Homeless Star Housing – DSS Accommodation Enquiry

Personal Details

Name *

Contact No *

Age *

Gender *

Type of Benefit *

Do you have an Online Universal Credit Journal? *

Yes No

Upload screenshot of journal

Benefit Payment Date *

Length of Time on Benefit *

Benefit Payment Amount *

Payment Frequency *

Monthly Weekly

Where are you currently living? *

Why do you need a room? *

Are you currently claiming housing costs? *

Yes No

Who receives the Housing Cost?

When you want to move *

Preferred City *

Preferred Area

Lived in shared accommodation?

Yes No

Lived in supported accommodation?

Yes No

Do you have a support worker?

Yes No

Anything else you'd like us to know?