Supported Accommodation Questionnaire form Published by: Andrew Plant, on: 13 January 2025 Supported Accommodation Provider Questionnaire Step 1 of 7 14% Company DetailsCompany Name:(Required)Company number at Companies House:(Required)Company's registered address:(Required) Street Address Address Line 2 City County Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Contact Name(Required) First Last Company Telephone Number(Required)Company Email Address(Required) Is your company not for profit?(Required) Yes No Please provide documentation to prove this:(Required) Drop files here or Select files Max. file size: 64 MB. Is your company a Registered Social Landlord?(Required) Yes No Please provide your registration number in the box below:(Required)Is your company a Voluntary Organisation?(Required) Yes No Please provide the relevant reference number and type of voluntary organisation e.g. Community Interest Company:(Required)Is your company a Charity?(Required) Yes No Please provide the charity registration number:(Required)Other Landlord Type - if this does not apply, please type NA in the Landlord type and Company Number box(Required)Landlord TypeCompany Number Add RemoveIf your company is not a registered social landlord, have you applied to be one?(Required) Yes No If you answered yes , what was the outcome? If you have answered no please provide details below about the reasons for not applying.(Required)If your company is not a registered social landlord, was it one once?(Required) Yes No Why did your company deregister?(Required) Supported accommodation resident detailsSupported accommodation address:(Required) Street Address Address Line 2 City County Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Number of units in the property:(Required)Type of unit:(Required)Please click the plus icon if there is more than one type of unit. e.g. one room with shared facilities Add RemoveClient group that the property will cater for:(Required) People with mental health difficulties People with an alcohol problem People with drug problems Offenders / Ex-Offenders Over 60's Young people / Care leavers (Under 25) People with learning disabilities People with physical disabilities Refugee / Asylum seekers Person at risk of domestic violence Homeless in need of support Other Age range of tenants accepted at the property:(Required)Please list in the box below all the tenants currently in the property and their benefit reference or national insurance numbers:(Required)Please click the plus button if there is more than one tenant.Tenant NameHousing benefit or National Insurance number Add Remove Ownership and lease informationHas the property been purchased by your company?(Required) Yes No Name of the Landlord(Required)Address of the landlord(Required) Street Address Address Line 2 City County Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please provide a copy of your lease with the owner of the property.(Required) Drop files here or Select files Max. file size: 64 MB. Did you negotiate a lower price? How was the purchase financed?(Required)Are there any links between the owner of the property or the organisation that you lease the property from and your organisation e.g. a director of your company was/is a director or employee of the owner?(Required) Yes No Please provide further information:(Required)Do you receive any help financially from the owner of the property or the organisation that you lease the property from?(Required) Yes No Please provide further information:(Required)If the property or units within it are empty, do you still pay rent for the lease?(Required) Yes No How is payment for the lease funded?(Required) Support, care and supervision detailsName of the support, care and supervision provider(Required)Contact Name(Required) First Last Contact Phone Number(Required)Email address of the support, care and supervision provider(Required) Address of the support, care and supervision provider(Required) Street Address Address Line 2 City County Post Code Do you participate in sector-led accreditation and benchmarking schemes, which demonstrate compliance with standards and are aimed at improving transparency and performance on value for money and quality of housing services? Can you confirm and provide proof if your company/organisation has done this or is in the process of doing so?(Required) Yes No Please provide evidence of this(Required)Max. file size: 64 MB. Please explain why you do not intend to take part in the above:(Required)Have you researched rents for comparable accommodation/schemes and those of general needs housing in Hyndburn?(Required) Yes No Please provide evidence of this:(Required) Drop files here or Select files Max. file size: 64 MB. Please explain why this has not been researched?(Required)Do you have working relationships with existing organisations within Hyndburn to give the best outcome for your tenants?(Required) Yes No Please give details below:(Required)If you answered no, please explain why not.Does your organisation have strong links with the local community?(Required) Yes No Please give details below:(Required)If you answered no, please explain why not.Considering Hyndburn’s diverse population, can you explain how the premises meet tenant’s diverse and cultural needs?(Required)Please confirm your referral process including which organisations you accept referrals from.(Required)Please provide a copy of your referral form.(Required) Drop files here or Select files Max. file size: 64 MB. Are your tenants from Hyndburn?(Required) Yes No Please give reason as to why you accept referrals from outside this area?(Required)How do you determine what type of support is needed for an individual tenant? Who carries out the assessment?(Required)Please provide a blank assessment form(Required) Drop files here or Select files Max. file size: 64 MB. Please provide information on the type of support that is provided, by whom is it provided, for how long, how often, and how it is funded?(Required)How often is the level of support required, reviewed for individual tenants?(Required)What considerations are there when deciding accommodation is suitable for an individual tenant?(Required)Please give details of the desired outcomes for your tenants stating if this will be their forever home or if it is intended for them to move on to general needs housing. How do you decide if this tenancy is not working for an individual and in what timeframe? Please confirm what steps you take once this has been established.(Required)Do you set out in writing what tenants can expect from the standard of their accommodation and the level and quality of the support they will be receiving?(Required) Yes No Please give details below:(Required)Please provide a case study from a tenant either current or former to show the support they received and the positive outcomes achieved. (Please ensure personal information is redacted.)(Required) Drop files here or Select files Max. file size: 64 MB. Are there systems in place to monitor and improve the quality of support?(Required) Yes No Please give details below:(Required)Is it mandatory for all tenants to receive support as part of their tenancy?(Required) Yes No Please provide a copy of the tenancy/licence agreement.(Required) Drop files here or Select files Max. file size: 64 MB. Please confirm the type of training staff receive to enable them to assist tenants with support such as with budgeting or welfare benefits.(Required)We require the job descriptions and salaries for all of the roles involved within this property, the staff structure, number of hours worked and how many hours per day staff are on site? If workers cover multiple sites, please confirm the geographical area they cover, how many properties they cover and how many tenants they support per site.(Required) Tenant Liability - Rent, Costs and ChargesPlease provide a full breakdown of the rent and evidence of how each cost was determined. If costs are averaged out over several properties, please give details of this and explain why this is the case.(Required) Each item listed on the breakdown must be accompanied by proof of this cost i.e. contract/invoice/receipts and how this cost has been apportionedPlease provide any evidence of the above:(Required) Drop files here or Select files Max. file size: 64 MB. Please provide a detailed, quantified, evidenced breakdown of the Intense Housing Management costs, service charges and care & support costs.(Required)We will need to see proof of these costs. Please provide any evidence of the above:(Required) Drop files here or Select files Max. file size: 64 MB. Are white goods included in the tenancy?(Required) Yes No If white goods are included in the tenancy, please confirm if these are for individual units or shared, how often they are serviced and how often they are replaced.(Required)We will need to see an invoice to evidence the purchase price. Please provide any evidence of the above:(Required) Drop files here or Select files Max. file size: 64 MB. Do the white goods become the property of the tenant?(Required) Yes No Give a detailed explanation of how your core rent figure was determined.(Required)Please complete the table in full:(Required)Please ensure all room types have been entered.Type of RoomNumber for sole use of one tenantNumber shared by more than one tenantNumber for staff use only BedroomWCBathroomKitchenLiving RoomDining RoomOfficeOther (Specify) Add Remove Please provide any further information below: Drop files here or Select files Max. file size: 64 MB. DisclaimerThis questionnaire does not establish any contractual relationship between Hyndburn Borough Council and you. Any personal information provided will only be used by the Council, partners and service providers. It will not be disclosed unless we are obliged or permitted to do so by law. We will only hold your information for as long as necessary for these purposes and will not pass it on to any other parties, except where required to carry out our duties and functions as a local authority or by law. For full details please refer to the Council’s privacy statement on its website.Declaration Please read this declaration carefully before you sign it: • I confirm that this information I have provided on this form is correct and complete • I understand that if I have given information that is incomplete or incorrect that you may take legal action against me • The council will use your information in line with the Data Protection Act 1998. We have a duty to protect public funds and we may use the information you have given us or share it with other organisations to prevent and detect fraud. • The council will also share your information if we have a legal duty to do so, or where we believe that by doing so we can provide you with a better standard or service. Name(Required) First Last Date(Required) MM slash DD slash YYYY Signature(Required)
