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Apply for Crisis Support and Income Maximisation

All fields with * are mandatory and should be completed in full.

Applicant Details

Are you completing this form for yourself or on behalf of somebody?

Yourself
On behalf of somebody

Referrer Details

Are you completing this as an organisation or individual?

Organisation
Individual

Referrer First Name

Referrer Last Name

Organisation Email Address

Confirm Organisation Email Address

Job Title

Agency

Other Agency

Services Provided

Relationship to applicant

Applicant Details

You must provide up to date contact details so that we can email or call you regarding your application.

First Name

Last Name

Telephone Number

Email Address

Confirm Email Address

Date of Birth

Day

Month

Year

National Insurance Number I do not have a National Insurance Number

Ethnicity

Other Ethnicity

Preferred time to contact

Applicant Address

Address Search

Additional address information i.e. "Room 1"

Crisis Support - What support do you need

Support with food

Please give full details why you require support with food

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Help towards energy and water payments

Please give full details why you require support with energy and water

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Who supplies your gas and electricity?

Other gas and electricity supplier

How do you pay for your gas and electricity?

Do you need help with household items?

We will only consider a claim for household items in genuine crisis. We do not replace through general wear and tear or damage and we do not provide white goods.

We can offer basic furniture items that are deemed essential requirements only for those who have been rehoused through homelessness or in an emergency as a result of a fire or flood and have no means to purchase/replace items will be considered. Please note all items supplied can be new or used but will be safe and without any risk.

Have you recently been rehoused through homelessness, domestic violence or in an emergency due to fire or flood in the last 2 months? - We will complete checks to verify the information that you have provided.

Please give full details of why you require support with household items?

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What household items do you require?

Have you encountered a financial shock?

A financial shock is a sudden, unexpected expense or drop in income, that can place pressure on your budget and wellbeing.

Are you expecting to have a significant financial change in the next 4 weeks?

Please provide full details of your current circumstances and explain why you are requesting support from the Crisis and Resilience Fund

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Have you accessed support from the Crisis and Resilience Fund in the last 12 months?

Have you engaged with resilience services?

What was the outcome of the support you received, and why are you now applying for further Crisis Support?

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In order to meet the criteria for further crisis support, you need to engage with the resilience services

Have you tried to get any support from anywhere else?

Please give details of what other help you have tried to get and where you have looked for support

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Please tell us why you haven't tried to access support from anywhere else

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Income Maximisation – Support, advice and guidance

Our Income Maximisation Service is a separate service to our Crisis and Resiliance Fund.

We offer free, confidential, specialist advice on Income Maximisation for people who live in Wigan and Leigh.

The focus of our work is on income maximisation by identifying potential benefit entitlement both from the local authority and wider DWP benefits. We focus on empowering people to know and claim their benefit rights.

We can help you work out what benefits you are entitled to, assist with claim forms, and support you with appeals if you disagree with a decision.

If you need support with debt, we can refer you to Citizens Advice for support.

Our Income Maximisation Team provide

Support maximising your income via a benefit check to ensure you are claiming all that you are entitled to from the Council and Department for Works and Pensions (DWP)
Assistance completing Wigan Council and DWP benefit and discount forms (except for new Universal Credit applications)
Benefit refusal advice
Advice on money management – prioritising and budgeting
A referral to our partners Citizens Advice for support with Debt.

Do you require specialist benefit income maximisation advice and support from our Income Maximisation team?

What is your preferred method of contact?

You can access face to face support by visiting an Income Maximisation event in your local area, for details of an event near year, visit – www.wigan.gov.uk/helptoclaim

Our Income Maximisation will attempt to contact you via telephone to discuss your circumstances and provide all available support in order to maximise your income between the hours of 9am to 5pm – Monday to Friday.

Advice on money management – prioritising and budgeting support

Assistance with completing DWP Benefit forms

What form do you require assitance with?

What date does the form need to be completed by

Please advise the form you require assistance with

Advice and support on a range of Welfare Benefits

Do you need support with debt management?

We will complete a referral to Citizens Advice on your behalf.

Please provide details about your circumstances relating to debt, including your main concern and the amount involved.

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