UKeff Crisis Payment Application

Application for short-term essential support following an immediate crisis affecting an Oldham resident.

1Before You Begin

2Applicant Details

3Household and Finances

4The Crisis and Support Needed

5Evidence and Documents

6Declaration and Review

Crisis and Resilience Fund

This form is for an Oldham resident who has experienced an unexpected event or sudden change that creates an immediate risk to their health, safety or ability to remain in their home, and who cannot meet essential needs without urgent help.

The scheme is discretionary and funding is limited. An application is not an entitlement or approval. UKeff will decide whether support is appropriate, its value and how it is provided. Support may include goods, a food parcel, supplier payment, a controlled payment method or a voucher; applicants and representatives must not assume or promise a supermarket voucher or cash payment.

The fund is not intended to cover ordinary ongoing budgeting pressure, general debts, fines, loans, rent arrears, ongoing housing costs, televisions/TV licences, telephone installation, general motor-vehicle costs, care-provision costs or non-essential goods.

Evidence is required. Have the applicant’s identity/address evidence, full PDF financial statements, benefit/income evidence and evidence of the crisis ready before starting. Screenshots, photographs of screens, cropped pages and transaction lists are not accepted as bank or Universal Credit statements.

If someone is in immediate danger, call 999. Do not wait for this application to be assessed.

Who is completing this application? *

The applicant
A friend, relative or other representative
A professional or partner organisation

Basic eligibility

Each statement must be confirmed separately before the application is submitted.

Eligibility confirmation 1 *

I confirm that the applicant is aged 16 or over.

Eligibility confirmation 2 *

I confirm that the applicant lives in the Oldham borough or can demonstrate that they are about to become an Oldham resident.

Eligibility confirmation 3 *

I confirm that an unexpected event or sudden change has created an immediate crisis.

Eligibility confirmation 4 *

I confirm that the applicant cannot meet the essential need from income, savings, credit or other support reasonably available to them.

Eligibility confirmation 5 *

I understand that support is discretionary and the type requested is not guaranteed.

Eligibility confirmation 6 *

I understand that the applicant must provide the evidence reasonably required to assess the application, or explain any accessibility barrier.

Oldham residence status *

Currently resident in the Oldham borough
About to become an Oldham resident

Explain when and where the applicant will become an Oldham resident *

Is there an immediate risk to health, safety, wellbeing or the ability to remain at home? *

This scheme is for an immediate crisis. Ongoing low income or general financial hardship without a sudden crisis event will not normally qualify. The applicant may still submit relevant information, but should also seek benefits, debt or budgeting advice.

Can the essential need be met in time from savings, available income, insurance, family support or another service? *

Explain what other resource is available and why a Crisis Payment is still required *

Applicant’s full name *

First

Last

Applicant’s date of birth *

National Insurance number

Enter if held. Format: AB 12 34 56 C.

Current living situation *

Owner-occupier
Private tenant
Housing association or council tenant
Temporary or emergency accommodation
Hostel, refuge or supported accommodation
Staying temporarily with friends or family / no fixed address
Rough sleeping
Other

Applicant’s current address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Use the current placement or accommodation address where applicable.

Safe correspondence address or contact point *

Give a care-of address, hostel, day centre or professional contact. Do not disclose a precise sleeping location if that could create risk.

Area where the applicant is currently staying *

Applicant’s telephone number

Applicant’s email address

Is it safe for UKeff to contact the applicant directly? *

Yes
Yes, with restrictions
No – contact through the representative

Give safe-contact instructions *

State safe methods and times, whether messages may be left, and any words or organisation names that must not be used.

Languages the applicant can use *

Include English where applicable.

Does the applicant need an interpreter? *

Yes
No
Unsure

Language and dialect required *

Interpreter arrangements or accessibility needs

Do not use a child as an interpreter.

Email address for the application acknowledgement *

This may be the applicant’s, representative’s or professional’s email. Only a brief acknowledgement will be sent.

Representative’s full name *

First

Last

Representative’s telephone number *

Representative’s email address *

Has the applicant consented to this application and to UKeff contacting the representative? *

Representative’s relationship to the applicant *

Job title *

Organisation *

Organisation address *

Have you spoken directly with the applicant and assessed their financial circumstances and immediate need? *

State what you have independently verified and what has only been reported by the applicant *

Explain why consent has not been obtained and identify any lawful safeguarding basis relied upon *

Number of adults in the household, including the applicant *

Number of children under 18 in the household *

Ages of children in the household *

Give ages only, not names.

Does a spouse or partner live with the applicant? *

Partner’s full name *

First

Last

Partner’s date of birth *

Partner’s National Insurance number

Does the applicant share finances, bills or essential household costs with a partner or another adult? *

Do not include an unrelated housemate whose finances are genuinely separate.

Name and relationship of each financially connected adult *

Has each financially connected adult agreed to the lawful provision of their financial documents? *

Do not upload another adult’s financial documents without an appropriate lawful basis. Obtain their agreement or contact UKeff before proceeding. Do not submit their documents merely because they live at the same address.

Does the household include any of the following? *

Care leaver under 25
Child under 5
Pregnant person
Only one working-age adult
Person aged 65 or over
Disabled person or person with a serious illness
Person at immediate safeguarding risk
None of these

Relevant vulnerability, health, disability or safeguarding information

Include only information relevant to urgency, safety, accessibility or suitable support.

Is the applicant working or self-employed? *

Employed
Self-employed
Not currently working

Does the applicant or partner receive Universal Credit? *

Does the household receive any other benefit, pension, wage or income? *

List each other income source and its usual amount and frequency *

Approximate total monthly household income (£) *

Approximate total monthly essential household expenditure (£) *

Money currently available across all accounts and cash (£) *

Total savings or other funds available (£) *

Approximate total of debts, arrears, fines and loans (£)

Debt itself is not normally funded, but the information may be relevant to the household’s overall circumstances.

Brief details of debts and current repayment commitments

Date of next expected income or benefit payment

Why can the household not pay for the essential need from its own resources? *

Does the applicant own any property other than the home in which they live? *

Give details and explain why the property cannot meet the crisis need *

Has a recent transfer, disposal of savings or other reasonably avoidable action materially contributed to the inability to meet this need? *

Explain what happened, when it happened and any exceptional circumstances *

Has anyone in the household received a Crisis Payment, CRF, LWP or comparable emergency award during the last six months? *

Yes
No
Unsure

Give the date, organisation, support received and reason, or explain what is uncertain *

Has the applicant applied to, been offered help by, or been refused help by another service for this need? *

Give the organisation, date, support requested, outcome and reference if known *

What unexpected event or sudden change caused the immediate crisis? *

Fire, flood or other sudden damage to the home
Fleeing domestic abuse or an immediate safety concern
Leaving care, prison, detention, hospital, residential care or supported accommodation
Sudden illness or disability
Bereavement
Relationship breakdown
Unexpected loss, delay or suspension of income or benefit
Sudden essential expense that could not reasonably have been anticipated
Other sudden crisis

Date the crisis began or occurred *

Describe what happened, what changed suddenly and why the situation is an immediate crisis *

Give dates and distinguish the sudden crisis from any longer-term financial difficulty.

What will happen if urgent support is not provided? *

Explain the immediate risk to health, safety, wellbeing, employment, education or the ability to remain at home.

What has the applicant already done to try to resolve the crisis? *

Include contact with the Council, DWP, landlord, insurer, employer, family, advice service or other fund where relevant.

What essential support is being requested? *

Emergency food assessment
Toiletries, personal hygiene or sanitary products
Baby items such as nappies or wipes
Bed or bedding
Essential furniture
White good – fridge/freezer
White good – cooker/cooking appliance
White good – washing machine
Kitchen starter pack
Fuel or energy support
Essential travel to work
Essential travel to education or training
Essential travel to a health appointment

Select all that apply. UKeff will decide the appropriate form and level of any support.

For approximately how many days can the household meet its food needs? *

Date money for food is next expected

Would the applicant accept an appropriate crisis food parcel if offered? *

Yes
No
It would not meet the household’s needs

A supermarket voucher is not automatic and must not be promised.

Dietary, allergy, medical or infant-feeding requirements

Explain specifically why an appropriate food parcel would not meet the immediate need *

List the exact essential items, sizes and quantities required *

List each item needed and explain why it is essential following the crisis *

What happened to the previous item, or why has the household never had one? *

Would suitable checked pre-loved items be accepted? *

Is the home ready and suitable for delivery and safe installation? *

Yes
No
Unsure

How is the energy account paid? *

Prepayment meter
Monthly or quarterly bill
Included in rent/service charge
Other

Describe the immediate energy crisis *

Include current credit, disconnection risk, loss of supply, debt balance and any health-related need.

Date of travel *

Give the destination, purpose, route, cheapest suitable fare and why the cost cannot be met *

Document standards

Upload complete, readable documents. Financial statements and Universal Credit statements must be original PDF downloads, not screenshots, photographs, cropped pages, edited files or transaction lists.

The most recent statement period must reach the date of application, or end no more than seven days before it. It must show the account holder’s full name and current address, account details, every transaction and running/current balances. Upload statements for every current, savings, online and other financial account held by the applicant. Where finances are shared, the same requirement applies to each financially connected adult.

Do not upload passwords, PINs, security codes or full payment-card details.

Proof of the applicant’s identity and current Oldham address *

Click or drag files to this area to upload. You can upload up to 4 files.

For example, official photo ID plus a recent address document. PDF, JPG or PNG.

Applicant’s statements for all accounts – most recent 30 consecutive days *

Click or drag files to this area to upload. You can upload up to 10 files.

