Surviving Winter Grant Application Form

Application Form 2023/24
Survivng Winter provides grant awards to households in Suffolk to help towards energy costs over the winter months.

The application should take about 10 minutes to complete, and will take details of your household situation and your income.

If you're unable to complete this form online, please contact Citizens Advice Ipswich who administer the project on 01473 298 634 for assistance.

Note: Surviving Winter is not an emergency grant, applications are usually processed in 2-3 weeks. If you are in urgent need of assistance, please contact your local Citizens Advice or other local advice agency.
By completing this form, you accept the following:
- Information given in this application will be used to assess your eligibility for a Surviving Winter grant award
- Information you provide will be checked against records held by Citizens Advice, and may be checked with partner organisations, for the prevention and detection of fraud
- By submitting this application, you are giving permission for Citizens Advice Ipswich (as administrators of the grant programme) to process your data and share information with other organisations (in accordance with the Data Protection Act 2018). This data will include your IP address, locality, and ISP information.
- If false, misleading or incomplete information is provided, Suffolk Community Foundation reserve the right to take action, including seeking prosecution and the refusal of future grant applications
- Based on the information you provide, information and advice may be emailed to you and, if further support is available, you may be contacted with details of this
- Anonymised data from applications may be collated and shared with other organisations for statistical and reporting purposes

Please verify that you are human
Initial questions
Do you live in Suffolk?*

YesNo
Have you already applied for a Surviving Winter grant since 1st November 2023?*

YesNo
Were you awarded a grant?*

YesNo
Have your circumstances changed since you last applied?*

YesNo
Hidden - IntialQualify?

Proof of address
In order to confirm your address, we need you to upload one of the following documents:
- Council tax bill
  (dated within the last 12 months)
- Utility bill - Gas, Electricity, Water
  (dated within the last 3 months. We can't accept mobile phone bills)
- Bank statement
  (dated within the last 3 months)
- Letter from Government or local Council
  (dated within the last 6 months)
Your name and full address must be clearly showing. Screenshots are not acceptable, but PDFs or printed copies of online statements or bills are fine.

Note: If you're using a device with a camera, you'll have the option to 'take a photo' of the document instead.
Please upload your proof of address here:

If you're unable to upload a document, please save this form and call Citizens Advice Ipswich on 01473 298 634
Cancelof

Your home
What best describes your housing situation?*

I rent from a private landlord or letting agencyI rent from a housing associationI rent from the CouncilI own my home (repaying a mortgage)I own my home outright (no mortgage)I have shared ownership (mortgage + rent)I'm staying with friends or relativesOther

Your household
Do you live with a partner?*

YesNo
Partner's first name*
Partner's surname*
What is your partner's date of birth?*

DayMonthYear
Do any other adults (aged 18+) live with you in your household?*

YesNo
How many other adults live with you in your household?
Age 18 - 65*
Age 66 or over*
Are there any children or young people in your household?*

YesNo
How many children or young people live in your household?
Age 0 - 3*
Age 4 - 17*
Hidden - Total Adults in Household
Hidden - Total Children in Household

Health & Disability

Your answers to these questions won't affect the outcome of your application, but we might be able to offer you further support. If you don't want us to process this information, please select 'Prefer not to say'.
Does anyone in your household have a long-term health condition or disability?*

YesNoPrefer not to say
Does anyone in your household receive one of the following disability benefits?

Attendance Allowance (AA)Disability Living Allowance (DLA)Personal Independence Payment (PIP)
No disability benefits

No, none of these
Would you like us to send you some information about these benefits, including how to make a claim?

YesNo

Benefit Income
Does anyone in your household receive any of the following benefits?

