Forms home Household Support Fund – Common Assessment Form 1Introductory message2Applicant details3Contact information4Housing details5Reason for applying6Residents7Accommodation8Support and vulnerabilities9Household income10Debts11Utility information12Your consent13Declaration Introductory Message The Household Support Fund (HSF) is designed to support vulnerable households facing financial difficulties with essential expenses, such as food, gas, electricity, water and essential expenses. The HSF will cover the period from 1st April 2025 to 31st March 2026. Applications will be assessed through a Common Assessment Form with a view to providing long term support and moving households in financial crisis to a position of resilience. Application Process: Support Beyond Financial Awards: The current round of the HSF emphasises practical assistance through collaboration with internal and external partners. Financial awards will only be considered when all other forms of support have been exhausted. Case-by-Case Review: Each application will be assessed individually, considering personal, household, and financial details. This ensures that the most appropriate support is identified for each household. Proactive Engagement Required: Applicant, including members of their household (where appropriate) must actively engage with the council and its partners, providing up-to-date information and evidence to support their application. Focus Areas: The fund is aimed at assisting households that: Struggle to meet basic financial commitments, such as expenses for food, gas, water, and electricity. Are at risk of falling into arrears with essential bills. Key Steps in the Process: Assessment: Applications will be reviewed using a Common Assessment Form to understand the applicant's circumstances fully. Identifying Support: We will explore all existing support offered by council services and external partners before considering financial assistance. Empowerment: Our aim is to help households transition from crisis to stability, equipping them with the tools for financial resilience and independence. Applicant details You will need to provide evidence of details given in your application. There must be proof of all income, the latest bank statement, copies of utility bills or utility top up details. We will reject applications where the necessary supporting documents are not included. These details will be used to contact you. These may help us make our decisions quickly. First name(Required) Last name(Required) Other names Date of birth(Required) Day Month Year Do you have a National Insurance number? Yes No Please explain why you do not have a National Insurance numberNational insurance number(Required) Do you have a recourse to public funds?(Required) Yes No Having recourse to public funds includes access to various types of welfare benefits and support provided by the government, such as housing support, income assistance, healthcare services, and educational grants. Contact informationPhone number(Required)Mobile number(Required)Email address(Required) Housing DetailsIs your address in Redbridge?(Required) Yes No Post code(Required)Find addressSelected address Address(Required) Address line 1 Address line 2 City County Post code Has a Housing Service from another Local Authority placed you in Redbridge?(Required) Yes No If yes, you will need to apply to that local authority for assistance Have you received support through the Household Support Fund in the last 6 months?(Required) Yes No Reason for applying For us to be able to consider your application you must tell us in detail about: A. The hardship you are experiencing B. Why you are not able to meet your expenses If you do not provide a reason, your application will be rejected. What hardships do you need assistance with?(Required) Food Clothing Energy & water bills top up Energy & water bills direct payments White goods Beds & bedding Other Please explain why you are applying for support, detailing the specific difficulties you are facing, relating to food, utilities, and other essentials(Required) ResidentsTotal number of people in household This includes the applicant and all dependants and non-dependants, even if they are temporarily absent, such as in hospital or at university. A dependant is typically a child under 18 years for whom you may receive Child Benefit for. A non- dependant is someone who lives in a household but is not financially supported by the main resident. They are typically expected to contribute to household costs. This might include adult children, relatives, or friends who are capable of supporting themselves. Residents First name Last name Date of birth Relationship to applicant Employment status Additional information Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Is any member of your houseold a carer? Yes No A carer is a person of any age who provides unpaid care and support to a family member, friend or neighbour who is disabled, has an illness or long-term condition, or who needs extra help as they grow older. This includes people who receive Carer’s Allowance in recognition of their caring responsibilities. Please provide details of carer(Required)In anyone in the household a care leaver? Yes No A care leaver is a young person aged 16 to 25 who has spent time in the care of their local authority, such as in a foster home, residential care, or under another formal care arrangement, before leaving that care setting Please provided details of care leaver(Required) AccommodationWhat type of accommodation do you occupy(Required) Private Rented Council Housing Association Sheltered/Supported Homeowner/Mortgage Living with family/friends Temporary accommodation Homeless Other If other please advise(Required) For private rented - please upload tenancy agreement(Required)Max. file size: 10 MB.For rented accommodation, was this furnished or unfurnished when the tenancy commenced(Required) Furnished Unfurnished Support and VulnerabilitiesDo you or any household member have any disabilities or long-term health conditions?