Chichester - DFG: Chichester District Council

You & the property

* First, please tell us about the property that’s going to have the adaptations done on it. Is it

This is required
A house which is owner-occupied by you or someone else A flat or maisonette which is owner-occupied by you or someone else A house which is rented by you or someone else A flat or maisonette which is rented by you or someone else A houseboat A caravan or mobile home

* Do you (or your partner) currently receive one of these benefits?

Housing Benefit Pension Credit (also known as Guarantee Credit) Universal Credit Employment & Support Allowance (ESA) which includes an income-related component Job Seeker's Allowance (JSA) (Income-based) Working or Child Tax Credit with income below £15050 Income Support Council Tax Reduction (sometimes called Council Tax Support). This is a means-tested benefit. It is not a discount which reduces the tax for single people or disability None of these

* Is the person for whose benefit the adaptations are planned a child or young person aged under 20 for whom you/you or your partner are getting Child Benefit?

Yes, the grant is for the benefit of a child or young person under 20 for whom I or my partner gets Child Benefit No

* Do you have a partner who is living with you?

This is required
Yes No

* Have you received a Disabled Facilities Grant for this property previously? (Any required contribution made then will reduce your liability in this application).

Yes No

More about you

* What is your date of birth?

* Are there any children or young people under the age of 20 living in your home for whom you are getting Child Benefit?

Yes No

* Other than anyone for whom someone is getting Child Benefit, is there anyone else aged 18 or over living in your home?

Yes No

* Are you employed, self-employed or both employed and self-employed? (If you're aged 60 or over and employed or self-employed, the calculator can't currently make a DFG estimate)

Yes, I’m employed, self-employed or both employed and self-employed No I get Employment & Support Allowance and the DWP has agreed that I can work “permitted hours”

* Do you get Working Tax Credit which includes the Disability or Severe Disability element?

Yes No

* Do you have any savings, shares or property (other than your home) which together are worth £6000 or more?

Yes No

You & your partner

* What is your date of birth?

* What is your partner's date of birth?

* Is your partner disabled, incapacitated or getting Employment & Support Allowance?

Yes No

* Are there any children or young people under the age of 20 living in your home for whom you or your partner are getting Child Benefit?

Yes No

* Other than your partner and anyone for whom you are getting Child Benefit, is there anyone else aged 18 or over living in your home?

Yes No

* Are you employed, self-employed or both? (If you're aged 60 or over and employed or self-employed, the calculator can't currently make a DFG estimate)

Yes, I’m employed, self-employed or both employed and self-employed No I get Employment & Support Allowance and the DWP has agreed that I can work “permitted hours”

* Is your partner employed, self-employed or both? (If your partner is aged 60 or over and employed or self-employed, the calculator can't currently make a DFG estimate)

Yes, my partner's employed, self-employed or both employed and self-employed No My partner gets Employment & Support Allowance and the DWP has agreed that he or she can work “permitted hours”

* Do either of you get Working Tax Credit which includes the Disability or Severe Disability element?

Yes No

* Do you and your partner have any savings, shares or property (other than your home) which together are worth £6000 or more?

Yes No

Children & young people

Children and young people for whom Child Benefit is received

* If you or your partner are in employment or are self-employed, do you have childcare provided by an approved provider for children aged between 8 and 16? (See "Tell Me More" for details)

Yes No, this doesn't apply

If so, how much is the average cost per child?

£

Period

Other adult residents

We need to know about everyone living in your household, such as an adult son or daughter or a parent living with you and sharing your accommodation (for instance, sharing your kitchen). Please complete a set of questions for each individual - for example, if someone has a partner living with you, you need to complete two sets, one for each person.

Your incapacity

* What Daily Living or Care Component do you get?

Personal Independence Payment (PIP) Daily Living Component enhanced rate or Disability Living Allowance (DLA) Care Component at the highest rate (£441.60 every 4 weeks, £110.40 pw.) PIP Daily Living Component standard rate or DLA Care Component middle rate (£295.60 every 4 weeks, £73.90 pw.) DLA Care Component lowest rate (£116.80 every 4 weeks, £29.20 pw.) Attendance Allowance higher rate (£441.60 every 4 weeks, £110.40 pw. Attendance Allowance lower rate (£295.60 every 4 weeks, £73.90 pw.) Armed Forces Independence Payment Constant Attendance Allowance None of these

* What Mobility Component do you get?

PIP Mobility Component enhanced rate or DLA Mobility Component higher rate (£308.20 every 4 weeks, £77.05 pw.) PIP Mobility Component standard rate or DLA Mobility Component lower rate (£116.80 every 4 weeks, £29.20 pw.) Neither of these

* Does anyone get Carer’s Allowance for providing care for you?

Yes No

Your partner's incapacity

* What Daily Living or Care Component does your partner get?

Personal Independence Payment (PIP) Daily Living Component enhanced rate or Disability Living Allowance (DLA) Care Component at the highest rate (£441.60 every 4 weeks, £110.40 pw.) PIP Daily Living Component standard rate or DLA Care Component middle rate (£295.60 every 4 weeks, £73.90 pw.) DLA Care Component lowest rate (£116.80 every 4 weeks, £29.20 pw.) Attendance Allowance higher rate (£441.60 every 4 weeks, £110.40 pw. Attendance Allowance lower rate (£295.60 every 4 weeks, £73.90 pw.) Armed Forces Independence Payment Constant Attendance Allowance None of these

* What Mobility Component does your partner get?

PIP Mobility Component enhanced rate or DLA Mobility Component higher rate (£308.20 every 4 weeks, £77.05 pw.) PIP Mobility Component standard rate or DLA Mobility Component lower rate (£116.80 every 4 weeks, £29.20 pw.) Neither of these

* Does anyone get Carer’s Allowance for providing care for your partner?

Yes No

Your employment

If you get Employment & Support Allowance and have agreed with the DWP that you will work only “permitted hours”, please skip these questions.

Your employment #1

* On average, how many hours a week do you work in this employment?

* When you work these hours, how much are you paid for this job before Income Tax, National Insurance and pension contributions are deducted?

£

Period

* How much Income tax is deducted?

£

* How much National Insurance is deducted?

£

* How much is deducted for an occupational or personal pension scheme, or for a qualifying retirement annuity contract, for this job

£

If you have a second job please give us the details of your income

On average, how many hours a week do you work in this employment?

When you work these hours, how much are you paid for this job before Income Tax, National Insurance and pension contributions are deducted?

£

Period

How much Income tax is deducted?

£

How much National Insurance is deducted?

£

How much is deducted for an occupational or personal pension scheme, or for a qualifying retirement annuity contract, for this job

£

If you have a third job please give us the details of your income

On average, how many hours a week do you work in this employment?

When you work these hours, how much are you paid for this job before Income Tax, National Insurance and pension contributions are deducted?

£

Period

How much Income tax is deducted?

£

How much National Insurance is deducted?

£

How much is deducted for an occupational or personal pension scheme, or for a qualifying retirement annuity contract, for this job

£

Self-employment

On average, how many hours a week do you work in self-employment?

How much is the annual net profit derived from your self-employment (or share of profit if your self-employed in a partnership)?

£

How much Income tax is due?

£

How much National Insurance Class 2 is due?

£

How much National Insurance Class 4 is due?

£

How much is paid into an occupational or personal pension scheme, or for a qualifying retirement annuity contract, for the self-employment?

£

Your partner's employment

If your partner gets Employment & Support Allowance and has agreed with the DWP that he or she will work only “permitted hours”, please skip these questions.

Your partner's employment #1

* On average, how many hours a week does your partner work in this employment?

* When your partner works these hours, how much is paid for this job before Income Tax, National Insurance and pension contributions are deducted?

£

Period

* How much Income tax is deducted?

£

* How much National Insurance is deducted?

£

* How much is deducted for an occupational or personal pension scheme, or for a qualifying retirement annuity contract, for this job

£

If your partner has a second job please give us the details

On average, how many hours a week do your partner works in this employment?

When your partner works these hours, how much is paid for this job before Income Tax, National Insurance and pension contributions are deducted?

£

Period

How much Income tax is deducted?

£

How much National Insurance is deducted?

£

How much is deducted for an occupational or personal pension scheme, or for a qualifying retirement annuity contract, for this job

£

If your partner has a third job please give us the details

On average, how many hours a week do your partner works in this employment?

When your partner works these hours, how much is paid for this job before Income Tax, National Insurance and pension contributions are deducted?

£

Period

How much Income tax is deducted?

£

How much National Insurance is deducted?

£

How much is deducted for an occupational or personal pension scheme, or for a qualifying retirement annuity contract, for this job

£

Self-employment

On average, how many hours a week does your partner work in self-employment?

How much is the annual net profit derived from your partner's self-employment (or share of profit if your partner is self-employed in a partnership)?

£

How much Income tax is due?

£

How much National Insurance Class II is due?

£

How much National Insurance Class IV is due?

£

How much is paid into an occupational or personal pension scheme, or for a qualifying retirement annuity contract, for the self-employment?

£

Your other income - Client of working age

You do not need to give details of • Working Tax Credit • Child Tax Credit • Guardian’s Allowance We do not deal with: • Adoption Allowance • Foster payments (or foster children) • War or Military Pensions such as War Widow or War Widowers Pension. • Maintenance payments for a child from a parent or payments from a former partner

* Do you get Carer’s Allowance?

Yes No

How much is the Carer’s Allowance?

£

Period

* Do you get Maternity Allowance?

Yes No

How much is the Maternity Allowance?

£

Period

* Do you get contribution-based or new-style Job Seeker’s Allowance?

Yes No

How much is the contribution-based or new-style Job Seeker’s Allowance?

£

Period

* Do you receive an income from an occupational pension?

Yes No

How much is the occupational pension?

£

Period

* Do you receive a personal pension or a retirement annuity? Or have you deferred a pension or annuity?

Yes No

How much is the amount of the personal pension or annuity which you receive or have deferred?

£

Period

* Do you get…

Bereavement Support Payment Bereavement Allowance Widow’s (or Widower’s) Pension Widowed Parent’s Allowance None of these

If you receive one of these benefits, how much is it?

£

Period

* Do you get regular payments from a charitable or voluntary body to pay for food, footwear, household fuel, clothing, Council Tax or rent?

Yes No

How much are these regular payments?

£

Period

* Do you get any other income? (You don't have to tell us about Working Tax Credit, Child Tax Credit or Guardian’s Allowance).

Yes No

What is this income?

How much is it?

£

Period

Your partner's other income - Partner of working age

You do not need to give details of • Working Tax Credit • Child Tax Credit • Guardian’s Allowance We do not deal with: • Adoption Allowance • Foster payments (or foster children) • War or Military Pensions such as War Widow or War Widowers Pension. • Maintenance payments for a child from a parent or payments from a former partner

* Does your partner get Carer’s Allowance?

Yes No

How much is your partner's Carer’s Allowance?

£

Period

* Does your partner get Maternity Allowance?

Yes No

How much is your partner's Maternity Allowance?

£

Period

* Does your partner get contribution-based or new-style Job Seeker’s Allowance?

Yes No

How much is your partner's Job Seeker’s Allowance?

£

Period

* Does your partner receive income from an occupational pension?

Yes No

How much is your partner's occupational pension?

£

Period

* Does your partner receive a personal pension or a retirement annuity? Or has your partner deferred a pension or annuity?

Yes No

How much is your partner's personal pension or retirement annuity, received or deferred?

£

Period

* Does your partner get regular payments from a charitable or voluntary body to pay for food, footwear, household fuel, clothing, Council Tax or rent?

Yes No

How much are these regular payments?

£

Period

* Does your partner get any other income? (You don't have to tell us about Working Tax Credit, Child Tax Credit or Guardian’s Allowance).

Yes No

What is this income?

How much is it?

£

Period

Your other income - Client of pensionable age

You do not need to give details of • Working Tax Credit • Child Tax Credit • Guardian’s Allowance We do not deal with: • Adoption Allowance • Foster payments (or foster children) • War or Military Pensions such as War Widow or War Widowers Pension. • Maintenance payments for a child from a parent or payments from a former partner

* Do you get State Retirement Pension?

Yes No

How much is your State Retirement Pension?

£

Period

* Do you provide care for someone for which you used to get Carer’s Allowance, but this allowance ceased only because you started to get State Retirement Pension?

Yes No

* Do you (or your partner) get any Savings Credit (part of Pension Credit)?

Yes No

How much is the Savings Credit?

£

Period

* Do you receive a personal pension or a retirement annuity? Or have you deferred a pension or annuity?

Yes No

How much is the amount of the pension or annuity which you receive or have deferred?

£

Period

* Do you get an income from an occupational pension?

Yes No

How much is the occupational pension?

£

Period

If you get an income from a 2nd occupational pension, how much is it?

£

Period

If you get an income from a 3rd occupational pension, how much is it?

£

Period

* Do you get regular payments from a charitable or voluntary body to pay for food, footwear, household fuel, clothing, Council Tax or rent?

Yes No

How much are these regular payments?

£

Period

* Do you get any other income? (You don't have to tell us about Working Tax Credit, Child Tax Credit or Guardian’s Allowance).

Yes No

What is this income?

How much are these regular payments?

£

Period

Your partner's other income - Partner of pensionable age

You do not need to give details of • Working Tax Credit • Child Tax Credit • Guardian’s Allowance We do not deal with: • Adoption Allowance • Foster payments (or foster children) • War or Military Pensions such as War Widow or War Widowers Pension. • Maintenance payments for a child from a parent or payments from a former partner

* Does your partner get State Retirement Pension?

Yes No

How much is your partner's Retirement Pension?

£

Period

* Does your partner provide care for someone for which they used to get Carer’s Allowance, but this allowance ceased only because your partner started to get State Retirement Pension?

Yes No

* Does your partner receive a personal pension or a retirement annuity? Or has your partner deferred a pension or annuity?

