Text version

Housing Outcome Form

April 2011 onwards

 Please see guidance notes before completing this form

Questions marked with a star(*) are required fields

You should only complete the section(s) relevant at the time of the 'outcome'.

*Name of your organisation

*Client Code i.e. JB010190M

*Date of Outcome

Section 1. Homelessness Applications Only for CBC Housing Options, Citizen's Advice, & YHAS

 If the client has made a homeless application to CBC, what was the decision?

IF the client appealled the decision, what was the outcome?

Section 2. Prevention of Homelessnes To be completed by accommodation providers - please answer 2a) & 2b)

2a) Securing Accommodation

2b) Tenure Type * Please state which provider (if known) using section 3b

Section 3. Housing your client  

*Please remember to complete another of these forms for when the client has entered your service.

3a) Ability to house

3b) Name of Provider

Section 4a.

*Is this household receiving support from any of the following agencies?

Section 4b.

*Have you referred the household to any of the following agencies?

This section should not be completed with any other section.

Please answer this question when the household leaves YOUR service, not someone elses.

Section 5. Reason for departure from your service/ Other reason for completing this form

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