Discretionary Housing Payment for Rent Deposit
Please read these notes carefully before completing the form.
This form is to apply for Discretionary Housing Payment (DHP) for rent deposits. The
decision is at the discretion of the Housing Benefit Team only. A decision can not be
confirmed until the completed application form and supporting evidence has been
received, the information checked and assessed.
DHP can only be paid for a rent deposit if;
 The new rent is affordable to you (Local Housing Allowance level or lower) please
refer to http://www.hillingdon.gov.uk/discretionary_housing_payment.
 The number of bedrooms in the new accommodation is suitable for the size and
structure of your household
 You receive HB in respect of your current address.
If you do not currently receive Housing Benefit from Hillingdon Council we can only pay
if you are moving to an address in Hillingdon. Although we can make a decision in
advance, we can only make the payment once you have moved in and claimed Housing
Benefit. The Payments are usually sent to your landlord bank account.
If you are currently claiming Housing Benefit outside of Hillingdon, you must apply to
your current council for the rent deposit even if you are moving into Hillingdon.
DHPs are available to claimants who are entitled to Housing Benefit (HB) and appear to require
some further financial assistance in order to meet housing costs. DHPs are not classed as
payments of HB. However, the council’s HB section will administer the DHP scheme. Hillingdon
Council is limited by Central Government in the total amount that it can pay in DHPs in any
financial year. Therefore, unless you can show an above average need for further financial help
with your housing costs you will not receive this extra payment.
Please answer all questions and provide the evidence listed on the last page. Please
return the completed form with the supporting evidence so that we can determine your
eligibility. If you do not provide the evidence with the form, there will be a delay in your
claim and no decision will be made until we have received all the required evidence. We
may request additional information before we assess your Discretionary Housing
Payment application.
If you bring your documents into our reception at the Civic Centre, Uxbridge or the Hayes One
Stop we will give you a receipt, scan the documents and give them straight back to you. We will
consider your claim and write to you with our decision and reasons.
Revenue & Benefits Service
Tel. 0300 123 1384 Fax: 01895 250361
LB Hillingdon Revenues & Benefits service
PO Box 531, Sale, M33 0FQ
www.hillingdon.gov.uk
Email: [email protected]
SECTION 1
My full name is:
My current address is:
(you MUST tell us this even if
your current address is
temporary)
Postcode:
Home telephone number:
Mobile telephone number:
Email address:
Would you like to receive your decision letter via email
Yes
No
My Housing Benefit reference number is
Date of Birth
National Insurance Number
How many bedrooms will the new accommodation have?
Who will be living with you at your new accommodation? (Please give the names, dates
of birth and their relationship to you)
If you have children living with you for some of the time, please give their name(s) and
details of when they stay (if Social Services are involved please give as much detail as
possible).
Are you expecting an increase in the number of people living with you in the near future?
e.g. Is anyone in the household expecting a child/adopting a child, or is someone else
coming to live with you?
SECTION 2
I wish to apply for Discretionary Housing Payment for Rent deposit:
How much are you applying for?
£
(Please provide evidence of what is required, for example letter from landlord / agent)
£
How much is the new monthly rent?
Address of property
The date I intend to move is:
Landlord Name & Address
Are you, your partner or any of your children related to your
new landlord/agent or your landlord/agent’s partner in any
way? Related includes related through marriage or civil
partnership, even if it has ended
Yes
No
If yes, the name of the person who is related to the
landlord or agent is
What is their relationship to the landlord/agent?
The person I would like the rent deposit
payment made to is:
Name:
(Please give name and bank details, sort code, and
account number)
Name of Bank:
Account Number:
Sort Code :
(We will normally make payments direct to the landlord / agent. If you want payment to yourself you must
provide evidence that you have already paid the deposit yourself. Also you must provide evidence of the
bank details)
In exceptional circumstances, we may consider assisting with your moving cost. For
example, if you are moving out of the borough to a more affordable property.
Name and address of removal
company/van hire company if
moving costs are being applied for
Please explain why you chose to
move with this company? Did you
get any other quotes?
How much are you applying for?
£
The person I would like the removal cost payment
made to is:
Name:
(Please give name and bank details, sort code, and
account number)
Name of Bank:
Account Number:
Sort Code :
(Please provide quotes / invoice from removal firm. If you want payment to yourself you
must provide evidence that you have already paid the removal company/van hire. Also
you must provide evidence of the bank details)
4
SECTION 3
Please list all current income and outgoings
Outgoings
£ per
week
£ per
month
Income
Rent
State Pensions
Council Tax
Work Pensions
Water Rates
State Pensions
Food
Work Pensions
Private pension
Disability
contributions
Benefits
Travel/car
Child Benefit
Gas
Main earnings
Electricity
Main earnings
Telephone
2nd earnings
Mortgage
2nd earnings
Clothes
Tips/gratuities
Insurance –
Working Tax
Life/contents
Credit
Child care
Child Tax Credit
£ per
week
£ per
month
(Please detail)
Other
Maintenance
(Please detail)
Other
Child Support
(Please detail)
Other
Other
(Please detail)
(Please detail)
Total:
Total:
Do you have any savings / capital?
Yes
If yes, how much savings / capital do you have?
No
£
When we look at your spending, we normally disregard reasonable household expenses
for food, fuel, clothes, telephone and toiletries. This is because the benefit calculations
include an allowance for essential day to day living expenses. But if some of these
expenses are especially high at the moment, please explain.
5
SECTION 4
Is your current address your normal home or a temporary address? Please explain the
arrangements at your current address (e.g. private renting, family, friends etc)
Please give your last normal address and explain why you moved out?
Why do you need to move out of your current / previous home? Please confirm if you were
evicted and give the reasons.
When did your landlord serve the notice and what steps have you taken to secure a new
accommodation?
What steps have you taken raise the funds and how much can you afford to pay
yourself?
What other methods have you tried to raise the money you need to move? For example
saving up, applying for a loan from the Credit Union?
Do you have any other financial resources that you could rely on i.e. family or friends? If
yes, please give details.
6
SECTION 5
Please explain why you need to live in Hillingdon?
How did you find your new address?
Was anywhere cheaper offered / available to you? If yes, why did you not take it?
If you paid a deposit before you moved in to your previous
address, will you get it back?
Yes
If yes, how much deposit will you get back?
No
£
If no, please state why you won’t get it back?
Have you ever received assistance from this council through a
rent deposit guarantee scheme or similar before?
Yes
No
If yes, please give details (amount, date received, address in respect of which it was
made etc.)
7
SECTION 6
Have you attempted to negotiate the rent deposit with your prospective landlord? If not,
why not? If so, what was the outcome?
Have you sought advice as to the level of Housing Benefit you may be awarded. If no,
please state why.
If the proposed rent is more than the Local Housing Allowance level, Yes
do you think your prospective landlord would be agreeable to
reducing the new rent to that level if HB were paid directly to your
landlord?
No
If the new rent is more than the Local Housing Allowance levels how do you propose to
make up the difference to meet your rent? Please provide a letter confirming any financial
support you will be receiving to meet shortfall.
What steps have you taken to improve your financial situation? Have you visited Citizens
Advice Bureau at Civic Centre or rung debt advice on 0800 138 1111 or visited
www.stepchange.co.uk. Please provide evidence.
8
SECTION 7
Are you a registered foster carer?
Yes
No
If yes, please give the name of who you are registered with and how many additional
rooms you need due to fostering. Please also provide the full name(s), date(s) of birth
and gender of the child(ren) you foster.
Are there medical reasons as to why you or your partner or any members of the
household, including children, need a separate bedroom? Please provide details and
original documentary evidence of the medical condition.
Do you or your partner have a carer (other than your
partner) who stays overnight in your home?
Yes
No
Is overnight care provided by a carer who doesn’t
normally live in your home?
Yes
No
Will you have a spare bedroom that the carer can use
to sleep in overnight?
Yes
No
Yes
No
If ‘Yes’, how often do they stay?
Who needs the overnight care?
Do you, or any member of your family who lives with
you, have any health problems, which means you need
to move to alternative accommodation, or might be
made worse if you had to stay where you are now?
If yes, please give details
9
SECTION 8
Non-Dependants
A non-dependant is anyone other than your partner or children that you get child benefit
for, such as an adult relative or a family friend, who lives as part of your household.
The Government expects these people to make some contribution to your rent
and council tax which means that your Housing Benefit and Council Tax Benefit may be
reduced.
Please provide evidence of your non-dependent's income. Last two months
payslips/Benefits etc are needed.
If you have any non-dependants living with you, how
much can they afford to pay towards the rent deposit?
£
If nil, please explain why your non-dependant cannot afford to pay some of the rent
deposit?
SECTION 9
Personal Statement - Please use this space to say why you believe you need a
Discretionary Housing Payment for a rent deposit, or to say anything else to support your
application.
10
DECLARATION:
You and your partner must read this carefully before you sign.
 This is my/our claim for Discretionary Housing Payment.
 The information I/we have given on this form is correct and complete as far as I/we
know.
 I/we give permission to you to check the information I/we have given with any of the
other sections of the council, other councils and benefit authorities. I/we understand
that the Hillingdon Council Benefits Service may use the information I/we have given
on this form to detect and prevent fraud, including sharing this information with other
organisations and Government departments.
 I/we understand that I/we must tell the Hillingdon Council Benefits Service in writing
about any changes in my/our circumstances that may affect my/our Housing Benefit.
 I/we understand that I/we may be prosecuted if I/we give information that is not correct
or complete, or if I/we do not report any changes of circumstances which might affect
my/our benefit.
 I/we have read and understood this declaration.
 Have you provided all supporting information on the next page.
Please sign here:
Your signature
Claimant
Date
Your partner’s signature
Partner
Date
If this form has been filled in by someone other
than the person claiming
Please tell us why you are filling in this form for the person
claiming
Name of the Person who filled in the form:
Signature:
Relationship to the person claiming:
Date:
Please read the next page for supporting evidence needed which must be
provided.
11
Checklist Info: Details of evidence you must provide:
In support of your application for a DHP, please provide all required information so that we can
determine your eligibility this will mean that there is no delay in dealing with your request. Please
tick what evidence you are providing. We may request additional information if needed.
If you are in receipt of Housing Benefit in Hillingdon, and your income has changed since
your last Housing Benefit Assessment, please provide details of the change and
documentary evidence.
If you are not in receipt of Housing Benefit in Hillingdon please provide the all required
information.
Evidence of Income, Benefits etc
Proof of your current benefits
Proof of your current income
Proof of your last three months wage slips/ recent self employed accounts
Bank statements for last three months for all account held
Pension letter and private or occupation pension advice slip or letter.
If you have a non-dependent, please provide evidence of their income
Evidence of any other income: Court order award notices or Child Support Agency letter
giving details of maintenance, Insurance policy or home income plan details.
Evidence of Rent:
A letter from the landlord/estate agent outlining the property address, number of bedrooms,
rent charged, rent deposit required or Tenancy
The agreement which gives contact details of the Landlord / Estate agent:
Name, address, telephone and email address.
If you want the payment to be sent to the landlord's bank account please provide a paying in
slip showing the name and bank details
If there is a shortfall in the rent, how are you going to afford the shortfall? Please provide a
letter outlining how you will afford it.
If you are in rent arrears, please provide proof of how much rent you are paying & rent
arrangement.
If you are not currently claiming Housing Benefit, provide evidence of your current address.
Additional Supporting Evidence if applicable.
Proof of any loan, bills or credit card or hire-purchase repayment agreements
Proof of any expenses that are especially high
Proof of medical evidence: letter from a doctor, hospital, social/welfare agency
Please ensure all the required information is provided, this will avoid any delay in dealing with
your request. If you come into the office, please ask to see an advisor so that we can advise you
if all information has been received. We may request additional information before we assess
your Discretionary Housing Payment application.
12
For Official use only:
DISCRETIONARY HOUSING PAYMENT RECEIPT
Claim No:
Date:
Name
Address:
Thank for your application with the following supporting evidence provided.
The following information must be provided. Please note the form will not be accepted
without this information.
Information
provided







Proof of your current benefit/income / your last three months
wage slips / recent self employed accounts.
Bank / Building Society statements etc. covering at least three
recent consecutive months of all accounts held.
If you have a non-dependent, please provide their last two
months wage slips
Evidence of rent charge/rent deposit needed
Yes
No
Yes
No
Yes
No
Yes
No
If there is a shortfall in the rent, how are you going to afford
shortfall. Please provide a letter outlining how you going to
afford.
If you are in rent arrears with your current address, please
provide proof of how much rent you are paying & rent
arrangement.
Evidence of assistance with finance; Outcome of CAB
Yes
No
Yes
No
Yes
No
Documents / Information required:
1
2
3
Date to provide by:
If the information is not provided by the above date, your claim will closed and you
will have to complete a new Discretionary Housing Payment to claim again
Claimant Signature
Verified by
Telephone number/Email address