Use this form to tell us:
- if you are at risk of homelessness
- you are homeless or sleeping rough
To complete this form you will need:
- your National Insurance number. If you don’t have your National Insurance number enter the code AA000000A in the National Insurance number box.
- a phone number or email address
- details of your housing history for the last 6 years, including any periods of rough sleeping
- details of anyone else in your household who is affected by your situation. This includes:
- dependent children (under 18 years old)
- non-dependant children (over 18 years old)
- other people living in the same property as you
- details of any medical, mental health or accessibility needs
- details of any sources of income
What happens after you have submitted the form
We aim to respond to you within 10 working days. We will contact you through your preferred method of contact.