Acceptance of smaller housing

Complete this form to confirm that you accept listing for and/or being allocated a property with fewer bedrooms than your entitlement based on your current household.

Application number:
Date listed for public housing: Declaration – applicant/s to read	
I/We		and				
Name of applicant			Name of ap	plicant		
Acknowledge that I/we are eligible for	bedroom housing. However, I/we agree	
to accept listing for and being allocated	bedroom housing because of the	
possible reduction in waiting time. I/we understand that the department will not consider or approve a transfer to larger housing at a later date, unless the number of household members increases.
Privacy Notice - The Department of Housing is collecting your personal information so we may provide you with housing assistance. To assist you with your housing needs and services, your personal information may be disclosed to partner agencies, service providers, local governments and non-governmental agencies that now, or will, provide you with housing and/or support services. Unless authorised or required by law, your personal information will not be disclosed to any other third party without your consent. More information about the Department’s privacy obligations is available on our website at www.housing.qld.gov.au.

Declaration
To the best of my knowledge, the information provided on and in conjunction with this form is true and correct. I/We understand that it is an offence liable to a penalty under the Housing Act 2003 to knowingly provide to the Department of Housing false or misleading information that may influence decisions about my eligibility for housing services.
Signature of applicants/tenants	
Name:	Signature:			Date:	
	
Name:	Signature:			Date:	

/	/

/	/

Please return completed form to your nearest Housing Service Centre.

Department of Housing use only	
Request assessed as per Housing Online For Me (HOME).	Yes	No	
Application APPROVED by delegated officer	Application NOT APPROVED by delegated officer	
Approval/Non approval letter sent	Note entered into SAP	

Department of Housing
www.housing.qld.gov.au	PH057 (27/07/2023)