Provide childcare costs information to support a Housing Benefit or Council Tax Support Claim Current Claimant Child details Preview Information message Filling out this form will email the relevant department Your details Claim reference Housing Benefit account number Name Customer name Title Title - Select -MissMsMrMrsDrOther…- Select -▾- Select -MissMsMrMrsDrOther… Enter other… First name Last name Address Customer address First line of address Second line of address City/Town Postcode Contact Email Phone number 14733
