Housing register change of circumstances including medical | London Borough of Barking and Dagenham

Current Change of circumstances for housing register application
Other information
Final page
Complete

1 of 4

How to complete this form

Use this form only to tell us about a change in your circumstances if you have already applied to join our housing register.

Your housing register account number

This is a 9 digit number starting with 00.

You can find this in the email we sent you when you registered. If you received a letter following your application, the number is in the top right corner under our address.

Main applicant details

First Name

Last Name

National Insurance number

Email address

We'll use this email address to send you a copy of your change of circumstances submission and for further contact regarding your application

Telephone

Tell us about your changes in circumstances - select all that apply

Change of address

Someone had a new baby

Someone is expecting a baby

Someone moved out

Someone moved in

Someone died

Someone started working 16 or more hours per week

Someone stopped working 16 hours or more per week

Someone's medical circumstances have changed

Change in sleeping arrangements

Another change in circumstances

Change of address

New address

Address line 1

Address line 2

Town

Postcode

Date moved in

Proof of where you live

We need 2 documents confirming your residence at your new address. These must be from different sources and dated.

Examples of acceptable documents:

bank or building society statements
utility bills
landline telephone bills
credit card bills
letters from an official agency eg Department of Work and Pensions

We do not accept medical cards, driving licences or mobile telephone bills as evidence of residence.

Unlimited number of files can be uploaded to this field.
5 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Upload your files

Previous address

Address line 1

Town

Postcode

About your new home

What is your new housing situation?

Barking and Dagenham council tenant

Reside tenant

Living with family

Living with friends

Housing association or housing trust tenant

Private landlord tenant

Owner-occupier (including shared ownership)

Living in a property with areas shared by more than 1 household, eg a bedsit with shared kitchen and bathroom

Living in temporary accommodation provided by Barking and Dagenham Council

Living in temporary accommodation provided by another council

Living in armed forces accommodation

Other

Describe your housing situation

What type of property are you living in?

Flat

House

Maisonette

Bedsit

Other…

Enter other…

Facilities

How many bedrooms are there at the property

Are you using all of these bedrooms?

Yes

If you are sharing bedrooms with someone not included in the application, give details of who you are sharing with?

Do you have a toilet inside your home?

Yes

Do you share a toilet with non-relatives?

Yes

Do you have a bathroom or shower?

Yes

Do you share a bathroom or shower with non-relatives?

Yes

Do you share cooking facilities with non-relatives?

Yes

Getting into your home

Do you have difficulty getting into your home (for example, because of stairs)?

Yes

How many steps are there to your front door?

If you live in a flat, bedsit or maisonette, tell us what floor level you live on

Does the property have a lift?

Yes

Does the lift stop at your floor?

Yes

Is the only access to your property an outside iron stairway?

Yes

Contact details for your new landlord, housing association or housing trust

Name

Telephone

Email address

Condition of your rented property

Is your current home in a good state of repair?

Yes

Tell us what is wrong with the state of repair

Has your property ever been inspected by Barking and Dagenham private sector housing team?

Yes

New baby

Who had a baby?

Main applicant

Another person in my housing register application

Name of person who had a baby

Baby's date of birth

Upload a clear photo or scan of the baby's birth certificate

Upload the birth certificate

One file only.
5 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Expecting a baby

Who is expecting?

Main applicant

Another person in my housing register application

Name of person who is expecting a baby

Due date

Someone moved out

Who moved out?

Main applicant

Another person in my housing register application

Name of person who moved out

Date they moved out

Do you know where they moved to?

Yes

Tell us their new address

Someone moved in

Tell us who moved in

Name

First name

Last name

Date they moved in

Relationship to the main applicant

New household members

If someone has joined your household - we need to know:

why
where they were previously living for 5 years prior to joining you, with dates for each address and what type of housing situation applied to this eg living with family, living with friends, as a tenant of a private landlord parents etc
any legal documentation that may apply to them joining you

Unlimited number of files can be uploaded to this field.
5 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Upload your files

Someone died

Tell us about the person who died

Name

First name

Last name

Date they died

Someone started working 16 hours or more per week

Who started working?

Main applicant

Another person in my housing register application

Name of person who has started working

Date they started working

Is this person working as employed or self employed?

Employed

Self employed

Self employment

What type of business is it?

Self employment

You must provide evidence of registration with HMRC and audited accounts or other information to substantiate the nature and extent of your self-employment
Unlimited number of files can be uploaded to this field.
5 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Upload your files

About your employer

Name of employer

Employer's address

Address line 1

City or town

Postcode

Employer's telephone number

Employment

We need a copy of your contract of employment and 3 most recent payslips
Unlimited number of files can be uploaded to this field.
5 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Upload your files

Someone stopped working 16 hours or more per week

Who stopped working?

Main applicant

Another person in my housing register application

Name of person who stopped working

Date they stopped working

Medical and disability changes in circumstances

Whose medical circumstances have changed?

Main applicant

Another person in my housing register application

Name of person whose medical circumstances have changed

Disability changes - select all that apply

Speech impairment

Hearing impairment

Wheelchair user

Mental health issues

Restricted mobility

Learning difficulty

Prefer not to say

Other disability

Add another disability

Do they have a disability or medical condition that is affected by their current accommodation?

Yes

Medical and disability issues selected

Tell us about any disability or medical condition(s) they have, indicating how long they have suffered with these

Are they taking any prescribed medication in relation to disability or medical condition(s)?

Yes

Details of prescribed medication you are taking and how often you are taking them

Do they have mobility problems?

Yes

Mobility issues

What walking aids do they use? Select all that apply.

Stick

Crutches

Frame

Trolley

Other

Tell us what other walking aids you use

Can they climb one or two steps?

Yes

Can they climb one flight of stairs?

Yes

Can they climb more than one flight of stairs?

Yes

Do they use a wheelchair?

Yes

Tell us how often they use a wheelchair - select all that apply

Permanently

Inside always

Inside sometimes

Outside always

Outside sometimes

Tell us which of the following tasks they can do on their own - select all that apply

Use a bath

Use the toilet

Wash and dress yourself

Use public transport

None

Sheltered housing factors

Are there any other factors you want us to take into account, for example social, physical or mental health?

Yes

Give some details about these factors

How often do they receive visits from friends or family?

Daily

Weekly

Fortnightly

Monthly

Never

How often do they receive visits from a support agency, such as social services?

Daily

Weekly

Fortnightly

Monthly

Never

Are they experiencing any form of anti-social behaviour?

Yes

Tell us about this antisocial behaviour

Another change in circumstances

Who does the change of circumstances apply to?

Main applicant

Another person in my housing register application

Name of person whose circumstances have changed

Tell us what has changed

Date the change happened

Sleeping arrangements

Tell us about changes to the sleeping arrangements for everyone in your property. If they are sharing bedrooms or rooms (used for sleeping purposes) with others, specify this below.

How many bedrooms are in your property?

Room 1

Number of people who sleep in room 3

Person 1

Name

First

Last

Gender

Male

Female

Prefer not to say

Other

Add their gender identification

Age

Relationship to the main applicant

What is their relationship to the primary applicant?

Person 2

Name

First

Last

Gender

Male

Female

Prefer not to say

Other

Add their gender identification

Age

Relationship to the main applicant

What is their relationship to the primary applicant?

Person 3

Name

First

Last

Gender

Male

Female

Prefer not to say

Other

Add their gender identification

Age

Relationship to the main applicant

What is their relationship to the primary applicant?

Person 4

Name

First

Number of people who sleep in room 5

Person 1

Name

First

Last

Gender

Male

Female

Prefer not to say

Other

Add their gender identification

Age

Relationship to the main applicant

What is their relationship to the primary applicant?

Person 2

Name

First

Last

Gender

Male

Female

Prefer not to say

Other

Add their gender identification

Age

Relationship to the main applicant

What is their relationship to the primary applicant?

Person 3

Name

First

Last

Gender

Male

Female

Prefer not to say

Other

Add their gender identification

Age

Relationship to the main applicant

What is their relationship to the primary applicant?

Person 4

Name

First

Last

Gender

Male

Female

Prefer not to say

Other

Add their gender identification

Age

Relationship to the main applicant

What is their relationship to the primary applicant?

Leave this field blank

Digital exclusion survey

How to complete this form

Your housing register account number

Main applicant details

Tell us about your changes in circumstances - select all that apply

Change of address

About your new home

Facilities

Getting into your home

Contact details for your new landlord, housing association or housing trust

Condition of your rented property

New baby

Expecting a baby

Someone moved out

Someone moved in

Someone died

Someone started working 16 hours or more per week

Self employment

About your employer

Someone stopped working 16 hours or more per week

Medical and disability changes in circumstances

Medical and disability issues selected

Mobility issues

Other problems and difficulties

Sheltered housing factors

Another change in circumstances

Sleeping arrangements

Room 1

Person 1 - main applicant

Person 2

Person 3

Person 4

Room 2

Person 1

Person 2

Person 3

Person 4

Room 3

Person 1

Person 2

Person 3

Person 4

Room 4

Person 1

Person 2

Person 3

Person 4

Room 5

Person 1

Person 2

Person 3

Person 4

Follow us on social media