Yes No

How much is your partner's personal pension or retirement annuity, received or deferred?

£

Period

* Does your partner get any income from an occupational pension?

Yes No

How much is your partner's occupational pension?

£

Period

If your partner gets an income from a 2nd occupational pension, how much is it?

£

Period

If your partner gets an income from a 3rd occupational pension, how much is it?

£

Period

Does your partner get regular payments from a charitable or voluntary body to pay for food, footwear, household fuel, clothing, Council Tax or rent?

Yes No

How much are these regular payments?

£

Period

Does your partner get any other income? (You don't have to tell us about Working Tax Credit, Child Tax Credit or Guardian’s Allowance).

Yes No

What is this income?

How much is it?

£

Period

Your capital

* Cash and current account

£

How much are your savings? #1

£

How much are your savings? #2

£

How much are your savings? #3

£

* How much are your shares, investments or property worth? #1

£

How much are your shares, investments or property worth? #2

£

Your capital and your partner's capital

* You and your partner's cash and current account

£

How much are your savings and the savings of your partner? #1

£

How much are your savings and the savings of your partner? #2

£

How much are your savings and the savings of your partner? #3

£

How much are your savings and the savings of your partner? #4

£

How much are your savings and the savings of your partner? #5

£

* How much are the shares, investments or property owned by you and your partner (jointly or individually) worth? #1

£

How much are the shares, investments or property owned by you and your partner (jointly or individually) worth? #2

£

How much are the shares, investments or property owned by you and your partner (jointly or individually) worth? #3

£

Previous grants for this property - Owner-occupier

* Have you received a Disabled Facilities Grant for this property as an owner-occupier in the last 10 years?

Yes No

How much was the contribution required for the previous grant(s)?

£

Previous grants for this property - Tenant, mobile home or houseboat

Have you received a Disabled Facilities Grant for this property as a tenant in the last 5 years?

Yes No

How much was the contribution required for the previous grant(s)?

£

Passported benefits

Thank you for the information. You have said that you receive a benefit (or have been assessed for a Tax Credit with a low income) which mean that you qualify for a full Disabled Facilities Grant. So we don't need any further information about your income or circumstances. We suggest that you finish the form by going to the next page and email the results to us and yourself and we will get in touch with you.

Application for a child or young person

Thank you for the information. You have said that the adaptations are for the benefit of a child or a young person for whom Child Benefit is payable. So we don't need any further information about your income or circumstances. We suggest that you finish the form by going to the next page and email the results to us and yourself and and we will get in touch with you.

Summary Page

Thank you for completing the questionnaire. Remember that when you close the App all the data will be deleted. So please make sure that you complete and save the assessment as described below.

First, you may like to check the answers you’ve given. We’ve listed below the questions which you’ve answered. If you want to check or change any of the answers just click on the question and the system will take you there.

To see the calculation, click the Calculate Results button and then on “DFG Results” in the bottom left-hand corner of the screen. We recommend that you save this somewhere on your computer. Once this App is closed, the data will be deleted.

We hope you found the app useful and we look forward to hearing from you.

Don’t forget to save the results document!

Application

You & the property

First, please tell us about the property that’s going to have the adaptations done on it. Is it

Chichester District Council

You & the property

More about you

You & your partner

Children & young people

Other adult residents

Your incapacity

Your partner's incapacity

Your employment

Your partner's employment

Your other income - Client of working age

Your partner's other income - Partner of working age

Your other income - Client of pensionable age

Your partner's other income - Partner of pensionable age

Your capital

Your capital and your partner's capital

Previous grants for this property - Owner-occupier

Previous grants for this property - Tenant, mobile home or houseboat

Passported benefits

Application for a child or young person

Summary Page

Application

You & the property

More about you

You & your partner

Children & young people

First child or young person for whom child benefit is paid

Second child or young person for whom child benefit is paid

Third child or young person for whom child benefit is paid

Fourth child or young person for whom child benefit is paid

Other adult residents

First other adult resident

Second other adult resident

Third other adult resident

Fourth other adult resident

Your incapacity

Other benefits and circumstances

Your partner's incapacity

Other benefits and circumstances

Your employment

Your employment #1

If you have a second job please give us the details of your income

If you have a third job please give us the details of your income

Self-employment

Your partner's employment

Your partner's employment #1

If your partner has a second job please give us the details

If your partner has a third job please give us the details

Self-employment

Your other income - Client of working age

Your partner's other income - Partner of working age

Your other income - Client of pensionable age

Your partner's other income - Partner of pensionable age

Your capital

Your capital and your partner's capital

Previous grants for this property - Owner-occupier

Previous grants for this property - Tenant, mobile home or houseboat

Passported benefits

Application for a child or young person

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Application

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Send results to Chichester District Council

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