Housing benefit supported accommodation property details "*" indicates required fields 1Using the form2Declaration3About the landlord, agent and care provider4About the type of company5About the scheme6About the property7About the care and support8About the care and support continued9About funding10Other information Use this form to let us know specific information required by the Department for Work and Pensions in line with their current guidance. The form must be completed by the landlord or agent of the supported housing scheme. Please answer all the questions and provide the required evidence listed below. Without this information and evidence, we will not be able to make a decision on this scheme and will delay the assessment of any claims. This form will ask you to provide your details agent, landlord and care provider details, if applicable information about the company property and accommodation details the care and support provided how the supported housing/care support or supervision is funded. Required evidence proof of ownership if the landlord owns the property lease arrangement if the landlord leases the property the contract between the landlord and the care provider and evidence of payment the contract between the landlord and agent floor plan (this does not need to be a surveyors plan) external photographs of the front and rear of the property and internal photographs of all rooms rent schedule, breakdown of all service charges (this will be provided). Without this information and evidence, we will not be able to make a decision on this scheme and will delay the assessment of any claims. Please have this information ready as pages time-out after one hour. Do not use your browser back button – if you need to go to a previous page click on the previous button at the bottom of each page. Privacy Statement Dover District Council is a Data Controller under GDPR. In submitting this form we will collect and process your personal data. For information about your rights and how the Council uses your data, please view our Corporate and relevant service privacy notice which can be found on our Privacy page. DeclarationPlease check the box below to confirm that you have read, understand and agree to the following statements before completing this form: I confirm the details I will give are correct and that the documents I will upload as proof are original copies and have not been edited in any way. I confirm that I will notify you of any relevant changes straight away. I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me. I understand my data may be shared with other departments as permitted by law. As a Landlord of supported accommodation, you have a responsibility to advise the Benefits Section of any changes in circumstances or level of care your clients receive.Declaration* I understand and accept the above declarationI am the* Agent of the supported housing scheme Landlord of the supported housing scheme About you the agentAbout you the landlordThis field is hidden when viewing the formYour full name*Job title/positionCompany or organisation nameAddress* Address line 1 Address line 2 Town or city Postcode Contact phone number*Email address* Enter email address Confirm email address About the landlord, agent and care providerIs there an agent?* Yes No About the landlordLandlord's name*Landlord's address* Address line 1 Address line 2 Town or city Postcode Landlord's contact phone number*Landlord's email address* Enter email address Confirm email address About the agentAgent's name*Agent's job title/positionCompany or organisation name*Agent's address* Address line 1 Address line 2 Town or city Postcode Agent's contact phone number*Agent's email address* Enter email address Confirm email address Is the care provider's name and address the same as the landlord?* Yes No About the care providerCare provider's name*Care provider's address* Address line 1 Address line 2 Town or city Postcode About the type of companyPlease provide registration number and details for all that apply, use N/A if not applicableCompany limited by sharesRegistration no.For profit*Please select…YesNoN/ANot for profit*Please select…YesNoN/ACompany limited by guaranteeRegistration no.For profit*Please select…YesNoN/ANot for profit*Please select…YesNoN/ARegistered social landlordRegistration no.For profit*Please select…YesNoN/ANot for profit*Please select…YesNoN/ARegistered charityRegistration no.For profit*Please select…YesNoN/ANot for profit*Please select…YesNoN/AVoluntary organisationRegistration no.For profit*Please select…YesNoN/ANot for profit*Please select…YesNoN/ACommunity interest companyRegistration no.For profit*Please select…YesNoN/ANot for profit*Please select…YesNoN/ACommunity benefit societyRegistration no.For profit*Please select…YesNoN/ANot for profit*Please select…YesNoN/A About the schemeScheme name and/or address*Supported Housing scheme categories Supported exempt accommodation A resettlement place, or accommodation which is provided by a county council, housing association, registered charity or voluntary organisation where that body, or person acting on their behalf, provides the claimant with care, support or supervision on more than a minimal basis. A managed property Cases that do not meet the definition of ‘supported exempt accommodation’ solely because care support or supervision isn't provided by the landlord or on their behalf, often due to the funding/care structures in place. The following conditions apply: The property is provided by a county council, housing association, registered charity or voluntary organisation. The claimant is admitted upon the condition that they are in need of, and in agreement to receive, the care support or supervision that is attached to the accommodation. Care support or supervision cannot be ‘floating support’ provided in standard social or third-sector housing. An indication of need may be shown through the provision of public funding for the care support or supervision, although this is not a mandatory requirement. Another consideration would be if the accommodation has been commissioned designed or designated as supported housing by the Local Authority or other appropriate statutory body. Temporary refuge accommodation (victims fleeing domestic violence) Temporary refuge accommodation provided by the same group of third and social sector landlords, but also a Local Authority, where the resident is accommodated because they are fleeing their home as a result of domestic violence. Domestic abuse does not need to be from within the household but other types of violence that may occur in a domestic setting, such as violence by a neighbour or landlord etc. Some refuge accommodation may fall under categories 'support exempt' or 'managed'.Under which category of supported housing does the scheme fall?