(Required) Yes No A disability or long-term health condition is any physical or mental impairment that significantly limits a person's ability to carry out day-to-day activities over a long period of time. This includes conditions such as mobility issues, chronic illnesses, mental health disorders, and sensory impairmentsPlease provide details of disability and long-term health condition(Required)Are you or any member of your household currently receiving practical, financial, or emotional support from a family member, a council department (such as social services or housing), or a local organisation (such as a charity or community group) Yes No Please outline the type of support you receive and details of the provide(Required)Are you or any of your household members a survivor of domestic abuse? Yes No A survivor of domestic abuse is an individual who has endured any form of physical, emotional, psychological, sexual, or economic violence by a partner, family member, or cohabitant within a domestic setting. This abuse can include actions such as physical harm, manipulation, threats, intimidation, isolation, and financial control, often aimed at asserting power and control over the victim Household income Work Redbridge is a free employment support service provided by the London Borough of Redbridge to assist residents aged 18 and over in finding work, training, volunteering, or self-employment opportunities. The service offers personalised support tailored to individual needs and circumstances.. Are you already engaging with Work Redbridge?(Required) Yes No If you or anyone in your household are interested in work, training, volunteering or self-employment opportunities contact Work Redbridge directly by emailing workredbridge@redbridge.gov.uk or calling 020 8708 2298. In some instances, we may be able to refer you or your family members to Work Redbridge. Would you like us to do this?(Required) Yes No Please explain why you do not wish to be referred(Required)For each household member, list all sources of income, including employment and benefits. You may select more than one income source where applicable. Name Type of income Amount Savings and Investments? Savings and Investments amount Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. You must provide proof of your household income. We will reject applications where the necessary supporting evidence is not included. Evidence Upload(Required)Max. file size: 10 MB. Provide a recent bank statement covering the last 3 months clearly showing the income source(s). This will need to be provided for each household member receiving any form of income. Debts A debt is money that you borrow from someone, like a person, bank, or company, with the promise to pay it back later. This could include things like loans, credit card balances, or unpaid bills. If you don’t repay on time, there may be extra costs, like interest or late fees. Debts can be incurred for various reasons including personal loans, credit cards, mortgages, and other financial obligations. You may select more than one type of debt. We will review the information provided and if necessary, can refer you for specialist debt advice to assist with your situation. Do you or your partner have any debt?(Required) Yes No Debts Type of debt Creditor name Total amount owed Monthly repayment Arrears amount Recovery action Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Utility informationUtility providers and Account details Utility type Provider Name Account Number Payment Type Current balance Payment plan in place? On Priority services register? Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Have you approached your utility providers for support, including grants? Yes No Explain what action was taken by you and your utility provider(Required)Upload utility bill(Required) Drop files here or Select files Max. file size: 10 MB. You need to provide utility bills covering the last three months for each utility service (gas, electricity, water) Your consent The London Borough of Redbridge may use contact details in order to contact customers about London Borough of Redbridge initiatives or to consult about its services, but only if consent has been given for us to do so. If you do not want us to contact, you for these purposes please tick the box. I would not like to be contacted. Declaration Please read this declaration carefully before you sign and date it This is my claim for a Household Support Grant only. I declare that the information I have given on this form is correct and complete as far as I know. I understand that the Council is under a duty to protect the public funds it administers and may use the information provided on this form for the prevention and detection of fraud. It may also share this information with other departments in the Council, other bodies responsible for auditing or administering public funds for these purposes. I understand that if I give misleading information or documents, I may be prosecuted under the Fraud Act 2006. I understand failing to follow all the points mentioned in the declaration, could affect any future claims I make for an Emergency Assistance Grant or other discretionary schemes within the Council. I understand that if the Council recognises that I may be entitled to or need further help, that they will contact other agencies and departments, including my landlord for further information where required. I will be notified and advised of the information the Council is seeking before any contact is made with another department, organisation or other third party. (Required) I understand and agree with all of the above
