Leeds DP Hub Referral Page

Please use this page to make a referral for somebody who is new to Direct Payments. If they are employing a PA please upload the DP costing information (SS25, SS26, DP Costing Calculator) to prevent any delays. A member of the Leeds DP hub will initially contact the person referred and send a welcome pack. If the person is already receiving support from the Leeds DP & PA Support Hub please contact us directly using the details below.

IF YOU ARE EXPERIENCING ANY PROBLEMS MAKING A REFERRAL WITH THIS PAGE PLEASE CONTACT THE LEEDS DP HUB DIRECTLY ON:

Leeds DP and PA Support Hub:

T: 0113 378 3936
E: Leedsdphub@leeds.gov.uk

Person assessed for a Direct Payment's date of birth

Person assessed for a Direct Payment's email address or contact number

Person Assessed for a Direct Payment

First Name of Customer (required) This field is required

Last Name of Customer (required) This field is required

Address line 1 - House/Apartment Number, Building Name if applicable, Street Name (required) This field is required - Cannot exceed 75 characters

Town/City (required) This field is required

Postcode (required) This field is required

Date of Birth

Contact Number

Email Address

Person Acting as the Employer or Contact Name if different (e.g. parent or nominated person)

First Name of Contact

Last Name of Contact

Employer

Address line 1 - House/Apartment Number, Building Name if applicable, Street Name Cannot exceed 75 characters

Town/City

Postcode

Contact number

Email Address

Name of Professional

First Name (required) This field is required

Last Name (required) This field is required

Contact number (required) This field is required

Email Address

Duty Team Email Address

DP and Support Information – please provide as much of the following information as possible

To prevent any delays please upload DP costing information (SS25, SS26, DP Costing Calculator etc).

How will the DP be paid? (required) This field is required

Support Required

Funding Stream (required) This field is required

Apex CiS reference number (Adults & Health only)

If ADAM (PHB Only), please supply ref number:

Equality Monitoring

We would appreciate it if you could complete the equality monitoring questions below relating to the person assessed for the Direct Payment.

Gender

Age

Do you consider yourself to be disabled?

If you have said yes, what is the nature of your disability?

Other

Ethnicity

Please indicate which best describes your ethnic origin