* Supported exempt accommodation A managed property Temporary refuge accommodation About the propertyAre you the owner, lessee or managing agent?* Lessee of the property Managing agent of the property Owner of the property Upload a copy of the signed lease* Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 2 MB, Max. files: 1. Upload a copy of the contract between the landlord and yourselves. (The landlord will need to supply us with the land registry or lease as appropriate.)* Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 2 MB, Max. files: 1. Upload proof of land registry entry or other proof of ownership such as a completion statement* Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 2 MB, Max. files: 1. The accommodation is* Self contained Bedrooms with shared facilities About the accommodationBathrooms*Number of rooms in shared accommodationNumber of shared roomsBedrooms*Number of rooms in shared accommodationNumber of shared roomsLiving rooms*Number of rooms in shared accommodationNumber of shared roomsKitchens*Number of rooms in shared accommodationNumber of shared roomsRooms solely used by care provider*Number of rooms in shared accommodationNumber of shared roomsShower rooms*Number of rooms in shared accommodationNumber of shared roomsToilets*Number of rooms in shared accommodationNumber of shared roomsOther rooms*Number of rooms in shared accommodationNumber of shared roomsIf other rooms, please provide detailsAre there any adaptations made to the property based on the needs of the tenants?*For example lift, stair lift, disabled access or wet rooms Yes No Please provide details of any adaptations*How many tenants are you able to accommodate in this scheme?*Upload a floor plan (this can be hand drawn and does not need to be a surveyors plan)* Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 2 MB, Max. files: 1. External photographs of front and rear of property* Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 4 MB, Max. files: 2. Photographs of each room in the property. If the property is occupied you do not need to supply photographs of each bedroom but we do need photographs of shared rooms* Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 2 MB, Max. files: 5. About the care and supportWhat client groups are catered for?*Please select all that apply Asylum seekers Estranged from the parental home Homeless People with learning difficulties People with mental health issues People with physical disabilities People with refugee status Previous or current drug / substance / alcohol problems Someone who has left foster care Someone who has offended, or there is a risk they may offend Victims of domestic violence Other Please provide details of what client groups are catered for*What is the referral mechanism for the accommodation?*Please select all that apply KCC/Social Services Local Authority NHS Self referral Other Please provide details of the referral mechanism for the accomodation*Are assessments made of the residents need for care support or supervision and of the suitability of the accommodation?* Yes No Who does the assessment for the suitability of the accommodation?*Is the provision of care support or supervision a condition to the occupation of this property, or available on request only?* Yes No Available on request only Would a person be granted a licence / tenancy if they weren’t in need of, and in agreement to, provision of the care support or supervision that is attached to this accommodation?* Yes No The property is intended as* Short term (less than 2 years) Long term Who is responsible for the following provisions? Please select landlord, agent or care provider?Provision of accommodation*Please select…AgentCare providerLandlordProvision of housing management beyond a normal landlord’s responsibility*Please select…AgentCare providerLandlordProvision of care, support or supervision*Please select…AgentCare providerLandlordIs the care, support and supervision provided by a separate care provider on behalf of the landlord?* Yes No Please upload a copy of the contract between you* Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 2 MB, Max. files: 1. About the care and support continuedHow many hours per week do your staff spend dealing with intensive housing management and general management for this scheme?*How many hours per week do support workers provide care/support to tenants of this scheme?*Is there 24 hour onsite support?* Yes No Is there an overnight carer?* Yes No What care, support or supervision is provided in addition to what would be expected from a general needs landlord?* About the fundingHow is the cost of housing and care, support or supervision funded? Please tell us if you receive funding form the following sourcesKCC/Social services*Please select…YesNoPercentage %*Local authority*Please select…YesNoPercentage %*NHS*Please select…YesNoPercentage %*Rent*Please select…YesNoPercentage %*Charitable donations*Please select…YesNoPercentage %*Please tell us which charties*If there is any care, support or supervision that is not commissioned?* Yes No Please provide details of any care, support or supervision that is not commissioned* Other informationPlease ensure that all of the requested information and evidence is provided. If insufficient information is provided the tenant will be treated as not occupying Specified Accommodation and any housing costs will have to be claimed through Universal Credit. Additional information and evidence may be requested separately.Please use this box to tell us any other informationIf you have no further information to give us, leave the box blank
