[Your address]
								[Your telephone number]
								[Your email address]
								[Date]

[Address of the Council’s housing benefit department]

By [first class post / hand / email to: [insert email address]


Dear Sir/Madam

Re:	Permission for disclosure of information to landlord

I hereby give the housing benefit department permission to share information about my claim for housing benefit with my landlord [name] of [address].

I specifically consent to you disclosing the following information to my landlord in relation to my claim should they request it:
* whether my claim has been received;
* the status of my claim;
* whether you are waiting for further information, documentation or evidence that you reasonably require in order to make a decision on my claim
* if so, a description of the information or documentation required
* if a decision has been made on my claim:
* the date my benefit starts and ends
* the weekly amount of my benefit
* when my benefit will be paid
* whether a decision has been made that there is a recoverable overpayment of benefit, and if so a summary of the overpayment decision.

This permission does not extend to the sharing of personal or financial data.  I understand that I can withdraw this permission at any time.

Please advise me in writing by return if you’re unable to give effect to this request for any reason.

Yours faithfully




[Your name]

Copy: 	[Name and address of landlord]










E&W_HB_CLAIMANT_02
From claimant to housing benefits
Authority for disclosure of information to landlord