Household Support Fund

Household Support Fund

This form is to refer people into our Household Support Fund. Households with key meter or smart meters that are pay as you go and topped up in a shop may be eligible. We are particularly hoping to support low income families and those of pension age. Our partnership agencies may refer clients in (with their permission). We also welcome self referrals. The fund is going to close on 30th September 2022. This form will take about 10 minutes to complete, if you struggle to complete this form, please call us on 01395 265 070 and we can help you. By continuing you understand the following. We have to record a few details about you to make sure we are treating you according to our quality service standards and as required by data protection laws. We will need to store basic information about you and your query on our secure database and we may need to ask further information before issuing the vouchers. We will share some of your data to issue your codes via Charis Grants and to do some statistical analysis of our work. You retain full rights over your personal data, you can view our privacy policy on our website www.citizensadviceeastdevon.org Only one person per household can apply for these codes and you can only have them for a maximum of two sets of vouchers at least a month apart. This support fund will be popular and you should expect to wait a while before they are issued. Vouchers will be issued on a first come first serve basis until they run out.
Name *

First Name Last Name
Email, please check this is correct as this will be the email that we will be sending your codes to via Charis Grants. If you do not have an email we can arrange to send them by post, but this will take longer. This email must be yours we will not be able to send codes to other people's email addresses.
example@example.com
Address *

Street Address

Street Address Line 2

Town County

Postcode
Please type your post code again - thank you. *
Telephone number *
How do you pay for your electricity and (if relevant) your gas? *

Key Meter Smart Meter that I can top up in a shop Pay my direct debit or other method - sorry this is not the right scheme for you, contact East Devon District Council.
Where do you normally top up? *

Paypoint Post Office Payzone (we are sorry that we not issue vouchers for Payzone) - please contact the council instead.
Who is your Utility Provider? *
Can you explain in a few words, why you are struggling to top up your prepayment meter? For example it might be that you have lost your job, made a new benefit claim, you have utility debts or it is now costing you £££ each day and you can't afford it. *
Have you had a Household Support Fund payment since May 2022? *

No, this is my first since May 2022 Yes, I have had one set of vouchers Yes, I have had two sets of vouchers
Has anyone from your household applied for these top up vouchers before? *

Yes No
If requested, would you be able to send a picture of your meter? *

Yes No No because I don't have a smart phone/internet
What is the current balance on the meter that you wish to top up? This will help us see how urgent your request is and will help us prevent fraud. *
How much do you spend on energy every month? *
What type of property do you live in? *

Flat House Bungalow Other
How many adults are there in your home? *
How many dependent children are there in your home and what are their ages? *
We use a system provided by Charis Grants to send out vouchers. We need your permission to put your email address into the system so that they can send out the voucher. They won't send out any other email apart from the voucher. Can you confirm your permission to put your email address into the Charis Grant system. *

Yes that is fine permission is granted No I would prefer to be send the vouchers by post. I understand that there might be a delay before I receive these.
Are you on any of the following benefits *

Universal Credit Pension Credit Child Tax Credits Disability Living Allowance Attendance Allowance Personal independence Payments State Retirement Pension None
As far as you are aware, are you in debt with your supplier? And if yes do you know roughly how much? We may be able to help you with grants from energy trusts *
Do you need any additional help at this time with other issues that the Citizens Advice might be able to help with? *

Debt - we will call you to arrange a debt assessment. If you have an emergency such as the bailiffs at the door, please call us for emergency help. Food Help - we will contact you to arrange a food bank voucher and tell you about other food help in your local area. Housing - if you have received eviction notice or section 21 please speak to the council and contact us for emergency help. Shelter also offers a helpline - 0808 800 4444. Benefits - we will call you and arrange a benefits check. You can also do a benefits check for yourself at policy in practice, turn2us or entitled to. Employment - ACAS can also give you help with employment issues, you can search for work on websites such as indeed, reed, or speak to your work coach. Immigration - the Exeter Law Clinic via the university also offers free immigration advice if you check their website. Something else - we will call you. No additional help required.
As part of receiving these vouchers, we would like to send you some energy hints and tips and or offer you further energy advice if necessary? Is this okay? *

Yes No
We would really like to contact you for feedback, saying no won't affect your eligibility for a grant - but it might help us improve our service and attract other projects. We may use a trusted partner to contact you and you can withdraw your consent to this at any time. *

Yes, by email Yes, by telephone/text Yes, by post No thank you
Should be Empty: