HB Bulletin G7/2016 Appendix

Section 1:  HB claimant details (including partner's details where appropriate)

1

HB claimant's name

2

HB claimant's NINo

3

HB partner's name

4

HB partner's NINo

Section 2:  Type of notification (tick applicable box)

5

New cap case and cap not applied (complete Section 3, number 10) for reason cap not applied)

6

Existing cap case, HB award has changed and the cap no longer applies (complete Section 3, number 10  for reason to remove cap)

7

Customer enquiry from claimant/partner (complete Section 4)

8

Dual case  (complete Section 5)

9

Request for HB information from DWP (complete Section 6 and Section 7)

Section 3: Reason for Change of Circumstances (tick applicable box)    

10

HB award amount ended/changed from date  (under cap threshold)  (please complete Section 6)

11

Cap case is now in receipt of an exempt benefit from date  

• DLA, WTC, AFCS etc.
• Supported Exempt Accommodation,

      under cap threshold after HB removed               

12

Housing Benefit Extended Payments (complete Section 6 with more details)    

13

Other (please provide details in Section 7)

Section 4:   Customer Enquiry (tick applicable box)    

14

Customer enquiry  from claimant/partner (please provide full details of the query in Section 7 , Including claimant/partners contact details) (and complete Section 6)

• DWP itemised calculation query
• Grace period query

Section 5:  Dual Case

15

Dual HB claim?  Yes              If Yes complete Section 5, Number 16

                           No                If No complete Section 6, Number 18                                                                          

16

If Yes to Dual case:  HB Award for lead LA                           £ , at date  

                                 HB Award for second LA                      £ , at date  

17

Are they in Supported Exempt Accommodation       Yes   

                                                                                   No    

If Yes which LA is S(E)A:

• HB Award for lead LA                    
• HB Award for second LA                

Section 6:  HB award confirmation (complete if not a Dual case)

18

Current HB award                                                £         at date     

As defined by the Data Protection Act, do not include the following sensitive personal data in the section below: racial or ethnic origin of the data subject, political opinions, religious beliefs or other beliefs of a similar nature, Trade Union membership, physical or mental health or condition, sexual life , The commission or alleged commission of any offence, Any proceedings for any offence committed or alleged to have been committed, the disposal of such proceedings or the sentence of any court in such proceedings.

Section 7: Notes

19

Please provide further details:

Section 8: LA to complete (complete in all cases)

20

LA officer sending notification

21

LA phone number

22

LA email address

23

Local Authority

24

LA reference number

25

Date

Section 1: HB claimant details (including partner's details where appropriate)

1

HB claimant's name

2

HB claimant's NINo

3

HB partner's name

4

HB partner's NINo

Section 2:  Type of notification (tick applicable box)

5

Outcome of LA referral (complete section 3)

6

Dual case (complete section 4)

7

HB information required to determine the cap (Complete section 6)

8

Grace period changes (complete section  5)

Section 3: Outcome of LA referral (tick applicable box)

9

Claimant/partner contacted, no changes to cap

10

Unable to contact claimant/partner, no further action taken

11

Other (please provide details in section 6)

Section 4:  Dual Case (tick applicable box) (For a Grace period complete Section 6)

12

Confirmation/Information required for a Dual case (Please complete Section 6 and provide details of the second LA including the email address)

13

In receipt of an exempt benefit (DLA, WTC etc.)

14

Itemised calculation completed and above the cap threshold (Atlas transaction sent)

Section 5: Grace period details

15

Grace period now applies from       to     , take appropriate action.

As defined by the Data Protection Act, do not include the following sensitive personal data in the section below: racial or ethnic origin of the data subject, political opinions, religious beliefs or other beliefs of a similar nature, Trade Union membership, physical or mental health or condition, sexual life , The commission or alleged commission of any offence, Any proceedings for any offence committed or alleged to have been committed, the disposal of such proceedings or the sentence of any court in such proceedings.

Section 6: Notes

16

Please provide further details:

Section 7: DWP to complete

17

DWP officer sending notification

18

DWP email address

19

Date