1. Discretionary Housing Payments / Exceptional Hardship Fund

  2. Section 1 - Personal Details
  3. Address lookup
  4. Please advise what you wish to claim for?*
  5. Is your DHP claim for:
  6. If your claim is for rent in advance, rent deposit or rent arrears then you will need to provide proof of either the rent in advance/deposit needed or rent arrears accrued or we will not be able to make an award from the fund.
  7. Please provide your last 3 months statements for all bank/building society accounts held as evidence of your outgoings.

  8. Section 2 - Weekly Outgoings
    1. Other (Please Give Details)
    2. Group2
    3. Group2
    4. Group2
    5. Group2
    6. Weekly Outgoings Calculator
  9. Section 3 - Weekly Income
    1. Other (Please Give Details)
    2. GROUP7
    3. GROUP8
    4. GROUP9
    5. GROUP10
    6. GROUP11
    7. GROUP12
    8. GROUP13
    9. GROUP14
    10. Weekly Income Calculator
  10. 1. Why do you need this extra help?
    1. Tell us about your weekly income within the household and the way you spend it.

      • Can you get help towards the shortfall in your housing costs from other members of your family?

      • What sort of contribution are you prepared to make, to meet the shortfall?

      • Tell us about any debts you have and how much they are, including any rent or Council Tax Arrears (provide evidence of any rent arrears).

    2. Based on your budget, what is the most you can afford to pay towards your rent?

      £ a week

      Based on your budget , what is the most you can afford to pay towards your Council Tax bill?

      £ a month

  11. 2. What are your family circumstances?
    1. Tell about any disabilities, health problems, special needs etc. for you or your family. Has your property been adapted to assist with any disability? If you receive DLA or PIP how do you spend this money? (continue on a separate sheet of paper if necessary).

    2. If you own your property and are applying for help with your Council Tax only go straight to Question 6. Declaration

  12. 3. What have you done to help yourself?
    1. Tell us if you have tried to re-negotiate the rent with your landlord, you have looked for cheaper accommodation or signed up with Devon Home Choice. Is there a particular reason why you cannot move, were you aware that your rent would not be met in full when you accepted the tenancy and if so, how you had planned to meet it. Have you sought any debt advise and if so where from?

  13. 4. If you have recently moved to this address please explain the reason for your move.
  14. 5. Is there anything else that you can tell us about your need for a discretionary housing payment?
  15. 6. Account Details
    1. Please provide the bank details for the account which the payment needs to be made to, rent arrears, rent in advance & deposit requests will normally be paid direct to the landlord. EHF awards will be awarded directly to your Council Tax Account.
  16. 7. Declaration
    1. Please check that you have completed the form accurately and then read and sign the following declaration.

      I understand all of the following:

      • If I give information that is incorrect or incomplete you may take action against me. This may include court action.

      • You will use the information I have provided to check my claims for Discretionary Housing Payments, Council Tax Reduction / Housing Benefit. You may check some of the information with other council records and with other councils.

      I know that I must let the Benefits Team know about any changes in my circumstances that may affect my claim.

      I declare that the information I have given on this form is correct and complete.

      I give consent for the details in my application to be shared with the councils Housing Department for the purposes of Homelessness Prevention and enquiries and with the Ministry of Housing and Communities and Local Government for the purposes of statistical data analysis.

      Please tick to confirm if you agree with the above statement:   

      I give permission to pass on my details to third party agencies for assistance with debt and money advice.

      Please tick to confirm if you agree with the above statement:   


    2. If someone else has helped you complete this form, please give their details here: