The applicant is affected by the welfare
reform
We will need to see evidence of the carers
allowance.
We will have this information.
Welfare reform is where housing benefit has been
reduced because you are under occupying your
property (spare room subsidy); you are subject to
the benefit cap or your rent is higher than the Local
Housing Allowance. Please tell us how you have
been affected.
Section 3
Financial assistance
We need to compare your income to expenditure. Please tell us about your income and capital
(including current accounts) from all sources. You do not need to tell us about housing benefit as
this will be on our records. If you need additional space, please use section 4
If you do not complete this section, we cannot process your application.
Type of income
How much?
How often are you paid this i.e.
weekly/fortnightly/monthly
Your wages
Your partner’s wages (if you
have one)
Benefits/Allowances (please
list)
If you are having deductions
from any of these benefits –
please provide the notification
letter from the Dept. for Work
and Pensions to confirm.
Tax credits
Child Maintenance
Pensions
Contributions from people living
with you
Anything else – please tell us
what it is
Capital/Savings/Money in all accounts - including post office, bonds, current accounts etc.
Name of bank/building society
Type of account
Balance
Please tell us what your weekly/monthly expenditure is for the following.
Expenditure
Rent (this should be the amount you pay in addition
to any Housing Benefit). Provide a recent rent
statement if you are paying extra for arrears.
Council tax.
Gas. Please send us evidence of this ie latest bill or
2 months receipts.
Electricity. Please send us evidence of this ie latest
bill or 2 months receipts.
Water . Please send us evidence of this ie latest bill
or 2 months receipts.
Maintenance/child support.
TV licence.
Court fines. Please send us evidence of your
payments.
Debts related to income tax/VAT.
Food
Other household items including toiletries
School meals
Payment for child care costs
Clothing
Phone - landline
Phone – Mobile
Broadband/internet
Sky/Cable TV package
Leisure – please specify
Health related – cost of dental treatment, glasses,
prescriptions etc. Give details.
How much?
Weekly/monthly
Vet bills and/or pet insurance
Car Tax
Car insurance
MOT or other running costs
Petrol – please describe what your petrol costs are
attributable to, for example travel to work, school
run, leisure
Public transport costs
Buildings and contents insurance
Life insurance
Any other insurance. Please describe what they are
Pension contributions
Outstanding debts/arrears
Please tell us about any outstanding debts you have that you are making a regular
payment to. For example this can be for arrears of rent, council tax or other utilities; loans
or credit cards/store cards; hire purchase, catalogue payments etc. We may ask for
evidence of these payments.
Type of debt
Amount
outstanding
Amount of
payment
How often do you pay this i.e.
weekly/monthly
Section 4 Other information and declaration
Please use the box below to give us any information that you have not been able to fully explain in
the form provided or anything else you think is important to your application.
Declaration I declare that the information provided on this form is true and complete. I
understand that you will use the information submitted with my claim for housing benefit/universal
credit to help determine this application. I know that if I deliberately give false information or fail to
tell you about a change in my circumstances, you can take legal action against me. I understand
that I have to pay back any money that I am overpaid. My partner agrees to me making this
application for both of us.
Signed……………………………………………………………….Date…………………………
Discretionary Housing Payments – guide to application
Please refer to this guide as you complete the form because it contains information to assist you
and tells you what information we will need to process your application.
Before you start
If you do not get any housing benefit or universal credit you cannot be awarded any DHP but if you
do qualify, an award cannot be made if you are already getting all of your rent paid via housing
benefit.
DHP cannot be paid to cover the following costs
 Ineligible service charges as specified in Schedule 1 of the Housing Benefit Regulations
2006 and Schedule 1 of the Housing Benefit (Persons who have attained the qualifying
age for pension credit) Regulations 2006
 Increases in rent due to outstanding rent arrears
 Sanctions and reductions in benefit for example a reduction in another primary benefit or
shortfalls caused by HB/UC overpayment recovery
 Any restriction in benefit due to a breach of a Community Service Order
 Benefit that has been suspended
There are sections in the form where we ask for evidence, please send this with the form if you can.
We may ask for other evidence we need to support your application; if you do not send evidence
when requested, we cannot process your application.
What happens to the application?
An officer in the benefits section will consider your application carefully. If you satisfy the criteria in
all 3 sections, you will be awarded a DHP and you will get a letter confirming how much you will get
and how long it will be paid for. This will be paid with your housing benefit where appropriate.
If you are unsuccessful, you will get a letter explaining why. You can also ask the council to look at
the decision again. Your letter will tell you how to do this. A panel of independent officers within
the council will consider your request and will write to you with their decision.
Section 1
A
Moving House
If you have been affected by the spare room subsidy or any of the other welfare reforms that have
resulted in an increased rent to pay, moving house is an option you may wish to consider.
You could ask your landlord if they have any alternative accommodation that would better suit your
needs.
The Council has housing advice and guidance on the website at
http://www.lichfielddc.gov.uk/info/200052/housing_advice/1456/housing_options
This includes a housing options directory that describes the type of affordable housing options you
could choose from locally.
You could also go to the U-choose website at
https://www.uchoosehomes.co.uk/
U-Choose is the place to find details of homes available to rent in southern Staffordshire and
northern Warwickshire.
If you feel you could not afford the costs associated with a move, such as a deposit on a new
property or hire of a removal van, please tell us. We may be able to help with these costs via the
DHP funding.
We will need to see evidence of what action you have taken, whether that is registering on UChoose or with a Letting Agency. We will contact you about this.
B Asking the landlord to reduce your rent
If you are in privately rented accommodation, your landlord may be willing to negotiate a lower rent.
C Do you have anyone living with you that could contribute to the household?
