Refer someone who is homeless or at risk of becoming homeless

About this form

Use this form to refer someone:

• if you think they are at risk of homelessness
• they are homeless or sleeping rough

To complete this form you will need:

• details of your public authority, including your authority’s name and address
• your contact details
• the referred person’s name, date of birth and contact details
• the referred person’s National Insurance number
• details of the referred person’s housing history for the last 6 years, including any periods of rough sleeping
• details of any medical, mental health or accessibility needs
• details of any sources of income
• details of any other people effected by the referral including:
  • spouse or partners
  • dependent children - under 18 years old
  • non-dependant children - over 18 years old
• Proof that consent has been given for your authority to refer the person

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.