Somerset Household Support Fund

It is important that we are able to quickly and easily contact you to avoid any delays to your application. If you are able to communicate by email please tick this box along with any other relevant methods

By providing your email address you are consenting to be contacted by email.

Your preferred contact number. By providing this telephone number you are consenting to be contacted by telephone.

An alternative contact number such as a landline or family members telephone. By providing this telephone number you are consenting to be contacted by telephone.

Please select the best option that describes your household. Your household is your family members that live with you.

In total, how many people including you live in your household?

Please provide the age of each child, aged 18 or under, that lives in your household. Use the + symbol to add more rows

Please provide the names of each adult (over 18) in your Household. Use the + symbol to add more rows

Means tested benefits are those that you are entitled to if you are on a low income, such as Universal Credit

These are benefits that pre-date Universal Credit and that you may still be in receipt of

Household income is defined as all income coming into the household from adults aged 18 or over from earnings, employment and self employment, benefits, pensions and income from savings and investments. Please do not include income from health related benefits such as DLA, PIP and Attendance Allowance. Please also do not include earnings from any young person who is still in full time education (school, sixth form or college) If your household includes 2 or more adults please give the total income for your whole household.

Savings and capital is defined as money you have in bank accounts, in any type of investment (including ISAs), and in ownership of valuable assets such as other property. Please do not include the home you live in or other assets you need day to day such as cars you need for work or childcare.

Household energy is Gas, Electric, Oil and Solid fuels

Other essentials linked to energy and water may be things like white goods, boiler repairs, clothes and blankets

Other household essentials maybe things like broadband, school uniform and transport costs

Exceptional cases of genuine household emergency are only likely to be cases of impending eviction due to rent arrears, where all other options have been exhausted. This cannot be used to pay for mortgage arrears

Please explain what else it is you need help with or what your housing emergency situation is

Please select vouchers for the supermarkets listed or a Bank Transfer to provide you with the money directly

Please select the correct voucher, cheque or a Bank Transfer to provide you with the money directly

Please tell us, in monetary terms, how much you need for each of the areas of assistance you have selected. For example. £50 for food, £100 for gas and electric, £100 for other household essentials. Please note that if you have chosen to receive your entire award, if approved, by Bank Transfer then we will do one transfer but we still need to know how you intend to split it.

Please provide a photograph or scanned image of official documents proving your ID and/or address. For example, a passport, driver's license, council tax bill, utility bill, bank statement or letter from DWP

Please provide a photograph or scanned image of a benefit award letter from DWP, HMRC or local council that is no more than 6 months old. If you only have an older letter please upload it but ALSO upload a bank statement showing payments of this benefit(s) in the last month

This must cover a full calendar month and be a period within the last 3 months. Screen shots of online banking must show your name as well as transactions. Please provide multiple screen shots if required. If you have more than one bank account please upload the latest bank statement for each account

This could be a friend, a family member, or a member of an organisation. Please provide their details below.

If the person who helped you fill in this form belongs to an organisation, please provide the name of the organisation

This is the preferred contact number of the person who helped you fill in this form

Please provide the email address of the person who helped you fill in this form

Please be aware that any email we send will come rom [email protected] This may end up in your Junk folder so please check

I confirm that the information I have provided in this application is accurate and a true representation of my/our household. I agree to Citizens advice contacting me via the method(s) I have provided, and also contacting anybody who I have stated helped me to complete this form, where necessary to assist in processing the application. I understand that where Somerset County Council suspects that fraud may have occurred it will investigate the matter as appropriate and this may lead to criminal proceedings. If I attempt to claim an award from the Household Support Fund by making a false declaration or providing false evidence I may have committed an offence under the Theft Act 1968.

This field is for validation purposes and should be left unchanged.

Somerset Household Support Fund Application Form

Information about you and your household....

Information about the amount of money you have to live on each month....

What essential support do you need....

If your application is approved how can we provide your grant....

Evidence to support your application....

Completion and Declaration....