Council Tax cognitive impairment discount application

Discounts are not given automatically and depend on certain things, so please read the notes here before you fill in the form.

The council tax charged on a property is based at first on the assumption that there are at least two adults (people aged 18 or over) living there.If there is only one adult then a discount may be claimed and we could reduce your bill by 25% (one quarter).If there are no adults then a discount may be claimed and we could reduce your bill by 50% (one half).

Some people are not counted as living in your home when we work out how much council tax you have to pay.For example, we do not count people who are cognitively impaired.

For council tax purposes, a person is cognitively impaired if they have severe impairment of intelligence and social functioning (however caused) which appears to be permanent.Such a person may be referred to as an individual with a cognitive impairment or a person with an intellectual (or mental) disability.

There are two conditions that need to be met before the above discount can be given. These are described below.

  1. The person must be entitled to receive (or would be entitled to receive, if they had not reached pensionable age) at least one of the following social security benefits.
  • incapacity benefits
  • attendance allowance
  • severe disablement allowance
  • the highest or middle rate care component of a disability living allowance
  • an increase in disablement pension for constant attendance
  • disabled person’s tax credit, but only if this is because of previously getting incapacity benefit, or severe disablement benefit, or income support which included a disability premium paid because of the person’s incapacity for work
  • unemployability supplement
  • constant attendance allowance or unemployability allowance payable under the industrial injuries or war pension schemes
  • income support which includes a disability premium because of the person’s incapacity for work or
  • the person’s partner is receiving jobseeker’s allowance which includes a premium to make up for losing one of the above benefits

and

  1. The person’s doctor will need to complete the second half of the enclosed application form to confirm the person’s condition.

How to apply

  • Complete part one of the application form, print, sign and attach a copy of proof of benefits.Then pass the whole form to the person’s doctor for them to complete part two.
  • The doctor should return the whole form to the Council Tax officer with any previously attached copy of proof of benefits.
Data Protection Act 1998

The information on this from will be used to help the council decide on liability for the Council Tax. The information will only be used in connection with the billing, collection and recovery of local taxes and revenues, including the calculation of any associated discounts, reliefs and benefits. The data may be disclosed to other local authorities for local taxation purposes only and to the council’s auditors.

This council is under a duty to protect the public funds it administers and to this end may use this information you have provided on this form within this authority for the prevention and detection of fraud. It may also share this information with other bodies administering public funds solely for these purposes.

Part one

To be completed by the person who is acting on behalf of the cognitively impaired person. Print, sign and give to the person’s doctor.

  1. How many people aged 18 or over live in the property?
  2. Of this number, how many people are impaired?
  3. Please provide their name(s). A separate form needs to be completed for each such person.

Title: Mr Mrs MissMs

First name:

Last name:

  1. Pension/allowance that the person named above is entitled to:
  2. Doctor’s name:
  3. Doctor’s address:

Declaration

I confirm that the above information is true and correct to the best of my knowledge and belief.I will tell the Council Tax office of any change in circumstance that could affect entitlement to the discount.I understand that a minimum £50 penalty can be imposed, or I may be prosecuted, if any information given above is found to be untrue or if I do not give information within 21 days of being asked for it.

Signed: ______Dated: ______


Name:


Telephone number:


Email address:

Part two – request to doctor

To be completed by the doctor of the cognitively impaired person. Please complete in BLOCK CAPITALS.

Please complete the certificate below, stating whether the person named in part one is cognitively impaired.After completion, please return parts one and two together with attached proof of benefit to:

PO Box 76
Town Hall
Weston-super-Mare
BS23 1YY

Telephone number: 01934 888 144

Name of applicant:


Address:

In my opinion the person named above is cognitively impaired and has been so since: (date)

yes no

The condition is permanent: yes no

Describe the condition:

Doctor’s name:


Address:


Official stamp:

Declaration

I certify that the above information is true and correct, and that for the purposes of the Local Government Finance Act 1992 the applicant is severely mentally impaired.

Signed: ______Dated: ______


Name:


Telephone number:


Email address: