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Rent supplement form 2025

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The document is a form for applying for a Rent Supplement from the Health Service Executive, detailing the information required from both the applicant and the landlord. It includes sections for personal details, rental information, tenancy agreements, and verification of housing needs. The form emphasizes the importance of providing accurate information and outlines potential legal consequences for false statements.

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Click ‘Get Form’ to open the Rent Supplement form in the editor.
In Section 1, complete your personal details including your P.P.S. number and name in block capitals. Specify the address for which you are claiming the Rent Supplement.
Indicate the amount of rent you pay (excluding heating and other costs) and select whether it is weekly, 4-weekly, or monthly. Ensure this matches your Tenancy Agreement.
Provide the date your tenancy commenced and attach any necessary documents like a Tenancy Agreement or utility bill as verification.
List all addresses where you have resided in the last 12 months along with corresponding accommodation types and periods of residency.
Answer questions regarding assessments by Local Authorities and applications for housing, providing details as required.
In Section 2, ensure your landlord completes their part accurately, confirming details about the accommodation and rental terms.
Finally, review all information for accuracy before signing and submitting the form.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a supplemental rental application?

The purpose of this Supplemental Rental Application is to determine whether you qualify for affordable rental housing under a government regulated affordable housing program. It is very important that you answer all questions fully and accurately.

What is a rent subsidy and who qualifies?

In subsidized rental housing, the government pays apartment owners to reduce the rent for tenants with low incomes. Learn how to find this type of affordable housing.

What is the Virginia rent relief program?

For every $1.00 of rent paid that is over the threshold, the single pensioner will receive $0.75. The maximum Rent Assistance payment is $215.40 for a single client. As $345.93 is greater than this amount, the client would receive the maximum payment of $215.40 per fortnight in Rent Assistance.