Housing Service Support Request

Request details

Type of request*
1. Request documents
2. Appointment scheduling
3. Book accommodation inspection
4. Outbound call for payment
5. SWEP alert
6. Issue Food Bank voucher
7. Investigate Welfare Needs
8. Mortgage Repossession
Appointment details
1. Appointment format
  
  In person
  
  Telephone
  
  Video call
2. Appointment location
  For example Elizabeth House
3. Appointment duration
  For example 30 mins
4. Documents required
Payment details
1. Please details the amount to pay (£0.00)
2. Please set out the payment period
Food Bank voucher details
1. Please state how many people in the household?
2. How old are they?
3. Please select items required
  
  Sanitary items
  
  Baby items
  
  Toiletry items
4. Please provide any dietary requirements
5. Source of income
  
  Earning no benefits
  
  Pension
  
  Earning and benefits
  
  Benefits not earning
  
  No access to a bank account
  
  No income
  
  Unknown
6. Reason for referral (select all that apply)
  
  Financial - Earnings related
  
  Financial - Benefits related
  
  Financial - debts, costs and expenses
  
  Rising costs of essentials
  
  Other unexpected expense
  
  Personal circumstances
  
  Health
  
  Other
Reason for request*
Is this request being submitted for more than one person? *
For example: SWEP alerts for multiple people
1. Yes
2. No
Please add number of people below
Please upload a spreadsheet below with the following information for each person.
Full name
Email
Contact telehone number
Address (if they have one)
Document upload
Permitted file types: JPEG, PNG, DOC, PDF. Maximum file size: 5MB

No file chosen
Urgency of request*
Please select how quickly you require this to be actioned
1. Same day
2. Within 48 hours
3. Within 7 days
4. Within 14 days
5. Not urgent
Please select your team*
1. Communities Team
2. Housing Accommodations Team
3. Housing Allocation Team
4. Housing Prevention Team
5. Housing Relief Team
6. Housing Rough Sleeper and Resettlement Team
7. Private Sector Housing Team
Name of requesting officer*

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Housing Service Support Request

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Housing Service Support Request

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