Housing Adaptations Enquiry

Eligibility
1. Have you completed the eligibility test?*
  
  Yes
  
  No
No answer
1. You are unable to complete this form until you check your eligibility
Declaration
1. Fields marked with * are required
2. DATA PROTECTION
  
  Completing this application form will lead to your personal information being processed for the purposes of managing your Disabled Facilities Grant, which may include:
  
  confirming your identity and eligibility
  
  understanding your needs to provide the service you have requested
  
  Secure storing of the information for as long as the case or application is current and for a period of 6 years afterwards on re-view as per the time period outlined in the Housing Privacy Notice
  
  All applications are treated with the strictest confidence and we may need to share your information with other organisations such as Norfolk County Council Social Care. This may also include other health professionals such as GPs, Community health, hospitals, local authorities, Housing Associations, Landlords and the CAB, who are obliged to keep your details securely, and use them only for the specified purpose. If we wish to pass your sensitive (special categories) information onto a third party, we will only do so once we have obtained your consent, unless we are legally required to do so. For further information please review the Housing Privacy Notice.
  
  Please tick this box to confirm that you have read and understood the above statements, as well as the Housing Privacy Notice.
3. I understand that by checking the declaration box it is classed as my electronic signature and is the legally binding equivalent to my handwritten signature*
4. Name of person signing this form*

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Housing Adaptations Enquiry

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Housing Adaptations Enquiry

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