Select all that apply
Income-related benefits

Employment and Support Allowance (old-style)Income SupportPension CreditTax CreditsUniversal Credit
No income-related benefits

No, none of these

Employment & earnings
Are you currently employed?*

YesNo
How much do you earn?*
Enter the gross amount - before any deductions for tax, pensions and national insurance
How often do you earn this amount?*
Hidden - calc applicant earnings (year)
That amount is over £40,000 a year - if this is correct, please continue

Employment & earnings
Is {partnersFirst} currently employed?*

YesNo
How much does {partnersFirst} earn?*
Enter the gross amount - before any deductions for tax, pensions and national insurance
How often do they earn this amount?*
Hidden - calc partner earnings (year)
That amount is over £40,000 a year - if this is correct, please continue

Employment & earnings
Are any of the other adults who live with you currently employed?*

YesNo
How much do they earn?*
Enter the combined gross amount - before any deductions for tax, pensions and national insurance
How often do they earn this amount?*
Hidden - calc other-adults earnings (year)
That amount is over £40,000 a year - if this is correct, please continue

Savings and other income
For these questions, 'you' means your household - you and any other people who live with you.

For example, if you live with a partner and you each have £800 of savings, your total savings would be £1,600.
Do you have total savings of more than £1,500?*

YesNo
Do you receive any other income?*

YesNo
How much do you get, in total?*
How often do you get this amount?*
Where is this income from? (e.g. "private pension", "child maintenance" or "lodger")*
Hidden - calc other income (year)
That amount is over £40,000 a year - if this is correct, please continue
Hidden - TOTAL HOUSEHOLD INCOME CALC (YEAR)

Your household income
Error - you have not entered any income.

Please provide us with details of your household income below, including:
- Income from employment
- Income from means-tested benefits, like UC
- Income from other sources (such as pensions, lodgers, or child maintenance)
If nobody in your household receives any income, please tell us about this.
What's your total household income?*
Enter the amount before deductions for tax or national insurance
How often do you get this amount?*
Please provide details of this amount - if you have no income, please explain why*
For example: "£100 - private pension and £200 - lodger"
HIDDEN - Calc Missing Income (year)
That amount is over £40,000 a year - if this is correct, please continue

Local Welfare Assistance Scheme

Suffolk County Council
Your answers to these questions will not affect your Surviving Winter application.

If we think you might be able to apply to the Local Welfare Assistance Scheme, we'll suggest that you apply there as well.

The Local Welfare Assistance Scheme (LWAS) is run by Suffolk County Council. It can provide a payment of upto £300 to households who are struggling financially, to help with the cost of living. The money is paid into your bank account, and can be used for whatever you need it for - food, energy, household bills etc.

You can apply to LWAS every 6 months if you need to.
Have you applied to the Local Welfare Assistance Scheme in the past 6 months?*

YesNo
Did you receive an award?*

YesNo
Have your circumstances changed since you last applied?*

YesNo

Local Welfare Assistance Scheme

Suffolk County Council
Based on the information you've given in your application, you might be eligible for an award from the Local Welfare Assistance Scheme.

We'll send you a link that you can use to apply.
Would you prefer to receive this by:*

SMSEmail
Mobile number:*
Email:*
Surviving Winter 2023/24

Application Result
We're sorry, but you're not eligible to apply for the Surviving Winter grant for one of the following reasons:

If you don't live in Suffolk

The Surviving Winter grant programme is only open to people living in Suffolk.

If you've already received a Surviving Winter grant since 1st November 2023

Only one award can be given between 1st November 2023 - 31st October 2024.

If you've applied before, but your circumstances haven't changed

Unfortunately, if your previous application was unsuccessful and your circumstances haven't changed, then any new application would also be unsuccessful.

If you're experiencing financial difficulties, please contact your local Citizens Advice office or other advice agency in your area, who may be able to help you access other sources of charitable support and grant funding.

If you are in debt, Citizens Advice Debt Helpline can provide full advice on your options and support you to access a solution. Advice is free, confidential and impartial. You can speak to a debt adviser by calling 0800 240 4420.

If you believe you've received this message in error, please call Citizens Advice Ipswich on 01473 298 634.
Please press 'Next' to continue

You may be asked to complete a captcha on the next page
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Application Form 2023/24

Initial questions

About you

Proof of address

Your home

Your household

Health & Disability

Heating your home

Energy questions

Benefit Income

Employment & earnings

Employment & earnings

Employment & earnings

Savings and other income

Your household income

Debt & Money

Local Welfare Assistance Scheme

Local Welfare Assistance Scheme

Surviving Winter 2023/24