Important
Please note that you should ONLY fill out this form if you have recently received a letter from DLR asking you to re-certify your application details.
Collection and use of data
The housing authority will use the data which you have supplied to administer your housing application. Data may be shared with other public bodies for the purpose of the prevention or detection of fraud. The housing authority may, in conjunction with the Department of Housing, Local Government & Heritage, process this data for research purposes including forward planning in relation to the assessment of housing needs. The housing authority may, for the purpose of its functions under the Housing Acts 1966-2009, request and obtain information from another housing authority, the Criminal Assets Bureau, An Garda Siochana, the Department for Social Protection, the Health Service Executive (HSE) or an approved housing body in relation to occupants or prospective occupants of, or applicants for, local authority housing and any other person the authority considers may be engaged in anti-social behaviour.
What is your Housing Application Reference Number - this is on your letter from DLR
*
Do you wish to remain on the DLR Housing List?
*
Yes
No
Why do you wish to be removed from the DLR Housing List?
Submit request to be removed from Housing List
Have you got a live application with another local authority?
Yes
No
Which Local Authority?
Name of the main applicant
*
First Name
Last Name
What is your current address?
*
Street Address
Street Address Line 2
City
County
Eircode
What is your contact number (Mobile or landline)
*
-
Area Code
Phone Number
What is your email address
example@example.com
What is your PPSN?
*
What is your Date of Birth
*
-
Day
-
Month
Year
Date
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What is your gender?
Female
Male
Neither
What is your civil status
Single
Married
Civil Partnership
Co-habiting
Widowed
Divorced
Separated
Legally Separated
Other
Do you identify as an Irish Traveller?
Yes
No
Prefer not to say
What is your employment status
Employed (Full or part time)
Self-employed
Student
Pensioner/Retired
Homemaker (no income)
Unemployed (receiving a welfare payment)
Lone Parent support only
Employed in Back to Work scheme
Other
Are you in receipt of rent supplement?
Yes
No
How much do you receive in rent supplement per month?
What best describes the household's current living accommodation?
Living with family/friends
Private rented accommodation
Homeless accommodation
Living with parents
Living in HAP accommodation
Joint Applicant name
First Name
Last Name
Joint Applicant PPSN No
Joint Applicant contact phone number
-
Area Code
Phone Number
Joint Applicant Email
example@example.com
Joint Applicant Date of Birth
*
-
Day
-
Month
Year
Date
Joint Applicant gender?
Male
Female
Joint Applicant status
Employed (Full or part-time)
Self-employed
Student
Pensioner/Retired
Unemployed (receiving a welfare payment)
Homemaker (no income)
Employed in Back to Work scheme
Lone Parent support only
Other
Which (if any) of your circumstances have changed in the last 24 months
*
Has anybody joined the application?
Has anybody left the application?
Has there been any change in employment status/income?
Your income has decreased
Have you changed address and not already told us?
Does anybody on your application have a medical condition or disablility that you haven't already told us about?
Does anybody on your application require wheelchair liveable accommodation?
Do you or anyone on your application own any land or property?
Nothing has changed
Submit as there have been no changes
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Next
Documents
The following documents must be uploaded as part of your application. They can be in PDF or picture format. Please ensure you have them before you start to fill out the form:
Who joined the application? To add more than 1 line, click on the +
Please upload proof of PPSN number and identity such as birth certificate for new additions
Browse Files
Drag and drop files here
Choose a file
Cancel
of
If you are using a phone or tablet you can use the camera to photograph the required documents and upload here
Take Photo of additional identity documents (including current Stamp 4 if applicable)
Who has left the household, who should be removed from your application for Social Housing Support? Click on the + to add an additional line.
Income details - please fill out the following about WEEKLY income for you and any other adult (persons aged 18 and over), included on your application.
Rows
Weekly Income Amount Main App
Weekly Income Amount Other Adult 1
Weekly Income Amount Other Adult 2
Name
Employment Income
Self-Employment Income
Social Welfare Income Amt
Social Welfare Type
Maintenance received
Any Other Income Amt
Other Income Type (Please write in where any other income is from)
Please upload documents showing recent proof of income
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Photos of documents showing proof of income
Upload photo of additional income document
Disability and/or Medical Information that you haven't already informed us about. Use the + to add additional lines.
*
Are there any special adaptions needed?
*
Other property/land owned details including address?
Declaration
I/We declare that the information and particulars given by me/us on this form are true and correct. I/We undertake to notify the housing authority of any changes in my/our household circumstances (example address, household composition, employment, medical conditions etc). I/We also authorise the housing authority to make whatever enquiries it considers necessary to verify details on my/our application.
Submit
Should be Empty: