Fillable Printable Queensland Application for Housing Assistance
Fillable Printable Queensland Application for Housing Assistance
Queensland Application for Housing Assistance
FORM 7
Housing Act 2003
Application for housing assistance pursuant to
Section 26A of the Housing Regulation 2003
Rental Application No.
A range of housing assistance is provided by the Department of Housing and Public Works to eligible Queenslanders for
the duration of their housing need. The types of housing assistance available include departmentally-managed housing,
long term community housing and Indigenous Council community housing on discrete Indigenous communities.
How to apply for housing assistance:
You can apply in the following ways:
• contact your nearest Housing Service Centre to arrange an appointment to discuss your eligibility and housing needs. At the
interview, you will complete and sign an Application for Housing Assistance form. Housing Service Centre staff will advise
which documents you need to bring to the interview, for example, proof of identification forms, evidence of your household’s
income and assets, citizenship or residency, and any specific housing needs, etc.
OR
• complete this application form and send it to your nearest Housing Service Centre. The department will contact you to
arrange an appointment to discuss your application.
OR
• apply through community housing providers who will then send the application to the department on your behalf.
OR
• If you are living on one of the 34 discrete Indigenous communities and you are applying to live on the same Indigenous
community in Indigenous Council community housing, you can contact your Council housing officer or your nearest Housing
Service Centre to discuss lodging an application.
Important information
Lodgement of an application for housing assistance is not a guarantee that the department will be able to assist you.
Your
eligibility, level of housing need and the type of housing assistance you are eligible for will be assessed based on
the information you provide at the interview and / or in this application form.
You must be eligible for housing assistance when you apply and continue to be eligible until being offered assistance
Fact sheets on housing assistance are available from any Housing Service Centre or from the department’s website at:
www.hpw.qld.gov.au
If you wish to complete this application form:
Read all the questions carefully and complete this application in full.
Write in block letters (for example: JOHN SMITH).
Show your answer with a tick, where there are Yes/No boxes (for example ).
Attach any supporting documentation if required. Provide proof of income and assets for each person with an independent
income, for example, Centrelink Income Statement, Employers Declaration, etc.
Sign the declaration and bring in necessary identification with this application form or have necessary identification signed by
a witness if you are mailing this application form.
Have this application form sighted and signed by an appropriate witness.
1
Version 6 November 2012
What is your first language spoken at home?
Do you require an interpreter for an interview? Yes No
2
If you would like to talk about your application in a language other than English, we can arrange for an interpreter to assist you.
We can also arrange a signing interpreter for people with hearing difficulties. Please tick the box below if you would like us to
arrange either of these services.
Language interpreter Signing interpreter
Language
1
What type of social housing do you want to apply for? (Please tick applicable boxes).
All social housing - this includes both departmentally-managed housing (social housing provided
directly by the department, including Aboriginal and Torres Strait Islander housing) and community managed
housing (social housing provided and managed by registered housing providers, including affordable
housing).
Note - listing for both types of housing will provide you with the most housing options.
Departmentally - managed housing only
Community - managed housing only
Indigenous Council community housing on one of the 34 discrete Indigenous communities in Queensland
Note: if you want to apply for Indigenous Council housing on a discrete Indigenous community only, you must
be already living on that same Indigenous community. If you are not already living on the community you want
to apply for, you must also list for housing in other locations.
2
Do you need assistance when making decisions?
Is there a person who assists you to make decisions, or who makes decisions on your behalf in regard to personal, lifestyle, or
financial matters? This person might be a formally appointed guardian and/or an administrator or a family member, friend or
advocate.
Yes
No
If yes, please complete and attach one of these forms which are available from your nearest Housing Service Centre or
from the department’s website www.hpw.qld.gov.au.
