HOUSING AID FOR OLDER PEOPLE APPLICATION FORM

Transcription

1 HOUSING AID FOR OLDER PEOPLE APPLICATION FORM Please read the attached conditions prior to completing this form All questions must be answered Please write your answers clearly in block capital letters Works must not commence prior to receipt by the Local Authority of the grant application and written approval from the Local Authority. The person for whom the grant is sought must be the owner of the house and must have occupied the house as his/her normal place of residence for the last 5 years. The minimum age limit for eligibility under this scheme is 66 years of age. All grant applicants must submit evidence that they have paid the Local Property Tax 1

2 Terms & Conditions of Scheme 1. Purpose of Grant The Scheme of Housing Aid for Older People is available to assist older people living in poor housing conditions to have necessary repairs or improvements carried out. The types of works grant aided under the scheme include re-roofing, re-wiring, repair and / or replacement of windows and doors and the provision of central heating (where none exists). N.B.:- There is no grant available under this scheme for upgrading an existing central heating system. These grants are available from the Sustainable Energy Authority of Ireland at Applicants applying to carry out rewiring must enclose with their application, written confirmation from a qualified electrician stating the condition of the existing wiring. Applicants applying to carry out roof repairs/replacement / chimney repairs will be required to submit with their application, written confirmation from their insurance company that such repairs are not covered by their existing insurance policy. Applications for windows and doors will be only be considered where single glazed timber windows & doors clearly demonstrate they have reached end of life under normal usage and weathering and not as a result of poor design/construction and for the replacement of aluminium windows (where glazing units cannot be replaced). Where an item can be repaired in-lieu of replacement, grant-aid will always reflect the repair cost as opposed to the replacement cost e.g. repair s to locks / latches, seals, slips/ sashes. No allowance will be available for the replacement of defective glass pane. 2. Level of Grant The level of grant aid available shall be determined on the basis of gross household income and shall be between 30% - 95% of the approved cost of the works. The table below sets out the level of grant available based on an assessment of household income. Gross maximum household income p.a. % of costs available Maximum Grant available Up to 30,000 95% ,001-35,000 85% 6, ,001-40,000 75% 6, ,001-50,000 50% 4, ,001-60,000 30% 2, In excess of 60,000 No grant is payable No grant is payable Note the maximum grant available for Windows and Doors is as follows Allow 250 towards each window with a maximum grant of 2,000. Allow 700 towards each external door with a maximum grant of 1,400. 2

3 3. Household Income Household Income for grant purposes includes the Annual Gross Income in the previous tax year of the Registered Property Owner together with all household members over 18 years of age. In determining gross household income local authorities shall apply the following disregards: - 5,000 for each member of the household aged up to age 18 years; - 5,000 for each member of the household aged between 18 and 23 years and in full time education or engaged in a FAS apprenticeship; - 5, where the person with a disability for whom the application for grant aid is sought, is being cared for by a relative on a full time basis; - Child Benefit; - Early Childcare Supplement; - Family Income Supplement; - Domiciliary Care Allowance; - Respite Care Grant; - Foster Care Allowance - Fuel allowance - Carer s Benefit/Allowance 4. Evidence of household income The following evidence of income must be included with all applications: In the case of PAYE workers, P60 and P21 Balancing Statement for the previous tax year. In the case of self-employed or Farmers, Notice of Assessment along with Form 11 Return Summary, together with a copy of accounts for the previous tax year; or If applicants are not required to produce accounts for revenue purposes, they should submit business Profit & Loss accounts, together with a Certificate of Tax Exemption. In the case of social welfare recipients a statement from Social Welfare stating weekly/annual payments or P21 Balancing Statement In the case of State Pensioners a copy of the payment card and a payment slip from An Post or P21 Balancing Statement for the previous tax year. In the case of earnings from savings and investments, a certificate of interest or a dividend certificate (Evidence of income must be submitted by all property owners and members of the household) 5. Tax Requirements In the case of contractors, the contractor s name, address, tax reference number and tax district. In the case of grant applications, the applicant must confirm that he/she holds a valid tax clearance certificate. Tax Clearance Certificates must be submitted for both the Contractor and the Applicant and must be valid at the time of application and at the time of payment. 3

