Liverpool City Council

Before you begin

PLEASE NOTE: This application process has now closed. Please do not continue with this form, as it will not be able to be submitted.

This form is to apply for the Household Support Fund if you are a single person aged under 35, on a low income and in receipt of Housing Benefit and/or Council Tax Support. You must have received a letter from Liverpool City Council inviting you to apply for support. Your letter includes a unique reference, which you must enter below to validate your claim.

Reference number Please enter the reference number you have been provided with

Eligibility

Select which of the following applies Please note you cannot make an application or receive an award under this scheme if you are aged 35 or over on 1 December 2021.

On 1 December 2021 the applicant is a single person aged under 25.
On 1 December 2021 the applicant is a single person aged between 25 and 35.

This application process has now closed. Please do not continue with this form, as it will not be able to be submitted.

Does the applicant receive help with rent (Housing Benefit) from Liverpool City Council?

Yes
No

Does the applicant receive help with Council Tax payments (Council Tax Support)?

Yes
No

Sorry, you do not qualify for a payment under this scheme.

Please confirm that by providing the information requested in this form you consent to us using the data you provide to confirm you are eligible for an award

I consent
I do not consent

As you have not provided your consent for us to process your personal information for the purposes of the Household Support Fund, you are not be able to submit an application.

Other support is available through our Liverpool Citizens Support Scheme. You can find more information on our website at liverpool.gov.uk/lcss or by calling us on 0800 456 1523.

Personal details

Who are you completing this form for?

Myself
Someone else

Relationship to applicant

Family member
LCC Advisor
Third Party Agency Advisor
Other (please provider details)

Please enter your relationship to the applicant

Your full name

Provide agency name - optional

Contact mobile number

Contact email address

Applicant details

First name

Middle name - optional

Last name

Date of birth

National insurance number

Address

Postcode

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Contact email address

Contact mobile phone number

Bank details

Do you have a bank account? Please note that we cannot pay an award in to another person’s bank account. The account name will be verified during the payment process. If we cannot verify your bank account your award may be delayed.

Yes
No

If you are entitled to an award we will contact you to discuss how the payment can be made.

Account holder's name

Account number

Sort code

Declaration

By submitting this form you declare that:

I confirm I am authorised to submit this application form on behalf of the applicant
I declare that I meet the criteria for an award under this scheme
I confirm that the information I have provided is correct and accurate
I provide consent for Liverpool City Council to verify the information that I have provided using information held by Liverpool City Council or information provided by the Department for Work and Pensions (DWP)

You must agree to the above declarations in order to submit this application.

Before you submit this form please review your answers below. If you need to change anything, use the 'previous' button on the bottom left to go back to a section. Then submit the form by selecting the 'Submit button' at the bottom of this page