Severe mental impairment council tax discount form

1. This form is to be used to be considered for a Council Tax discount or exemption if someone living with you is severely mentally impaired and without them there is only one adult living in your home.
  
  As part of the form we require a certificate from a Registered Medical Practitioner. This certificate will help us decide whether the person named is severely mentally impaired for Council Tax purposes. This can be uploaded via this form.
  
  For more information and proof you will be required to supply please visit the Severe Mental impairment page.
  
  This form has one page of questions and should take around 5 to 10 minutes to complete.
2. Name of person to be disregarded
3. Address of their main residence
4. Address of their main residence (optional)
5. Town/city
6. Postcode
7. Date of Birth
8. How many adults resident in the property?
9. A person may only be disregarded on the grounds of being severely mentally impaired if he/she is entitled to but not necessarily in receipt of one of the following benefits: (optional)
  
  Incapacity benefit
  
  Attendance allowance
  
  Severe disablement allowance
  
  Disability working allowance
  
  Unemployability supplement
  
  Unemployment allowance
  
  Employment and support allowance
  
  Disability element of working tax credit
  
  Standard or enhanced rate of personal
  
  Care component of a disability living allowance
  
  An increase in the rate of disablement pension
  
  Income Support which includes a disability
  
  A constant attendance allowance
  
  Universal Credit with one of the above qualifying benefit elements
  
  Universal Credit including limited capability for work and work-related activity
10. Please state the date that the above benefit(s) are applicable from: (optional)
11. Please upload evidence of the entitlement, for example copy of DWP decision note, showing the date that the benefit was first granted. (optional)
12. Please upload evidence of the entitlement, for example copy of DWP decision note, showing the date that the benefit was first granted. (optional)
13. Details of person completing the form
  1. Name of person acting on applicant's behalf
  2. Relationship to the applicant
  3. Name of Doctor and Address of Surgery/Hospital: (optional)
  4. Contact telephone number (in the event of a query)
  5. Email address (optional)
14. The Local Government Finance Act 1992 states that a person is severely mentally impaired if he/she has a severe impairment of intelligence and social functioning (however caused) which appears to be permanent.
15. Certificate signed by a Registered Medical Practitioner
  1. You will also need to ask your doctor or GP practitioner to complete a severely mentally impaired (SMI) certificate.
    
    If you have not yet completed a SMI certificate, you can download the form for a Severe Mental Impairment discount here. (Opens as a PDF document, in a new window).
  2. The General Medical Services Committee of the BMA has agreed that, for the purpose of The Act, medical certificates should be issued without charge to the applicant or his / her representatives.
  4. Preston City Council will use your information in a manner compatible with the General Data Protection Regulation (GDPR).
    
    Any disclosures or sharing of information will only take place where required or permitted by law. For further information please visit our privacy notice page.

This website uses cookies

Severe mental impairment council tax discount form