Housing Benefit Form

Housing Benefit Form is filled when people would like to be helped to pay for part or all of the rent. Housing benefit can be applied whether people are unemployed or working. This file includes eleven parts: basic information about you and your partner, about backdating, more information about you and your partner, monitoring information, about children and young people, about other people who live with you, about your income, about rent and where you live, payment details, anything else you need to tell us, and declaration to be completed by all applicants.

HB1- HOUSING BENEFIT CLAIM FORM FOR NEW CLAIMS
Do not use this form if you currently receive Housing Benet and are moving home ask for a Change of
Address form instead. Complete all the sections that apply to you but do not complete any white boxes as
these are for NIHE use.
PART 1. – Basic information about you and your partner
First we need some basic information about you and any partner you may have. By partner we mean someone you
are married to, in a civil partnership with or someone you are living with as if you were married or civil partners.
YOU YOUR PARTNER
Title (Mr, Mrs, Ms, other)
First name
Last name
Other names used
Date of Birth
National Insurance Number
Home telephone number
Work telephone number
Mobile telephone number
E-mail address
Address for which you are
now claiming Housing Benet
Post Code
What date did this tenancy start
What date did you move in
If not yet moved in when do you expect to do so
If you or your partner have previously claimed Housing Benet please give us the address from which that claim
was made
YOU YOUR PARTNER
Post Code Post Code
Claim Reference Number
Date form issued to claimant Issued by
Tenancy type/tenure
Receipt date Start date End date
Last CTAX responsibility ended Date ended from
Joint tenancy % Responsibility
Old correspondence address ended Date ended from
CL/PT details input Household details input
Built by Checked by
Date built Date checked
I am a
Housing Executive Tenant
Housing Association Tenant
Private Tenant
Hostel Tenant
Other
Please tick one box √
I wish to claim Housing Benet
Yes No
I wish to claim Rate Relief
Yes No
I wish to claim Lone Pensioner Allowance
Yes No
Housing Benefit Form
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