" APPLICATION FOR RELOCATION GRANT
"

     1. For question 4.1 substitute - 

" Are you, or is your partner, receiving (and entitled to receive) income support or an income-based jobseeker's allowance? Note 8


Yes

Please give details including dates

---



(please go to the Declaration at the end of this Part)


No ".

     2. Renumber question 4.1a as question 4.1A.

     3. For question 4.6, substitute - 

     " 4.6 Have you, or has your partner, been incapable of work, or treated as incapable of work, for at least the last 364 days continuously? Note 12



	You	Your partner
Yes


Please give details including dates

---





	You	Your partner
No		".

     4. For question 4.7, substitute - 

     " 4.7 If you are, or your partner is, terminally ill, have you or has your partner, been incapable of work, or treated as incapable of work, for at least the last 196 days continuously? Note 13



	You	Your partner
Yes


Please give details including dates

---





	You	Your partner
No		".

     5. Omit question 4.22.

     6. In question 4.29 insert in the appropriate place - 

Community care payment:

£

£

Note 43A".

     7. In question 4.31, insert in the appropriate place - 

Career Development Loan:

£

£

Note 45A

" (Please give details of what the payments are intended to cover, e.g., heating, meals)".

     8. In question 4.38 - 

(a) omit ", or one or more of the children," (where those words first occur);

(b) for the words after "local authority," to "eleventh birthday" substitute "and the charge relates to a period beginning on the child's 8th birthday and ending on the day before the first Monday in September following his 12th birthday"; and

(c) above "(If "Yes" for one or more" insert - 

" (If you have named more than one child in question 4.15, please give this information in respect of each child.)".

     9. For the Authorisation substitute - 

" AUTHORISATION
(For persons receiving certain income related benefits) Note 55A



(a) For those receiving income support or an income-based jobseeker's allowance it may be possible for the Council to process the application more quickly if those in such receipt give permission for your local Department of Social Security office to confirm this fact. To give permission, please complete the authorisation below. If not, go to Part 5.



I authorise the Department of Social Security to confirm on request by the Council that I now receive income support/an income-based jobseeker's allowance*.

Name:

---



DSS reference number (case paper), if known:

---



Signature:

---



Date:

---



*please delete as appropriate


(b) For those receiving housing benefit (HB) or council tax benefit (CTB) but not income support or an income-based jobseeker's allowance, it may be possible for the Council to process the application more quickly if those in such receipt give permission for them to refer to their HB or CTB records. They can only do this with your consent. To give permission, please sign the authorisation below.



For the purpose of this application, I give my consent to the Council to refer to information provided by me for the purposes of my application(s) for housing benefit/council tax benefit*.

Name:

---



HB/CTB* reference (if known):

---



Signature:

---



Date:

---



*please delete as appropriate.".

     10. In note 19 of the Notes at the end of the form, after the words "income support", insert "or an income-based jobseeker's allowance.".

     11. Omit note 28.

     12. At the end of the list in the first paragraph of note 43, add -