4 6. Appeals Procedure In processing applications under the Housing Aid for Older People Scheme the authority recognises that some applicants may be dissatisfied with the authority s decision. The authority will give every applicant an appeal mechanism, which will allow him or her to have the decision in his or her case reconsidered by another official. The following procedure shall apply to each appeal: Applicants are invited to submit a written appeal on any decision notified to them by the local authority on their application within 3 weeks of the date of the decision stating the reasons for the appeal. The appeal will be considered and adjudicated upon within 4 weeks of receipt. A decision on an appeal will be notified to each applicant within 2 weeks of the decision being made. 7. Checklist Please ensure that the following documentation is included in the application for grant aid: Fully completed application form with declaration at the end duly signed (HOP1). Proof of property ownership. Birth Certificate(s) in respect of owner/applicant and all household members. Completed G.P. medical report (HOP2), if required. Completed Tax Form duly signed (HOP 3). Documentary evidence in respect of income of the home owner, his and her spouse, and any other occupant of the property. See 4 above: Evidence of household income. Valid Tax Clearance Certificate for the Applicant Valid Tax Clearance Certificate for the Contractor Copy of receipt of payment of Local Property Tax 1 written itemised quotation detailing the cost of the proposed works; Documentary evidence from Educational/Training body for household members ages between 18 and 23 years who are in full time Education or engaged in a FAS apprenticeship Letter from Insurance Company if applying for Re-Roofing Electrician s report if applying for Rewiring Incomplete application forms will be returned to sender for completion. Please ensure that you have supplied all the relevant information and supporting documentation to process your 4

5 application. However, be advised that the housing authority may ask for further supporting documentation at a later stage. If you require assistance in filling out this form please contact: The Housing Department, Roscommon County Council, Áras an Chontae, Roscommon F42 VR98 Tel: housing@roscommoncoco.ie ROSCOMMON COUNTY COUNCIL COMHAIRLE CHONTAE ROSCOMÁIN HOP 1 HOUSING AID FOR OLDER PEOPLE APPLICATION FORM Applicant: Address: Telephone No: Mobile No: Date of Birth: P.P.S. No: Occupation: If retired, in addition to stating retired above, please state your previous occupation Name of person for whom grant aid is sought (if different from Applicant): The person for whom the grant is sought must occupy the house as his/her normal place of residence. Name of the owner of the property to which the proposed repairs/improvement works are to be carried out: Proof of property ownership and date of when property transferred into your name must accompany application form. Relationship to applicant, (tick as appropriate): Property Owner: Spouse of Property Owner: Other: 5

6 If other please specify: Gross Annual Household Income: (Please refer to explanatory note 3 below) Is the person for whom the grant is sought residing at the address above: How long has s/he been living at this address: Do any of the occupants of the household suffer from any specific illness? If so, please give brief description and complete the attached doctor s certificate: Details of all persons living in property for which grant aid is sought (including applicant): Name Relationship to applicant Date of birth P.P.S. Number Gross Income (previous tax year) Occupation (if applicable) Note: Birth Certificates must be submitted for all occupants of the house including the applicant. Documentary evidence must be submitted from Educational/Training body in respect of household members aged between 18 and 23 years who are in full time education or engaged in a FAS apprenticeship. Number and description of rooms in the dwelling: Upstairs Downstairs Bedrooms Living Dining Kitchen Other General description of proposed works: 6

7 Estimated cost of works: (Please submit 1 written quotation in respect of the estimated cost of works) Amount of grant you are applying for: Balance of costs: How do you propose to fund the balance of costs: Has an Essential Repairs Grant, Special Housing Aid for the Elderly Grant or Housing Aid for Older People Grant been paid previously in respect of the same premises or person? If yes, please give details: Have you applied for or received any funding under SEI, the Warmer Homes Scheme or any other Grant Scheme? If yes, please give details. I have read and understand the Terms of the Scheme and undertake to abide by them. I declare that all the information I/We have given in this application form is true and accurate. I/We understand that any false or misleading information could lead to the refusal/withdrawal or in some cases, lead to Roscommon County Council pursuing the refund of any grant aid paid. Signature of Applicant: Date: 7

8 HOP 2 CERTIFICATE OF DOCTOR HOUSING AID FOR OLDER PEOPLE SCHEME Please note that this form must be fully completed on behalf of your patient in order to accurately assess his/her eligibility for financial assistance under the above scheme. If the Council considers it necessary the application may also be assessed by an Occupational Therapist. The medical information provided will be treated in the strictest confidence. 1. I HAVE EXAMINED OF AND CERTIFY THAT HE/SHE IS DIAGNOSED AS SUFFERING FROM 2. I CERTIFY IN MY OPINION THAT THE ABOVE NAMED IS: (A) PHYSICALLY DISABLED (B) SEVERELY MENTALLY DISABLED (C) IS SUFFERING FROM SEVERE MENTAL ILLNESS AND IS UNDERGOING TREATMENT FOR SAME 3. PLEASE CERTIFY THE CONDITION OF THE APPLICANT BASED ON THE FOLLOWING PRIORITIES. (Please tick appropriate box) PRIORITY 1 PRIORITY 2 PRIORITY 3 The applicant has a high level of need. Alterations/adaptations would facilitate discharge from hospital or would alleviate the need to be hospitalised in the near future. Cases with terminal illness or presenting with rapid progression of a degenerative condition. Without the recommended alterations or adaptations the disabled persons ability to function independently would be hindered. Where the alterations/adaptations would enhance the Disabled Person s quality of life/living conditions. 4. YOUR PATIENT SINCE: DAY MONTH YEAR DATE CONDITION COMMENCED: DAY MONTH YEAR HOW LONG DO YOU EXPECT THIS CONDITION TO CONTINUE: WOULD YOU CONSIDER THE DISABILITY TO BE PROGRESSIVE: YES NO HOW DOES THE DISABILITY IMPACT ON APPLICANTS LIFE: 8

9 PLEASE INDICATE THE DEGREE TO WHICH THE APPLICANT S DISABILITY HAS AFFECTED HIS/HER MOBILITY. IS THE APPLICANT: FULLY DEPENDENT INDEPENDENT WITH HELP INDEPENDENT MOBILITY: (Please tick where appropriate) WHEELCHAIR BOUND PAINFUL MOBILITY UNABLE TO CLIMB STAIRS CONFINED TO BED UNABLE TO GO OUTSIDE UNAIDED ONLY ABLE TO WALK USING A WALKING AID OTHER PLEASE SPECIFY: SIGHT: (Please tick where appropriate) (A) Blind (D) No defect (B) Slight corrected with glasses (E) Other Please specify (C) Partially sighted CONTINENCE: (Please tick where appropriate) (A) Incontinent (C) Partial Incontinence (B) Continent (D) Other Please specify 5. THE APPLICANT HAS APPLIED FOR THE FOLLOWING ADAPTATIONS/MODIFICATIONS TO HIS/HER HOME: 6. DO YOU CONSIDER THAT ALL/SOME OF THESE ADAPTATIONS/MODIFICATIONS ARE NEESSARY: 7. WHY DO YOU CONSIDER THAT THE WORKS PROPOSED BY YOU ARE NECESSARY: 8. ANY OTHER COMMENTS OR ADDITIONAL INFORMATION: NAME OF DOCTOR: DOCTOR S STAMP ADDRESS: SIGNED: DATE: 9

