Financial assessment form for Adult and Community Services support

This form provides us with the information on how much the Council will pay towards care.

We need the following information to work out whether you will pay towards your support, and how much.

If you receive Guaranteed Pension Credit or Income Support and you will be receiving support in your own home, you will not pay anything towards your support from us. Please complete only sections A and G and return this form with a copy of written proof of the benefits you receive.

If you do not wish to tell us about your financial information, or have savings above the upper limits and have been told you will be paying full cost or the maximum charge, please complete sections A, B and G and then return this form to us.

If you have less than the upper savings limits and have been told you are likely to contribute towards the cost of your support, or if you are unsure whether you will need to contribute, please complete this form with details of your income, savings and expenses.

If you are going to receive ongoing care in a nursing or residential home, we may need to treat your property as a part of your capital, unless it is occupied by your spouse or partner.

Download the financial assessment form for Adult and Community Services support(pdf, 131KB).

Help with completing the form

If you have any questions or you need help with filling out this form, please contact us:

Telephone: 020 8831 6215
Email: charginghelpline@richmond.gov.uk