If there is another adult in the household, your benefit may be reduced by a ‘non-dependant’
deduction. Your non-dependant may or may not be contributing towards the household costs, but
you should consider asking them to increase any contribution they make.
D Can you take in a lodger? (Subject to the landlord’s permission)
For some people, offering a spare room to a lodger may be an option. This would mean that
Housing Benefit would no longer consider the room to be spare. In addition to this, the first £20 of
weekly income from a lodger is ignored and won’t affect your benefits. If you receive more than £20
a week in rent the extra cash is likely to affect your benefits although overall you should be better
off. The Department for Work and Pensions or the Local Authority will be able to advise you on the
effects additional income will have on your benefit.
Homeowners and tenants who let furnished accommodation and take a lodger are exempt from
paying tax on rental income of up to £4,250 a year and because it’s tax free it also won’t affect the
amount that you receive in child tax credit or working tax credit either.
Step by step guide to renting out a room
1. If you are a tenant, you must ask your landlord for permission to rent out a room.
2. Make sure your home and the room you want to rent out is safe, fire proof and that you have
general safety sorted.
3. Check to see what effect the extra income has on your benefits.
4. Advertise your spare room – this could be a notice in your local shop or go on-line and
advertise for fee through one on the many websites available. Simply put ‘rent a room out’
in the search engine.
5. Find someone that is right for you. Letting someone live in your home is a big step, so it
pays to be prepared. Take your time to talk to the people viewing your property to make
sure they are a good fit for your home. It is also good to lay down some simple ground rules
early, so you both know what to expect.
6. Get references. Ask your new lodger if they can provide references from an employer or
previous landlord. This can give you extra peace of mind that the agreement you are
entering into is likely to be alright.
7. Always have a written agreement between you and your lodger. This should include the
rent figure and payment details; which rooms/facilities the lodger is entitled to use; services
you agree to provided; any share of household bills; how long until the payment amount is
reviewed; house rules and notice period.
8. Safety tips – always have a friend accompany you to interview new lodgers; keep valuables
locked away during the interview and use the interview as an opportunity to ask about
anything that concerns you.
For further advice, the following websites may help.
A general guide to letting a room is available at
https://www.gov.uk/government/publications/letting-rooms-in-your-home-a-guide-for-residentlandlords
and other information on can be found at
https://www.gov.uk/rent-room-in-your-home/rent-bills-and-tax
https://gov.uk
https://adviceguide.org.uk
E If working, can you increase your hours?
If you are in employment, your employer may be willing to increase your hours.
.
F If you and/or your partner are of working age, able to work, but not working, are you
looking for employment?
If you are a job seeker, your benefit will only be paid if you are actively seeking work. You should
be receiving the appropriate support from an advisor at the job centre. Please tell us what support
you are receiving from the job centre.
If you are looking for work, please tell us what you are doing.
Further help is available from
https://www.gov.uk/moving-from-benefits-to-work
https://www.gov.uk/jobsearch
Lichfield District Council also runs work clubs
http://www.lichfielddc.gov.uk/info/100008/jobs_and_careers/1389/work_clubs_across_lichfield_distri
ct
G If you have outstanding debts or have difficulty budgeting, have you sought professional
advice?
If you need debt advice to assist with managing your non-priority debts to a level that enables you
to pay your essential expenditure, there are many organisations that can help you and their
information is on the internet.
You may find the following useful.
http:/www.lichfielddc.gov.uk/manageyourmoney
Alternatively you may choose to visit
http://www.adviceguide.org.uk/england/debt_e/debt_help_with_debt_e/debt_budgeting_e.htm
Section 2 Eligibility criteria
Eligibility will depend on certain conditions as described below. Some of the information we will
already know from your application form, but we may ask for evidence.
Information on benefits

Disability Living Allowance is a tax free benefit for disabled children or adults administered by
the Department for Work and Pensions. It has two parts, called ‘components’; a care
component – if you need supervision or help looking after yourself, and a mobility component, if
you can’t walk or find it very difficult to walk. In some cases, people may qualify for both
components. These are now being replaced by Personal Independence Payments (PIP).
 Attendance Allowance is paid to people aged 65 or over who need help with personal care
because they are physically or mentally disabled. It is paid at two different rates and depends
on the level of care required.
 Carers allowance is paid to someone who is looking after another person with substantial care
needs. You don’t have to be related to, or live with the person you care for, however you must
be aged over 16 and spend at least 35 hours a week caring for them. Carer’s allowance is
taxable and can affect other benefits.
For more information on all of the above benefits please go to www.gov.uk
Vulnerability
If you feel that you are vulnerable in some way that we have not already covered in this form, we
need you to tell us about this. It may be that you just need some help on a short term basis.
Examples of vulnerability are
 Young people leaving care
 Mental health problems
 Addiction problems
 Learning difficulties
 People who have been institutionalised e.g. prisoners
This list is not exhaustive and we would encourage you to let us know about anything that affects
you, preventing you from moving or changing your circumstances in some way.
Section 3 Financial Assistance
Please complete this section as fully as you can. Where you have bills, such as utility or credit
cards, we may ask to see evidence from the provider of the amount you are charged.
There are some items of expense we will know about, for example your rent and council tax. We
will need to see your gas, electricity and water bills to confirm what you are paying and we may ask
for evidence of other items.
Income from Disability Living Allowance and Personal Independence Payments will not be counted
but we still need to know about it.
In the first instance we will look at your priority expenditure/debts. These are the bills that you must
pay because if you do not, the consequences of not paying them can be more serious than for other
debts. Secondly we will consider payments that you have committed to and are unable to withdraw
from the agreement without financial penalty. Any other payments that are not essential may not be
used to reduce your income.