Crisis Help Form

"*" indicates required fields

Eligibility

Residents may be eligible for a crisis payment from the Crisis & Resilience Fund if they:

Live full time in Somerset (please note that other areas operate their own schemes).
Are facing financial hardship: applicants must be experiencing a crisis, such as inability to pay for essentials (e.g. food or fuel) or have a sudden loss of income.
Have an immediate need.
Have an adult in the household that is currently entitled to a means tested, passporting benefit, including Universal Credit, Pension Credit (Guarantee Credit), or Housing Benefit or have a low household income after paying essential living costs.
Can show they are a household that does not have sufficient resources to resolve the immediate crisis without missing out on essentials, incurring unmanageable debt, or exacerbating financial harm.
Have limited access to savings.

Access to assistance will be based on the outcome of this application form and the evidence you provide. As this is a discretionary fund there is no right of appeal if you disagree with the outcome.

Evidence

Due to unprecedented demand, there may be a delay in our response. We will contact you regarding the next steps as soon as possible. Thank you for your patience and understanding. To ensure your application is processed as fast as possible, please ensure you attach all the requested evidence to this form. We cannot process your application without:

All bank transactions from the 30 days leading up to today, and the current balance of the account. This evidence must be from all bank accounts belonging to adults in your household.
Photo ID
Proof of your Somerset Address
Proof of crisis or financial shock

We cannot process your application without the evidence described above, please ensure the banking evidence you attach to this form is up to the date you submit the application. You can upload photos or screenshots/PDFs with this application form. If you are unable to do this we will email you so you can attach the documents to a reply.

About your data

Applications for this fund are processed on behalf of Somerset Council by Citizens Advice Somerset. We are Data Processors for this purpose.
The following information only will be shared with Somerset Council for audit and reporting purposes:

Adult (applicant’s) name
Address
Postcode
Child’s name (oldest aged under 18)
Child’s date of birth
Date grant awarded
Details of grant awarded.

In order to process this application, we need to record details of your case. Under data protection law (GDPR) we have a legitimate interest to hold this information in order to help you progress your case.
If you want more detail about your rights and how we use your information you can read our Privacy Policy here.

About you and your household

Your Full Name*

Prefix First Last

Your Date of Birth*

DD slash MM slash YYYY

Your Gender*

Your Gender Description*

Your Address

Address Line 1 Address Line 2 Village or Town Post Code

Ethnic Origin*

By answering this question you are providing consent for Citizens Advice to process and record the special category personal data you are providing.

Primary Phone Number*

Your preferred contact number. By providing this telephone number you are consenting to be contacted by telephone. PLEASE NOTE: The call may be from a Withheld/Unknown number.

Can We Leave a Voicemail if Necessary?*

Yes

Can We Send a SMS Text if Necessary?*

Yes

Please note that if we phone you it may be from a withheld number

I Have Access to an Email Address*

This could be the email address of someone you trust (e.g., support worker/friend/family member).

I have access to my own Email address

I have access to someone else's Email address

I DON'T have access to an Email address

Your Email Address*

By providing your email address you are consenting to be contacted by email.

Enter Email Confirm Email

SOMEONE ELSE'S Email Address*

By providing this email address you are consenting to us contacting this email address regarding your application to this fund.

Enter Email Confirm Email

Your Household*

Please select the best option that describes your household. Your household is your family members that live with you.

How many people in total live in your household?*

In total, how many people including you live in your household?

How many of these people are adults aged 19 or over (excluding cared for adults)*

How many of these people are cared for adults aged 19 or over?*

How many of these people are children aged 18 or under?*

Name and Date of Birth of Youngest Child*

Please provide the date of birth and name of the youngest child that lives in your household.

Information about the amount of money you have to live on each month....

Is Your Household In Receipt of Means-Tested Benefits?*

Means tested benefits are those that you are entitled to if you are on a low income, such as Universal Credit or Pension Credit

Yes

What is the total amount of income your household receives each month?*

Household income is defined as all income coming into the household from adults aged 18 or over from earnings, employment and self employment, benefits, pensions and income from savings and investments. Please do not include income from health related benefits such as DLA, PIP and Attendance Allowance. Please also do not include earnings from any young person who is still in full time education (school, sixth form or college) If your household includes 2 or more adults please give the total income for your whole household.

Do you have any savings and capital?*

Savings and capital is defined as money you have in bank accounts, in any type of investment (including ISAs), and in ownership of valuable assets such as other property. Please do not include the home you live in or other assets you need day to day such as cars you need for work or childcare.

Yes

How much do you have in savings and capital?*

Tell us about your crisis?

Please note this fund is for crisis payments to help people experiencing an unexpected financial shock. Examples of a financial shock include (but are not limited to):

a sudden loss of income or reduced hours,
an unexpected essential bill or cost,
a delay or change in benefits,
illness, caring responsibilities or a family emergency,
urgent housing issues, that increase financial pressure.

Heating oil help

If you are at risk of running out of oil and are struggling to afford buying more please tick the box below.

We will ask you to provide your last oil purchase invoice or receipt.

I need help with heating oil

Please describe the crisis you are facing. Describe what has lead to your financial difficulties.*

Please tell us what specific help you are hoping to receive (we can't guarantee we can provide this).*

For example running out of food or gas/electric, or an essential item is beyond repair.

Evidence

You will need to provide evidence to demonstrate your eligibility for assistance.

Please tick to confirm the evidence you are uploading

Proof of identity

Proof of address

Financial evidence

Proof of crisis

Documents Missing?

If you are unable to upload some or all of the documents, please tick this box. We will contact you to talk about your next step options.

I am unable to upload some or all of the documents

Documents Upload

Drop files here or

Accepted file types: jpg, pdf, png, doc, docx, Max. file size: 10 MB.

Completion and Declaration....

Did Someone Help You to Fill in This Form?*

This could be a friend, a family member, or a member of an organisation. Please provide their details below. Please note that their details will be stored confidentially along with your application.

Yes

Their Name*

Prefix First Last

Their Organisation*

If the person who helped you fill in this form belongs to an organisation, please provide the name of the organisation

Their Telephone Number

This is the preferred contact number of the person who helped you fill in this form

Their Email Address

Please provide the email address of the person who helped you fill in this form

Declaration*

I confirm that the information I have provided in this application is accurate and a true representation of my/our household. I agree to Citizens Advice Somerset contacting me via the method(s) I have provided, and also contacting anybody who I have stated helped me to complete this form, where necessary to assist in processing the application.

I understand that the information contained in my application – as detailed in the Data Protection section above – will be shared with Somerset Council.

I confirm.