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11 Tax requirements in respect of Housing Aid for Older People Scheme HOP 3 TO BE COMPLETED BY APPLICANT Name of Applicant: Address: PPS Number/Income Tax Reference No*: I hereby confirm that to the best of my knowledge my tax affairs are in order. Signed: Date: * In the case of persons paying income tax under PAYE, or those in receipt of social welfare payments, please quote your PPS Number; In the case of self-employed persons please quote the number on your return of income. All Applicants are required to produce a valid Tax Clearance Certificate. The application form for a Tax Clearance Certificate is available from the Revenue Commissioner s website, Alternatively applicants can request an application form from their local Revenue District. As an alternative to producing a valid tax clearance certificate an applicant may authorise the local authority to confirm electronically that he/she holds a valid tax clearance certificate using the on-line verification facility on the Revenue Commissioner s website. The applicant gives permission to the local authority to confirm his/her tax clearance status by quoting the PPS number and tax clearance certificate number, which appears on the Tax Clearance Certificate. PPS No: Tax Clearance Certificate No: N.B. Applicants must be Tax Compliant from the time of application up to and including the date of final payment. 11

12 HOP 4 TO BE COMPLETED BY CONTRACTOR Name of Contractor: Address: Tel: Income Tax serial number: Tax District dealing with your tax affairs: Tax Clearance No: Expiry Date: Contractor is required to produce a valid Tax Clearance Certificate. As an alternative to producing a valid Tax Clearance Certificate the contractor may authorise the local authority to confirm electronically that he/she holds a valid Tax Clearance Certificate using the on-line verification facility on the Revenue Commissioner s website. The contractor gives permission to the local authority to confirm his/her tax clearance status by quoting the customer number and tax clearance certificate number, which appears on the Tax Clearance Certificate. PPS No: Tax Clearance Certificate No: N.B. Contractors must be Tax Compliant from the time Roscommon County Council receives notification that the works are to commence up to and including the date of final payment. 12

13 HOP 4 HOUSING AID FOR OLDER PEOPLE SCHEME CHECK SHEET Name: REF: HOP. 1. ROOF REPAIRS (a) Repair/Replace flat roof (b) Felt/laths/slates or Tiles (c) Rafters, etc. (d) Ridge, barge, etc (e) Fascia/Soffits (f) Gutters/downpipes 2. CHIMNEY REPAIRS (Specify) DESCRIPTION OF WORK Linear/ Sq. mtrs M 2 M 2 M M M M CONTRACTORS PRICE FOR OFFICIAL USES ONLY 3. CEILINGS (a) Attic Insulation (b) Repair Ceilings (c) Replace Ceilings 4. WALL REPAIRS (a) External Plastering (b) Internal Plastering (c) Drylining 5. FLOORS (a) Repair floors (b) Replace floors 6. RADON REMEDIATION (Specify) 7. ELECTRICAL WORKS (with RECI or equivalent Cert) (a) Re-Wiring (b) Smoke Alarms (Min 2 No.) 8. CENTRAL HEATING (provide details of type of heating system being installed & rooms where the radiators are being installed) M² M 2 M² M² M 2 M² M² M² No. 9. WATER SUPPLY TO DWELLING (Check Water Services) 10. CONSTRUCT SEPTIC TANK AND PERCOLATION AREA TO CURRENT STANDARDS WHERE THERE IS NONE 11. CONTRACT CLEANING 12. PAINTING Subtotal 13.5% Total Signed: (Contractor) Date: 13

14 When returning this form to the Housing Section, kindly give details of directions to the house from the nearest town on the space provided below. This will help the representative from the County Council when calling to you regarding the work to be carried out under the scheme. 14

15 Completed postal application forms should be returned to our head office at: The Housing Department, Roscommon County Council, Áras an Chontae, Roscommon F42 VR98 Or alternatively applicants may hand deliver completed application forms to the housing office located at: The Housing Department, Roscommon County Council, Áras an Chontae, Roscommon F42 VR98 15

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