Havering Test & Trace Support Payment Scheme Form

London Borough of Havering logo

Applicant details

Title*:

Application information

If you have been contacted by NHS Test and Trace and have been told to self-isolate, you may be entitled to financial support.

Test and Trace Support Payment

If you meet all of the following eligibility criteria, you are entitled to a Test and Trace Support Payment of £500:

  • You have been told to self-isolate by NHS Test and Trace on or after 28 September 2020.
  • You are employed or self-employed.
  • You cannot work from home and will lose income as a result.
  • You are currently receiving at least one of the following benefits: Universal Credit, Working Tax Credit, income-based Employment and Support Allowance, income-based Jobseeker’s Allowance, Income Support, Housing Benefit and/or Pension Credit.

Discretionary payments

You may be eligible for a £500 discretionary payment if you meet all the other eligibility criteria above, but:

  • You do not currently receive Universal Credit, Working Tax Credit, income-based Employment and Support Allowance, income-based Jobseeker’s Allowance, Income Support, Housing Benefit and/or Pension Credit.
  • You will face financial hardship as a result of not being able to work while you are self-isolating.

This application is for one person only and any further applications within the same household must be made by each individual.

Please ensure that you have the below information available before starting the application:

  • National Insurance number
  • Your 8-character NHS Test and Trace Account ID
  • Your most recent bank statement, wage slip or proof of self-employment

Is this form being completed by someone else

Who are you completing this application for?*:

Details of person completing the form - 3rd party application

NHS Test and Trace

Have you been contacted by NHS Test and Trace?*:

NHS Test and Trace

Help: This Account ID will have been issued to you by the NHS by email, text or phone
Help: This is the date you tested positive for COVID-19 or the date you first developed symptoms. Please use the following format: 07/10/2020
Help: This is the date of when your isolation ends

Employment status

Please select your employment status*:
Help: If you are both employed and self-employed, please select the main option that will result in you losing most income as a result of self-isolating e.g. where you have no entitlement to statutory sick pay if self-employed or where your full wages will not be covered by your employer if you self-isolate

Job Role

Help: e.g. Administrative Assistant/ Sales Advisor If you have more than one job, please provide the details of one that you will lose most income from as a result of self-isolating
Are you able to work from home?*:

Self-employed

Help: e.g. Electrician/Taxi Driver/Hairdresser
Are you able to work from home?*:

Reduced income

Will you have a reduction in earned income?*:
Help: Not required if you are self-employed

Benefits

Which of the following benefits/support do you receive?*:

Unfortunately, you do not meet the criteria for a Test and Trace Support Payment.

You can still be considered for a discretionary payment if you will face financial hardship as a result of not being able to work while self-isolating.

Do you wish to continue and apply for a discretionary payment?*:

NI number

Please enter all 9 characters without any spaces, for example: QQ123456C

Banking information

Help: Please enter your details carefully and check them before moving on to the next page. This must be an account in your name as this will be the account into which any eligible self-isolation payment you are entitled to will be paid.
Help: Sort codes must be entered without hyphens or spaces i.e. 112233

Declaration

I confirm that the information is true and accurate. I agree to stay at home and self-isolate for the required period. I understand that if I fail to do so, I will be required to pay the funds back and my contact details may be passed on to the police for further action.

Your data will be processed under the terms of the London Borough of Havering Privacy Notice. You can view this here [link to local authority’s Privacy Notice]

Please tick the box to confirm you have read and understood the declaration:

It appears you have refreshed the page whilst completing this application, please re-upload the following evidence below.

Confirmation of supplied details

Please check details before pressing the "Send" button. Print this page if you want to keep a copy for your records.

For more information on how your data is handled, please read our privacy policy.

Evidence re-upload

Help: Not required if you are self-employed
Applicant's name
Telephone
Email
Address ,

Applicant's name - third party application
Relationship with claiment
Reasons for completing on their belhalf
NHS Test and Trace Account ID
Self isolation dates Start:
End:
Employment status
Job Role
Job Role
Employer's name
Business name
Employer's address
Business address
Employer's contact number
Benefits recieved
    National insurance number
    Date of birth
    Account holder's name
    Account number
    Sort code
    Bank name

    Sorry, you are not eligible