Ryedale District Council

 

You are here: Home Living Here Housing Homelessness Refer homeless cases Duty to refer referral form

Duty to refer referral form

Service users can chose to which local housing authority they wish to be referred. However, it is advisable for them to choose a local authority with which they have a local connection. In general, a service user is likely to have a local connection to an area if they live or have lived there, work there or have a close family connection. However, a service user should not be referred to an area where they would be at risk of violence.

A guide to the duty to refer includes advice on the duty to refer and local connection.

Consent to refer

Having discussed the accommodation status of the service user, I can confirm that they provided me with oral consent to refer their case to Ryedale District Council. I explained to the Service User that the Council may use this information to contact them and to help assess their needs for assistance with housing and that this is not a homelessness application.

Has consent been received?(*)
Invalid Input

About the referring professional (to be completed by the professional)
Public authority referring (e.g. prison, hospital, etc.)(*)

Invalid Input

Role of person referring (e.g. social worker)(*)
Invalid Input

Name of referrer(*)
Invalid Input

Address of referrer(*)
Invalid Input

Email address of referrer(*)
Invalid Input

Phone number of referrer(*)
Invalid Input

Name and contact details of any other person who could be contacted for further information, if not the referrer (e.g. a support provider)
Invalid Input

Information and contact details for the service user being referred
Name
Invalid Input

Household composition (e.g. single person, couple, family with X children/X adults)(*)
Invalid Input

Current address (if applicable)
Invalid Input

Home phone number
Invalid Input

Mobile number
Invalid Input

Email address
Invalid Input

Gender(*)
Invalid Input

Date of birth(*)
Invalid Input

Language and communication needs
Invalid Input

(identify any assistance the service user will need for an assessment to be completed)

What is the main reason you are referring the individual?(*)

Invalid Input

Please explain your answer (e.g. they are facing eviction from their home)(*)
Invalid Input

Please provide any additional information you are aware of which may help housing options officers support the individual.
What type of accommodation is the individual currently living in?
Invalid Input

If the service user is threatened with homelessness, on what date are they likely to become homeless?
Invalid Input

If the service user is due to leave prison or hospital, or is leaving the armed forces, with no accommodation available, please state when the release/ discharge will take place.
Invalid Input

Are there any additional needs/risks to be aware of?
Invalid Input

Additional needs/risks might include: • previous history of sleeping rough • lack of support from family/friends • history of substance misuse • risk of domestic or other abuse

Please provide information on any physical or mental health needs that the service user has, and any treatment that they are receiving.
Invalid Input

Please provide any additional information. In particular, are there any known risks to staff visiting the service user at home or any other issues that we need to be aware of prior to initial contact?
Invalid Input

Please select(*)
Invalid Input

Contact us


Ryedale District Council
Ryedale House
Old Malton Road
Malton, North Yorkshire
YO17 7HH

Email: Contact the Council

Phone: 01653 600666

Connect with us

 

Like us on Facebook Facebook 
Follow us on Twitter Twitter
Follow us on Flickr Flickr
 Subscribe to us on Youtube= YouTube
 Connect with us on LinkedIn= LinkedIn