Original PDFs for every account. Each must identify the applicant and show all pages, transactions and balances.

Financially connected adult’s statements for all accounts – most recent 30 consecutive days *

Click or drag files to this area to upload. You can upload up to 10 files.

Original PDFs for every account, supplied with that adult’s knowledge and an appropriate lawful basis.

Latest full Universal Credit statement *

Click or drag files to this area to upload. You can upload up to 3 files.

Upload the complete original PDF showing claimant details, assessment period, all award elements, deductions and payment information.

Evidence of every other income source *

Click or drag files to this area to upload. You can upload up to 8 files.

For example wage slips, benefit or pension award letters, or self-employment evidence.

Applicant’s statements for all accounts – preceding two complete months *

Click or drag files to this area to upload. You can upload up to 10 files.

Together with the recent 30-day statements, these must provide a continuous three-month financial history.

Financially connected adult’s statements for all accounts – preceding two complete months *

Click or drag files to this area to upload. You can upload up to 10 files.

Together with the recent statements, these must provide a continuous three-month history.

Is evidence or independent professional confirmation of the accommodation situation available? *

Evidence of temporary accommodation, homelessness or rough sleeping *

Click or drag files to this area to upload. You can upload up to 6 files.

For example placement/hostel letter, notice, outreach confirmation or signed professional letter.

Explain why evidence is unavailable and give the service or professional UKeff may contact to verify the circumstances *

Is evidence of the sudden crisis event available? *

Evidence of the crisis event *

Click or drag files to this area to upload. You can upload up to 10 files.

For example fire report, flood/insurance evidence, discharge document, safety or support letter, bereavement evidence, tenancy notice, DWP decision or benefit journal PDF.

Explain why documentary evidence is unavailable and how the crisis can be verified *

Evidence of the essential household-item need *

Click or drag files to this area to upload. You can upload up to 10 files.

Upload tenancy/placement documents and relevant photographs, measurements, appliance details, repair assessment or quotation.

Current energy evidence *

Click or drag files to this area to upload. You can upload up to 6 files.

Upload a recent bill, meter/credit evidence, disconnection notice or account statement.

Evidence of the essential journey and cost *

Click or drag files to this area to upload. You can upload up to 6 files.

For example appointment, work or education evidence and the cheapest suitable fare.

Other relevant supporting evidence

Click or drag files to this area to upload. You can upload up to 10 files.

Only upload information necessary to assess this application.

Accessibility barrier or reasonable adjustment needed to provide evidence

Explain any disability, language, literacy, digital-exclusion, safety or other barrier and the adjustment requested.

How UKeff will use the information

UKeff will use the information to assess and administer this application, verify eligibility and evidence, prevent duplicate or inappropriate awards, arrange support, safeguard people where necessary, meet funding/audit duties and refer or signpost the applicant to appropriate resilience services.

Where necessary, lawful and proportionate, information may be checked or shared with Oldham Council, DWP, another local authority, statutory services, the referring organisation, suppliers or another relevant organisation. Financial, health, domestic-abuse and other sensitive information must only be included where relevant.

Read UKeff’s Privacy Policy for information about data-controller details, lawful bases, retention, rights and complaints.

Optional equality monitoring

These questions help UKeff monitor whether the scheme is accessible and fair. They are optional and must not determine eligibility.

How does the applicant describe their sex or gender?

Female
Male
Another term
Prefer not to say

Applicant’s broad ethnic group

Applicant declaration

Each statement must be confirmed separately.

Applicant declaration 1 *

I confirm that the information and documents provided are complete and accurate to the best of my knowledge.

Applicant declaration 2 *

I confirm that all accounts, income, savings, financial resources, relevant previous awards and other support applications have been disclosed.

Applicant declaration 3 *

I understand that UKeff may verify relevant information and may lawfully share it where necessary to assess or administer the application, prevent fraud or address safeguarding concerns.

Applicant declaration 4 *

I understand that applying does not guarantee an award, voucher, cash payment or the type or value of support requested.

Applicant declaration 5 *

I understand that false information, omitted relevant information or altered evidence may result in refusal, recovery of an award and referral for investigation.

Applicant declaration 6 *

I consent to UKeff contacting me or my authorised representative about this application and to appropriate signposting or referrals discussed with me.

Representative declaration

Each statement must be confirmed separately.

Representative declaration 1 *

I confirm that the applicant knows about and has agreed to this application, except where I have recorded a lawful safeguarding exception.

Representative declaration 2 *

I have read the completed application with the applicant or ensured that they understand the information submitted.

Representative declaration 3 *

I have not promised a supermarket voucher, cash payment or any other particular outcome.

Representative declaration 4 *

I am authorised to provide the documents uploaded and have not included unnecessary third-party information.

May UKeff contact or refer the applicant to appropriate advice or resilience services to help address the causes of the crisis? *

Review before submitting

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