Application to:
Wicklow County Council
County Buildings, Wicklow, Co. Wicklow, A67 FW96
Tel: 0404 20100
Email:
customerservice@wicklowcoco.ie
Web: www.wicklow.ie
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Important: Please Read the Following Information Carefully
1. If you are unsure about how to answer any of the questions in this application form, please ask an officer in the Housing Section or Customer Service Unit of your local authority or your local Citizens Information Centre to help you.
2. When filling out this form, please make sure you write clearly so that your application can be processed as quickly as possible.
3. Make sure you have answered all of the questions fully where these are relevant to you. If you do not fully answer all the questions relevant to you, you might not get the correct priority for housing or else we may have to return the form to you, and it would delay your application. Only fully completed applications will be processed.
4. Your rights as a data subject under the General Data Protection Regulation (GDPR) apply in full and will be clearly set out in the relevant data protection policies and procedures for the local authority to whom you are submitting your application. If you have any query in relation to your rights under GDPR, you can contact the nominated Data Protection Officer for that local authority. Details of how to submit your query will be supplied by the local authority directly
5. This application cannot be completed without a Personal Public Service Number (PPSN) for all members of the household included on the application form. If you are not aware of the PPSN for any children for whom accommodation is sought, they can be obtained by contacting your local Social Welfare Office either by telephone or in person. Please note that you will need to have your own PPSN to hand.
6. You must supply the relevant supporting documentation so that your application can be processed. Please use the checklist provided to make sure you have included everything that is needed to consider your application.
7. This application cannot be completed without documentary evidence of income details given in this application, as outlined in the checklist below.
8. In carrying out its functions under the Housing Acts of 1966-2014, the local authority may request and obtain information from another local authority, the Criminal Assets Bureau, An Garda Síochána, the Department of Social Protection, the Health Service Executive (HSE), the Revenue Commissioners or an Approved Housing Body in relation to occupants or prospective occupants of, or applicants for, local authority housing. Your data may also be shared with other public bodies in accordance with our obligation to prevent and detect fraud.
9. Any change in the details given, particularly any change of address or income, should be notified to the local authority immediately so that your record can be updated.
10. Local authorities are required to report annually to the Department of Housing, Local Government and Heritage, the number of households in need of social housing support, under a process known as the Summary of Social Housing Assessments. This process may require us in the future to contact you and request you to confirm details provided on this form are accurate and up to date. Failure to respond to any such request may result in your housing application being closed. Information supplied through this process may be shared with the Local Government Management Agency and The Housing Agency for the purpose of compiling the Summary Assessment report, which is a statistical summary at national level that informs policy and future planning in terms of the national housing need.
11.Please ensure that you have supplied all the relevant information and supporting documentation to process your application. However, be advised that the local authority may ask for further supporting documentation at a later stage.
Applicants are strongly advised to submit their applications in person at this office as posted applications are frequently not completed correctly and have to be returned.
Please ensure that your application includes the following original documentation (an official translation into Irish or English is required, where appropriate):
* An Employment Detail Summary for the previous year will provide information on the Income tax, PRSI and USC paid by an applicant in the previous year.
** An applicant’s current income can be demonstrated by submitting a Pay and Tax Summary. This summary provides information on PRSI, Income tax and USC for the current year.
Notwithstanding the required documentation set out above at points 1-6, in certain situations for example, where a particular document cannot be provided, the local authority may, at its discretion, request alternative documentation to satisfy itself in relation to the specific information being sought.
Please answer ALL questions and place a tick (✓) in the boxes provided. Please use BLOCK LETTERS
Please complete the following in respect of yourself and Applicant 2 (if applicable).
* EEA: this refers to the European Economic Area (EEA) whose member states include: Austria, Belgium, Bulgaria, Czech Republic, Croatia, Cyprus, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden.
Please complete the following in respect of yourself and Applicant 2 (if applicable).
Please complete the following in respect of yourself and Applicant 2 (if applicable)
Gross income is the total amount of money earned before any deductions are made. Each source of income should be supported by relevant documentation, i.e. social welfare statement, Statement of Liability (or equivalent), payslips.
(i.e. excluding Applicant 1 and Applicant 2)
Please copy this sheet for further household members
10. Is the household member a dependant?
Is the household member a joint applicant?
11. Citizenship status (attach proof of citizenship)
12. Employment status
10. Is the household member a dependant?
Is the household member a joint applicant?
11. Citizenship status (attach proof of citizenship)
12. Employment status
* please see note in part 2: Nationality Details
Tick box and add description
Please give details of previous accommodation over the last 5 years
| Address |
Nature of tenure (e.g. owner, private rented, staying with relative, etc.) |
Date at address From (DD/MM/YYYY) - To (DD-MM-YYYY) |
Reason for leaving |
|---|---|---|---|
| – | |||
| – | |||
| – | |||
| – |
1. Please provide details, including dates and duration of tenancy, of any dwelling or site provided by a local authority, or an Approved Housing Body, previously let or sold to the household or any household member at any time in the past. A letter from the local authority where you or any member of your household was a tenant should be provided in relation to any previous tenancy
2. Please provide details, including dates and duration of tenancy, of any dwelling previously let to the household or any household member under a Rental Accommodation Scheme (RAS) tenancy agreement at any time before the application is made
Housing authorities must make an assessment of the accommodation needs of Travellers under Section 6 and 7 of the Housing (Traveller Accommodation) Act, 1998. This information is requested for that purpose only and will not be used or have any impact on your eligibility for social housing support.
Do you identify as an Irish Traveller?
Note: The site to be transferred must be clear of any burdens, financial or otherwise.The following must be provided:
Name and address of owner of proposed site:
Exact location of site (incl. townland):
* Seperate application forms are required, discuss with your local authority.
The following must be provided:
Name and address of owner of proposed site:
Exact location of site (incl. townland):
| In support of your application on medical or disability grounds, please provide the following details and a completed Medical and/or Disability Information Form (HMD-Form 1), available from your local authority: | |
|---|---|
| Name of household member with an enduring medical condition/disability that would affect the type of housing you need. | |
| The nature of the medical condition or disability and noting whether the condition is enduring. | |
|
Where applicable, the type of accommodation (e.g. ground floor),
and any specific adaptations required for the medical
condition/disability. (Occupational therapist’s report to be submitted in support of application) |
|
Basis for application to:
NB: it is important to note that you may only apply for social housing support to one local authority, and it must be one of the following:
Note: local connection means:
1. Please indicate the basis for your application as follows (only one box should be ticked)
Household is normally resident in the local authority area
Household has a local connection with the local authority area
Please specify the nature of the local connection (see note above)
The local authority should consider the application for social housing support for the following reason(s)
2. Are you or any household member currently on the housing list of any other local authority? Yes No
If yes, please provide the name of the household member and the local authority to which they have applied for social housing support.
Household Member:
Local authority:
Please tick the areas, within the local authority, where you would accept an offer of accomodation
A maximum of 3 areas of choice may be ticked from the following list of areas of choice. Please note that listing areas of choice on the application form is not a priority listing, i.e. all areas of choice specified on the form are deemed to be of equal priority. It should be noted that you are committed to these areas of choice for a period of 12 months.
Information in this section will be cross-checked with the Revenue Commissioners by the local authority, utilising the PPSN(s) provided.
Under Section 14 of the Housing (Miscellaneous Provisions) Act 1997, a local authority may refuse to allocate or defer the allocation of a dwelling to a person where the authority considers that the person is or has been engaged in anti-social behaviour or that an allocation to that person would not be in the interest of good estate management.
In the 5 year period prior to the date of this application, has any member of the household been convicted of an offence under any of the following statutory provisions (1-4)?
1. Criminal Justice (Public Order) Act 1994.
Yes No
Section
5: Disorderly conduct in public place
Section 6: Threatening,
abusive or insulting behaviour in public place
Section 7:
Distribution or display in public place of material which is
threatening, abusive, insulting or obscene
Section 14: Riot
Section
15: Violent disorder, or
Section 19: Assault or obstruction of
peace officer
If 'Yes', please give details (including name, address and details of conviction):
2. Sections 3, 3A and 4 of the Housing (Miscellaneous Provisions) Act 1997: subject of an excluding order or interim excluding order. Yes No
If 'Yes', please give details (including name, address and details of excluding order/interim excluding order):
3. Section 117 of the Criminal Justice Act 2006: failure to comply with a behaviour order. Yes No
If 'Yes', please give details (including name, address and details of conviction):
4. Section 257F of the Children Act 2001 (No. 24 of 2001): failure to comply with a behaviour order. Yes No
If 'Yes', please give details (including name, address and detals of conviction)
5. Have you, or any other persons listed on this application form, ever squatted in a local authority dwelling? Yes No
6. If 'Yes', please state address and dates of
occupancy
Address:
From
To
7. Have you, or any of the other persons listed on this application form, ever been evicted from previous accommodation? If ‘Yes’, please give details of eviction and the reason why it happened (if you need more space, attach another page):
Please provide any other information which you might consider relevant to your application. (if you need more space, attach another page)
Please read the following information relating to the collection and use of your personal data and the declaration carefully. The declaration should only be signed and dated if you are entirely satisfied that you understand all of the information presented in this form. Please note that an application for social housing support can only be accepted when the application has been completed, and this declaration has been signed.
ALL data supplied by you when completing this form (including any personal data you submit) will be used for the purposes of assessing and administering your application for Social Housing Support. The law allows this local authority in certain circumstances to share your data with other public bodies. For example, we may share your data with the Central Statistics Office under the Statistics Act 1993. The data supplied by you when completing this application may be shared with the Local Government Management Agency (LGMA) and The Housing Agency in order to fulfil a statutory requirement to provide an annual Summary of Social Housing Assessments, including the production at a national level of statistical reports that inform policy and future planning in terms of the national housing need.
In carrying out its functions under the Housing Acts of 1966-2014, the local authority may request and obtain information from other organisations. These include another local authority, the Criminal Assets Bureau, An Garda Síochána, the Department of Social Protection, the Health Service Executive (HSE), the Revenue Commissioners or an Approved Housing Body in relation to current or prospective occupants of, or applicants for, local authority housing. Your data may also be shared with other public bodies in accordance with our obligation to prevent and detect fraud.
Your rights as a data subject under the General Data Protection Regulation (GDPR) apply in full and are clearly set out in Wicklow County Council's Privacy Statement. Copies of this are available from https://www.wicklow.ie/LivingYour-Council/Governance/Privacy-Policy
If you have any questions about your rights under GDPR, you can contact Wicklow County Council's Data Protection Officer, or you may also contact the Data Protection Commission (DPC).
For more information, please contact dpo@wicklowcoco.ie
Declaration
1. I (or we) declare that the information and details given by me (or us) on this application are true and correct.
2. I (or we) promise to notify the local authority of any change in my (or our) household circumstances such as our address, the people who make up the household, their wages or payments, or medical conditions if this changes from the details we gave on this form
3. I (or we) also agree that the local authority can make whatever enquiries it considers necessary to check that the details of this application are correct.
4. I am (or we are) aware that it is against the law to give false information on this form and that I (or we) can be prosecuted for doing that.
5. I (or we) understand that my (or our) personal data will be shared with the LGMA, and The Housing Agency for the purposes set out above
6. I (or we) understand that my (or our) personal data will be shared with other public bodies only as provided by law.
7. I (or we) understand that a failure to respond to a request for updated information, as part of the Summary of Social Housing Assessments process, may result in my (or our) housing application being closed.
Applicant 1.
Applicant 2.