Local welfare provision referral form | Local welfare provision

Local welfare provision

* Please note: Support will be provided in the form of referrals, vouchers, second hand goods or signposting. If we highlight a more appropriate organisation to support you, or benefits that you are entitled to claim, this may be instead of local welfare provision. You may be required to meet with the Local Welfare Provision Officer and provide evidence to support your application. We are not able to provide loans or cash grants.

We are not currently accepting applications for furniture or white goods. Please visit www.turn2us.org.uk to complete a grant search for charitable funding.

Are you completing this form for yourself or someone else? Required

Applicant details

Title

First name Required

Please provide full first name

Last name Required

Address

Postcode

Do you have any communication needs?

Do you have any communication needs? For example, do you need an interpreter? Large print documentation? Etc.

Date of birth Required

National Insurance number

Do you have a partner? Required

Do you have any health issues? Required

Do you have a support worker or a social worker? Required

Do you have any dependent children living with you? Required

Assistance required

Please tell us what assistance you require from local welfare provision and give an overview of your circumstances.

Please note: We are not currently accepting applications for furniture or white goods. Please visit www.turn2us.org.uk to complete a grant search for charitable funding.

Assistance required Required

Contact details

Email address Required

Contact telephone number

Alternative telephone number

As part of the local welfare provision application process, Herefordshire Council will collect personal data about you and your dependants.

This information collation will include:

Details about you, such as your address, telephone number, email address, National Insurance number, date of birth, household composition and income details
Other relevant information needed to process your application

We will use this data to process your application and may check some of the information with other sources to ensure this data is accurate.

We will not normally share your information with organisations other than our partner organisations without your consent. However, there may be certain circumstances where we would share without consent, such as where we are required to do so by law, to safeguard public safety, and in risk of harm or emergency situations. Any information which is shared will only be shared on a need to know basis, with appropriate individuals. Only the minimum information for the purpose will be shared.

We will only keep your information for the minimum period necessary. The information outlined in this privacy notice will be kept after all action on your claim has finished and the period required by the council for legal and audit purposes has passed. All information will be held securely and destroyed under confidential conditions. View the full privacy notice.