Application form: housing benefit, council tax benefit or second adult rebate

To apply you will need to:

answer all questions in the application, please use black ink - if the questions do not apply please write 'none' or 'does not apply'.

Please do not delay in returning this application form, if you do not have all the information to hand, send the application in and submit further evidence as soon as possible after.print off and fill in the application form at the bottom of this page

Use this form to claim:

Housing Benefit  - Housing Benefit is a benefit to help you pay your rent.

Council Tax Benefit - Council Tax Benefit (including Second Adult Rebate) can help you with your Council Tax.

Second Adult Rebate - Second Adult Rebate is Council Tax Benefit for people, a) who may not have a partner, or b) whose partner is disregarded for Council Tax purposes, but who share their home with someone who:

• Is 18 or over; and
• Is on a low income; and
• Does not pay them rent

If you are claiming Second Adult Rebate, only fill in Part 1, Part 3 and Part 17 of this form.

Filling in the form

Use black ink to fill in the form. Do not:

• Use pencil;
• Use correction fluid or tape.

If you make a mistake, just cross it out and put the right answer next to it.

Answer 'Yes' or 'No' questions by putting a tick in the relevant box. If you are picking an answer from a list of answers, put a tick in the relevant box.  If someone else fills in the form for you, there is a designated space for them to sign in Part 17 of the form.

If you need help filling in the form

• You may telephone us on 01248 752226 / 752658.
• You may call at any of the council offices noted on our contact page.
• You may contact organisations like the Citizens Advice Bureau.

Evidence

We need to see evidence of some of the things you tell us about, we must see original documents.  Please see the "Evidence Check" at the end of each Part for advice about what documentation is required. There is also a checklist at the end of the form to help you.  If you are not sure if we need to see evidence of something, get in touch with us.  We will tell you what we need to see.  We cannot pay you benefit until we have seen the evidence we have asked for.

What to do next

When you have filled in the form, sign it and send it to us, with the original documents we need to see. Do not send valuable items such as bank books or passports in the post.  Bring them to one of our offices listed on the front of this form and we will get the information we need and give them back to you.

If you cannot get the evidence we need straightaway, do not worry.  Send the form to us, but let us know that you will be sending some evidence later.  If you do not send the form to us straightaway, you might lose money.  If you cannot get the evidence within 2 or 3 weeks, let us know.  We may be able to help you.

When we usually pay benefit from

To make sure your Council Tax Benefit or Housing Benefit starts from the earliest date possible you should contact us as soon as you need benefit to tell us that you plan to claim.

You can do this by:

• calling or writing to one of our offices: Isle of Anglesey County Council, Revenues and Benefits Office, POBOX 29, Llangefni, Anglesey, LL77 7ZF or Holyhead Area Office, Isle of Anglesey County Council, Newry Street, Holyhead, Anglesey, LL65 1HU. (Please note that our office in Holyhead is an Area Office only, please do not post any correspondence to this address)
• faxing on 01248 752233; or
• sending an e-mail to benefits@anglesey.gov.uk

Your claim form and supporting documents should then be returned to the office immediately.

We can usually award benefit from the Monday after the day we receive your request to claim.  If you want to claim from an earlier date see Part 16 of the form

Changes you must tell us about

You must tell us straight away of any changes in your circumstances (this list is not exhaustive), such as;

• any of your children leaving school or leaving home;
• anyone moving into or out of your home (including lodgers and subtenants);
• your income or the income of anyone living with you, including benefits, changes;
• you or anyone living with you starts work;
• you or your partner's capital, savings or investments change;
• you or anyone living with you becomes a student, a Youth Trainee, goes into hospital or a nursing home, goes into prison, changes or leaves a job
• your rent changes;
• you move;
• you or your partner are going to be away from home for more than a month;
• you receive any decision from the Home Office; or
• anything you have told us about changes.

You must make sure that you tell us about these changes.  Don't rely on someone else to pass the message on.

If you don't tell us about these changes you may lose money you are entitled to or you may get too much benefit, which you will probably have to pay back.

It is an offence not to tell us about any change of circumstance that affects your benefit.  If you do not, we may take court action against you.

National Fraud Initiative

The Isle of Anglesey County Council is participating in an exercise to ensure that public money is being spent properly.  The Council is required by law to protect the public funds it administers. It may share information provided to it with other bodies responsible for auditing or administering public funds in order to prevent fraud and detect fraud.

The Auditor General for Wales currently requires us to participate in this anti fraud initiative.  For this initiative, we are providing details of our council tax payers for the purposes of comparing these with information from other public bodies.  The details supplied will apply in respect of council tax payers during April 1st 2008 - 31st March 2009 and future years.  This will ensure that public money is being spent effectively.

We will not give information about you to anyone else, or use information about you for other purposes, unless the law allows us to.

We, The Isle of Anglesey County Council, are the data controller for the purposes of the Data Protection Act.  If you want to know what information we have about you, or the way we use that information, please ask us.

Useful Contacts

AGORFA(Bond Scheme): Unit 5A, Llangefni Industrial Estate, Llangefni LL77 7XA
Tel: 01248 753940.
HM Revenues and Customs: Tel: 0845 3003900
The Pension, Disability and Carers Service: Tel: 0800 991234