Household Support Fund – Common Assessment Form

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.

While filling in this form, you will be asked to upload some supporting documents. We strongly recommend you upload these as you go, as it will help us process your application faster. If you cannot upload them right away, you must send us everything within 10 working days of applying or email us if you need more time. If we do not hear from you, your application will not be processed and will be refused.

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.

Are you completing this form on behalf of the applicant?

Yes

No

If you are completing this form on behalf of the applicant, we may need to contact you to discuss their needs. Please complete the following

Name	Contact telephone number	Contact email address representative	Organisation	Actions

There are no Entries.

Applicant first name(Required)

Applicant last name(Required)

Other names

Applicant date of birth(Required)

Does the Applicant have a National Insurance number?

Yes

No

Please explain why the applicant have a National Insurance number

National insurance number(Required)

Is the applicant a person from abroad with 'No Recourse to Public Funds’?(Required)

Yes

No

A person with ‘No Recourse to Public Funds’ means you are not allowed to access most UK government benefits due to your immigration status. This usually applies to visa holders or people without permanent immigration status. If you are unsure, check your immigration documents for a ‘No Recourse to Public Funds’ condition.

Does the applicant currently receive any support from the Home Office under any asylum support scheme?(Required)

Yes

No

This includes accommodation and/or financial support from the Home Office such as Asylum support (Section 95 or 98), Section 4 support (for people refused asylum) or Support through the National Referral Mechanism.

Upload evidence such as Home Office letter or ASPEN Card

Max. file size: 10 MB.

Contact information

Applicant phone number(Required)

Applicant mobile number(Required)

Applicant email address(Required)

Housing Details

Is your address in Redbridge?(Required)

Yes

No

Post code(Required)

Find 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

You cannot continue with the remainder of this application. You will need to apply to the local authority that placed you 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)

Residents

Total 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.
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	Relationship to applicant	Date of birth	Employment status	Actions

There are no Entries.

Is any member of your household 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.

Name of carer(Required)

Is the carer in receipt of Carer’s Allowance?(Required)

Yes

No

Name of person for whom care is provided(Required)

Does the ‘cared for’ person live in the same household?(Required)

Yes

No

If not, please provide their age(Required)

How many hours per week is care provided?(Required)

In anyone in the household a care leaver?

Yes

No

A care leaver is a young person aged between 16 and 25 who has been in the care of the local council, like a foster home or children’s home, and has now left, or is about to leave, that care.

Please provide the full name of the care leaver(Required)

Support and Vulnerabilities

Do 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 impairments

Please provide details of all household members with a disability or long-term health condition

Name of household member	Details of disability and/or long-term health condition	Actions

There are no Entries.

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 household members receive and details of the provider

Name of household member	Type of support	Provider	Actions

There are no Entries.

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

You must provide proof of your household income. We will reject applications where the necessary supporting evidence is not included.

Evidence Upload(Required)

Drop files here or

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.

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 / benefit	Actions

There are no Entries.

Do you receive any of the following seasonal or discretionary payments?

Cold Weather Payments

Discretionary Housing Payments

Free School meals

Healthy Start Vouchers

Homeless Prevention Grant

Ilford Grocery Store membership

School Uniform Grant

Warm Home Discount

Winter Fuel Payment

Savings and Investments

Evidence Upload

Drop files here or

Max. file size: 10 MB.

Please provide bank statements covering transactions for the last 3 months for every account declared. These will need to be provided for each household member with savings and /or investments.

Do you have any savings and investments?(Required)

Yes

No

Bank and cash accounts

Account held	Type of savings account	Last four digits of account number	Balance	Actions

There are no Entries.

Please provide bank statements covering transactions for the last 3 months for every account declared. These will need to be provided for each household member with savings and /or investments

Other savings

Type of saving	Investment held	Last four digits of account number	Number of units held	Total Value	Actions

There are no Entries.

Please provide evidence of the other savings you have declared. These will need to be provided for each household member

Other capital

Type of capital or asset	Value	Actions

There are no Entries.

Please provide evidence of other capital or assets you have declared. These will need to be provided for each household member

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

Creditor name	Type of debt	Recovery action	Total amount owed	Monthly repayment	Arrears amount	Actions

There are no Entries.

Evidence upload

Drop files here or

Max. file size: 10 MB.

Utility information

Utility providers and Account details

Utility type	Provider Name	Account Number	Payment Type	Payment plan in place?	On Priority services register?	Current balance	Actions

There are no Entries.

Are you or any of the declared household members responsible for the utility costs of your home?(Required)

Yes

No

Have you approached your utility providers for support, including grants?(Required)

Yes

No

Explain what action was taken by you and your utility provider(Required)

Upload utility bill(Required)

Drop files here or

Max. file size: 10 MB.

You need to provide utility bills covering the last three months for each utility service (gas, electricity, water)

Expenses

Please advise us of your average monthly expenditure on food shopping.(Required)

Please advise us of your average monthly expenditure on clothes shopping.(Required)

Your consent

The council’s Household Support Fund team will contact you to discuss your application, either by telephone, email or post. It is important that you work with the team to ensure your application is processed effectively.

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.

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 do not consent to be contacted for these purposes

Declaration

Please read this declaration carefully before you sign and date it

This is my application 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.

I understand and agree with all of the above

Introductory Message

Applicant details

Contact information

Housing Details

Reason for applying

Residents

Accommodation

Support and Vulnerabilities

Household income

Savings and Investments

Debts

Utility information

Expenses

Your consent

Declaration