PPSL Supported Housing referrals

STEP 1 OF 5Referrer & applicant

Referrer & applicant

Tell us who is making the referral and who needs accommodation.

Organisation *Referrer name *Work email *Telephone *Applicant first name *Applicant surname *Date of birth *Applicant gender

Applicant phone (if available)Current location or address *Include prison, hospital or rough sleeping location where relevant.Is the applicant aware of this referral?

Housing & support

Describe the accommodation needed and the help required to maintain it.

Preferred area *Date accommodation is needed

Local connection

Tell us why the applicant is connected to the preferred area.

Does the applicant have a local connection to the preferred area? *

Local connection details *Include residence, work, family or support networks, relevant dates and evidence. If none or unknown, explain.

Areas that must be avoided and whyReason for referral and housing-related support needed *Include budgeting, tenancy skills, practical support and the frequency needed.Previous accommodation issuesInclude evictions, damage, rough sleeping, incidents in shared accommodation and dates.Can the applicant manage a tenancy without support?

Will they accept a private room with shared kitchen and lounge?

Current support agencies and contactsNames, roles, contact details and expected frequency of contact.

Health & benefits

Share information relevant to safe placement and financial sustainability.

Physical and mental health needs, medication and current treatmentAlcohol and drug useSubstances, frequency, most recent use, treatment engagement and relapse plan.Benefits and other incomeState which awards are in payment and which are only applied for or anticipated.National Insurance number (if known)Does the applicant have photo ID?

Recourse to public funds

Children in their care or relevant safeguarding needs

Risk assessment

Assess each risk below as Low, Medium or High. Give a full explanation and details of every risk identified, including incidents and dates, who may be affected, triggers, current evidence and how the risk is managed. Explain the basis for a Low rating too; do not leave a risk unexplained.

Convicted of or accused of arson?

Convicted of or accused of a sexual offence?

Details of any arson or sexual offence accusation or convictionOffending history, orders and restrictions