It is very important that you read the following section carefully before you agree to this declaration. If you do not agree, we will not consider your request to look at your assessment of benefits again.

I am responsible for the completion of this form. I have read and understood each question. I realise you may increase my weekly entitlement to Housing Benefit / Council Tax Support as a result of the information I give.

I know that I must inform you of any changes in my circumstances, and I realise that it is a criminal offence to deliberately give you false details or withhold information to claim benefit.

You are providing your information to Brent Council, contact 020 8937 1800. The Council’s Data Protection Officer can be contacted via dpo@brent.gov.uk , or 020 937 1402.

Your information is collected for the purpose of processing your claim for Discretionary Housing Payment (DHP), as required to fulfil the council’s duties under The Discretionary Financial Assistance Regulations 2001.

Your information shall be processed for as long as required as stated in the Local Government Finance Act 2012, which is usually 7 years. Housing Benefit claims are retained for 7 years after last action taken and, shall be processed in adherence to your legal rights, including but not limited to right to copies of your information and right to be forgotten. You have a right to lodge a complaint with the Information Commissioner’s Office (www.ico.org.uk).

Further information can be found at www.brent.gov.uk/privacy

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