• Formal Guardian and/or Administration Details’, - if you have a Guardian and/or Administrator who was formally
appointed by the Queensland Civil and Administrative Tribunal (QCAT) or the former Guardianship and Administration
Tribunal (GAAT), or
• Informal Decision-maker Details - if you have a family member, friend or advocate acting in the capacity of an informal
guardian and/or administrator and who helps you make decisions.
3
Your address and contact details.
What is your current address?
Wha
Postcode
What is your mailing address?
Postcode
Telephone Private Business
3
Mobile
N Note - the department may also send you
information by SMS (text messages).
Email
Please indicate the way you would prefer the department contact you
(eg telephone, letter, SMS, email. Note - you can list more than one way)
You must advise us of any change to this address or your application may be cancelled.
Please provide the name of a relative, friend or organisation with a different address to you, whom the department could
contact if unable to contact you directly.
Person/organisation
Address
Postcode
Telephone Private / Mobile Business
Are you, or any person to be housed with you, a currently living in a Department of Housing and Public Works rental
property?
Yes
No
If yes, name of person
Address of property
Account number (if known)
Date occupied (if known)
6
Are you, or any person to be housed with you, currently living in community-managed housing? Yes
No
If yes, name of person
Address of property
Household member role
Name of the community
housing provider
Date occupied (if known)
Are you, or any person to be housed with you, currently living in Indigenous Council community housing?
Yes
No
If yes, name of person
Which Indigenous community?
Address of property
Household member role
Date occupied (if known)
Have you, or any person to be housed with you, applied for or been assisted in the past in Queensland with:
First Time Second Time
Public rental housing Yes
No
Yes
No
4
Aboriginal and Torres Strait Islander housing Yes No
Yes No
Bond loan assistance Yes No
Yes No
Housing loan assistance Yes No
Yes No
Community-managed housing Yes
No
Yes
No
I Indigenous community housing Yes No
Yes No
Indigenous Council community housing Yes No
Yes No
If ‘yes’, name of person/s
Address of property
Date vacated property Account number (if known)
Name of community or local
government (including Indigenous Councils)
housing provider
If there is not enough space, please provide similar details for each person on a separate page and attach to
this application.
8
Have you, or any person to be housed with you, been known by another name/s in the past?
(e.g. name changed by deed poll, marriage or divorce) Yes
N
o
If yes, please list the name of each person and their past names
Household member details
Please provide details of all of the people to be housed. Please include all adults and children
.
Household member No. 1 No. 2 No. 3 No. 4
Title
Surname
First name /s
Middle name
Date of birth
Male / female
Relationship to applicant Applicant
Centrelink’s Customer Reference Number
(CRN) or Department of Veteran Affairs
(DVA) Reference Number
We are committed to improving housing outcomes for Indigenous people. The following information is collected for
reporting and planning purposes and/or to determine your eligibility for housing assistance.
For each household member please tick
;
which of the following apply
Aboriginal origin
Torres Strait Islander origin
Australian South Sea Islander origin
Another cultural or linguistic
background
None of the above
What is your residency status in Australia?
(please tick
;
the option that applies for each person’s residency status)
Australian citizen
Permanent resident
Have a permanent protection visa
Have a Resolution of Status visa
Have a Bridging Visa and have applied
for a permanent protection visa
On a Bridging Visa and have applied
for a Resolution of Status visa
Have applied for permanent residency
Have a Temporary Protection Visa
Not a permanent resident
You must provide evidence of your residency status e.g. Birth Certificate /from an Australian State or Territory or Australian Passport or
Australian Citizenship certificate or documents from Department of Immigration and Citizenship (DIAC) verifying your citizenship status (e.g.
letter detailing residency or visa status or Certificate of Resident Status or Certificate of Identity etc) or permanent residency stamp in
applicant’s Passport etc.
5
Household member details continued…
Use this page for additional household members.
Household member No. 5 No. 6 No. 7 No. 8
Title
Surname
First name / s
Middle name
Date of birth
Male/female
Relationship to applicant
Centrelink’s Customer Reference Number
(CRN) or Department of Veteran Affairs
(DVA) Reference Number
We are committed to improving housing outcomes for Indigenous people. The following information is collected for
reporting and planning purposes and/or to determine your eligibility for housing assistance.
For each household member please tick
;
which of the following apply
Aboriginal origin
Torres Strait Islander origin
Australian South Sea Islander origin
Another cultural or linguistic
background
None of the above
What is your residency status in Australia?
(please tick
;
the option that applies for each person’s residency status)
Australian citizen
Permanent resident
Have a permanent protection visa
Have a Resolution of Status visa
Have a Bridging Visa and have applied
for a permanent protection visa
On a Bridging Visa and have applied
for a Resolution of Status visa
Have applied for permanent residency
Have a Temporary Protection Visa
Not a permanent resident
You must provide evidence of your residency status e.g. Birth Certificate from an Australian State or Territory or Australian Passport or
Australian Citizenship certificate or documents from Department of Immigration and Citizenship (DIAC) verifying your citizenship status
(e.g. letter detailing residency or visa status or Certificate of Resident Status or Certificate of Identity etc) or permanent residency stamp in
applicant’s Passport etc
6
Household income and asset information
Please provide details of all of the income and asset information for each household member.
Please attach evidence of your income and assets to the back of this application
.
Note - the department can obtain your income and assets details electronically from Centrelink with your consent. Please complete
an Income Confirmation Service Consent Form and return it with this form. Contact your nearest Housing Service Centre for this
form or visit the department’s website
www.hpw.qld.gov.au.
Household member No.1 No. 2 No. 3
No. 4
Surname
First name / s
Income $
$ $ $ $
Income type
(wages, pension, allowance,
family payments)
Other income
(for example, maintenance,
superannuation, etc.)
Do you own, or any household member, or part own property either in Australia or overseas?
Please tick
;
all options that apply. Note - for any option that you do not tick, you are declaring that you and your
household do not own that type of property.
Residential
(including a house, flat, unit,
townhouse or manufactured
home)
Vacant land of any type
(including residential, commercial
or industrial etc.)
Live-aboard boat, caravan,
mobile home, donga or cabin
Industrial property
Commercial property
If yes to any of the above, complete the information below and attach supporting documentation.
Name of person who owns or part owns the property
7
Address of property
Amount of property owned e.g. 50%
Current value of the property Date of ownership
Is the property mortgaged? Yes No If yes, amount of mortgage owing
Details of the property ownership
$
/ /
Postcode
$
Household income and asset information continued
Use this page for additional household members if required
.
Please attach evidence of your income and assets to the back of this application.
Household member No. 5 No. 6 No. 7
No. 8
Surname
First name / s
Income $
$ $ $ $
Income type
(wages, pension, allowance,
family payments)
Other income
(for example, maintenance,
superannuation, etc.)
Do you own, or any household member, or part own property either in Australia or overseas?
Please tick
;
all options that apply. Note - for any option that you do not tick, you are declaring that you and your
household do not own that type of property.
Residential
(including a house, flat, unit,
townhouse or manufactured
home)
Vacant land of any type
(including residential, commercial
or industrial etc.)
Live-aboard boat, caravan,
mobile home, donga or cabin
Industrial property
Commercial property
If yes to any of the above, complete the information below and attach supporting documentation.
Name of person who owns or part owns the property
Address of property
8
Postcode
Amount of property owned e.g. 50%
Current value of the property Date of ownership
$
/ /
Is the property mortgaged? Yes No If yes, amount of mortgage owing
$
Details of the property ownership
Household income and asset information continued
If you, or any household member, has any of the following assets, please detail the value of the assets below.
Note - for any option that you do not complete in the table below, you are declaring that you and your household do not
have that type of asset.
Please attach evidence of all assets owned by each person this application.
Household member
No.
1
No.
2
No.
3
No.
4
Balance of all cash and
bank accounts
(including bank, building society,
credit union and interest free
accounts)
$
$
$
$
Deposits
(including interest free bearing
deposits, fixed deposits etc)
$
$
$
$
Bonds
$
$
$
$
Debentures
$
$
$
$
Shares
(Australian and international)
$
$
$
$
Property Trusts
$
$
$
$
Managed investments of
any type including friendly
society bonds
$
$
$
$
Superannuation
- allocated pension / s
(if you were born before 1 July 1960)
$
$
$
$
Superannuation -
- lump sum payment/s
(if you were born before 1 July 1960)
$
$
$
$
Proceeds from a property
sale
$
$
$
$
Share of a property
settlement
$
$
$
$
9
Household income and asset information continued - use this page for additional household members if required
If you, or any household member, has any of the following assets, please detail the value of the assets below.
Note - for any option that you do not complete in the table below, you are declaring that you and your household do not
have that type of asset.
Please attach evidence of all assets owned by each person this application.
Household member
No.
5
No.
6
No.
7
No.
8
Balance of all cash and
bank accounts
(including bank, building society,
credit union and interest free
accounts)
$
$
$
$
Deposits
(including interest free bearing
deposits, fixed deposits etc)
$
$
$
$
Bonds
$
$
$
$
Debentures
$
$
$
$
Shares
(Australian and international)
$
$
$
$
Property Trusts
$
$
$
$
Managed investments of
any type including friendly
society bonds
$
$
$
$
Superannuation
- allocated pension / s
(if you were born before 1 July 1960)
$
$
$
$
Superannuation -
lump sum payment/s
(if you were born before 1 July 1960)
$
$
$
$
Proceeds from a property
sale
$
$
$
$
Share of a property
settlement
$
$
$
$
10
Are any of the household members on the application expecting a child?
Yes No
If yes, name of the person/s
Expected date of delivery (due date)
Note - a letter from their doctor is required.
Are you applying for housing assistance on any of the following grounds?
Note - please tick all grounds which apply to your household. Note - if you do not tick any of the grounds below, you
are declaring that you and your household are not applying for housing for any of these reasons.
Referral from Disability Services or a non-
government support provider
- Housing with
Shared Support (HwSS) program to fill an individual
vacancy in an existing household
You are in contact with Child Safety Services for
assistance with your family
You are exiting a correctional facility
11
Referral from Disability Services or a non-
government support provider
- Housing with
Shared Support (HwSS) program to be a member of
a new household
You have been the victim of a natural disaster affecting
your current housing
You have been the victim of a major crime affecting
your current housing
You are a young person
who
is exiting the care of the
State and Transition Planning is underway
You have a disability and/or mental illness and
succession planning is proceeding either through
the establishment of a Special Disability Trust or
through documentation from Disability Services,
Queensland Health or a non-government provider
confirming eligibility for special disability services to
establish independent living
Referral from a support provider as receiving
assistance under the Street to Home or 50 Lives: 50
Homes Initiatives
Referral from Child Safety Services as the safety of
a child in your care is at risk
None of the above
Which of the following best describes your current housing situation?
Note - you can tick more than one if the people listed on your application are not currently living together.
Public housing or Aboriginal and Torres Strait Islander
housing
Private boarding house
Community Housing - including long term community
housing, affordable housing and longer term Community
Managed Studio Units
Private hostel
Caravan park
Temporary and Supported accommodation -
including refuges, shelters or emergency, crisis and other
housing delivered by specialist homelessness services to
people who are homeless or at risk of homelessness
Cabin
Donga
Community Housing - transitional (including Community
Rent Scheme, Same House Different Landlord and
transitional Community Managed Studio Units program)
Hotel / motel
Living on the street or sleeping in the park
Medical institution/facility or hospital and have no other
housing to go to
Living or squatting in a derelict, makeshift or
illegal building
Correctional facility Living with family or friends
Own home Living on a boat
Renting privately (including sharing a house/flat) Living in Indigenous council housing
Boarding privately
