This form should only be used to report changes relating to Housing Benefit/Council Tax Reduction.Your details Full Name * (Title, forenames and surname) Address Telephone number E-mail Benefits claim number * National insurance number Please tell us about your change of circumstances Please include the date it took place and any other relevant information. Circumstances Have you or your partner started work, changed employer, changed the number of hours you work or has your pay gone up or down? Yes No Have you or your partner started work, changed employer and/or hours? You Your partner You How many jobs do you have? What date did you start work/change hours/employer? Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2020202120222023 What is your occupation? What is your employer's name and address? How many hours, on average, do you work per week? How often are you paid? - None -WeeklyMonthlyFortnightly How are you paid? - None -CashChequeDirect to bank What is your payroll number? Have you applied for tax credits? Yes No How much do you receive per week? Are you self employed? Yes No If you are we will need to contact you for further information. If you pay a registered child minder, please supply their registration number and the amount you pay weekly Your partner How many jobs do you have? What date did you start work/change hours/employer? Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2020202120222023 What is your occupation? What is your employer's name and address? How many hours, on average, do you work per week? How often are you paid? - None -WeeklyMonthlyFortnightly How are you paid? Cash Cheque Direct to bank What is your payroll number? Have you applied for tax credits? Yes No How much do you receive per week? Are you self employed? Yes No If you are we will need to contact you for further information. If you pay a registered child minder, please supply their registration number and the amount you pay weekly Have you changed your address or are you going to change your address soon? Yes No Change of address Your new address Your new landlord's name and address Your landlord's telephone number Date you moved into your new home Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year201220132014201520162017201820192020202120222023 Start date of your new tenancy Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2020202120222023 Date you left your previous home Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2020202120222023 End date of your previous tenancy Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2020202120222023 What type of property is your new address? - None -FlatMaisonetteBungalowHouseBedsitRoomOther Other (please state) Is the property - None -TerracedSemi-detachedDetachedStatic caravanTouring caravan How many floors are in the building? - None -12345678910111213151617181920 Does your new home have central heating? Yes No Do you have a garage? Yes No Is your landlord responsible for decorating inside your home? Yes No Is your new home furnished by your landlord? - None -NoFullyPartially Please tell us about the rooms in your new home Tell us about the rooms in your new home Please tell us the number of rooms used by you and your family for each type below Living room Living room Bedroom Bedroom Kitchen Kitchen Bathroom Bathroom Bedsit Bedsit Other Other Number of other tenants you share rooms with Please tell us the number of other tenants you share rooms with for each room type below Living room Living room Bedroom Bedroom Kitchen Kitchen Bathroom Bathroom Bedsit Bedsit Other Other Number of rooms you share with other tenants Please tell us the number of rooms you share with other tenants for each room type below Living room Living room Bedroom Bedroom Kitchen Kitchen Bathroom Bathroom Bedsit Bedsit Other Other Total number of rooms in your property How much is your rent? How often do you pay rent? - None -WeeklyMonthly4 weekly Do you have weeks when you do not have to pay rent? Yes No When are these weeks? If you are a Housing Association tenant, do you want your benefit paid to your landlord? Yes No If you would like your housing benefit to be paid to you by BACS, please supply your account name, sort code, and account number below: Account name Account number Sort code Some charges for services such as heating, hot water and meals will not qualify for housing benefit. They must be deducted from your rent if it includes them. If you cannot tell us how much they are we will deduct the standard amounts. Please tick which of these are included in your rent. Included in your rent Meals Heating Lighting Hot water Cooking Gas or electricity for cooking Cleaning Laundry Personal care General care How much do you pay for meals? How much do you pay for heating? How much do you pay for lighting? How much do you pay for hot water? How much do you pay for cooking? How much do you pay for gas or electricity for cooking? How much do you pay for cleaning? How much do you pay for laundry? How much do you pay for personal care? How much do you pay for general care? Do you receive any meals? - None -NoBreakfast onlyHalf boardFull board Overlapping benefit on two homes We may be able to pay benefit for two homes for up to a maximum of four weeks. If you have been “HELD TO NOTICE” at your previous address and have to pay rent for both properties you may be entitled to claim benefit. Do you wish to apply for Held to Notice overlapping benefit? Yes No Held to Notice: this section should be completed if you require overlap of housing benefit for your previous address Please give reasons and supply proof to support your claim If there has been a delay in moving due to adaptations to the property due to adaptations to the property due to disability and you are liable for the rent on both properties or you are waiting for a social fund loan to assist with the removal you may be entitled to claim benefit. Prior to moving in: this section should be completed if there was a delay in moving in to your new home Please give reasons and supply proof to support your claim If you have had to move through ‘fear of violence’ and you intend to return to the property you have left you may be entitled to benefit for both properties. Two homes: this section should be completed if you have had to move through fear of violence. Please give reasons and supply proof to support your claim Anything else you think we should know Is there anything else you think we should know about? Yes No Please tell us anything else you think we should know What is your preferred method of contact should we require further information? Phone E-mail E-mail * Phone number * See our evidence checklist to find out if you are missing anything (opens in new window) Declaration This is a change connected to my claim for housing benefit and/or council tax reduction scheme with Argyll and Bute Council. I confirm that as far as I am aware the information I have given on this form is accurate and complete. I give Argyll and Bute Council permission to make any necessary enquiries to check the information on this form. I understand that if I give information that is not correct or complete, or I do not tell the council benefit section about any changes that may affect my benefit then my payments of benefit may be suspended and I may be liable to prosecution. The council is under an obligation to manage public funds properly; accordingly information that you provide will be used to ensure appropriate payment of housing benefit and council tax reduction scheme. The information may be shared with other authorised bodies in order to prevent and detect fraud. This authority operates within Government guidelines of best practice, which means you will in the lifetime of your claim receive a visit or visits from council benefit officers who will wish to verify that the details we hold for your claim are still current and remain unchanged. The officer will formally identify him/herself and will fully explain the procedure to you. Failure to cooperate with this procedure could result in suspension or cancellation of any benefit in payment. Please state your full name to confirm you agree with this declaration The information you have supplied on this form will be used for the purpose for which you have provided it, and appropriate measures are in place to protect your personal data. A full privacy notice, which provides information about your rights under current data protection legislation and details about what will happen to your personal data can be found here:Privacy Notice - Housing Benefit and Council Tax Reduction Leave this field blank