Financial Assessment Form for non-residential care Adult - Hackney - hackney gov 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with SECTION A: PERSONAL DETAILS. Fill in your surname, first name, address, date of birth, phone number, and National Insurance Number. Indicate if you live alone and provide details about any other adults in your household.
3. In SECTION B: IMPORTANT NOTICE, read the information carefully. If you choose not to provide financial details, sign the declaration stating you agree to pay the full charge for community care services.
4. Proceed to SECTION C: YOUR INCOME. List all sources of income including benefits and pensions. Be thorough to ensure accurate assessment.
5. In SECTION D: INCOME RELATED TO YOUR CARE, indicate if you receive Independent Living Fund payments or Direct Payments and specify amounts.
6. Complete SECTION E: HOUSING by stating whether you receive Housing Benefit and providing relevant details.
7. Fill out SECTION F: YOUR SAVINGS by listing all savings accounts and their balances.
8. In SECTION G: YOUR SPENDING, detail your regular expenses such as rent and mortgage payments.
9. Finally, review SECTION H: DECLARATION. Ensure all information is accurate before signing and submitting the form as instructed.

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