Online forms: Duty to refer - homelessness referral form Form progress: 0% - Page 1 of 4 Public authorities can complete this form to refer a potentially homeless household to Rugby Borough Council for a homelessness assessment under the Housing Act 1996 - Section 213 B (Part VII), as amended under the Homelessness Reduction Act 2017. PLEASE NOTE - under the legislation, a public authority is defined as "a person (other than a local housing authority) who has functions of a public nature." This includes social services, NHS trusts, GPs, Job Centre Plus and prisons. Only complete this form to refer customers who may be homeless or threatened with homelessness in the next 56 days. A referral does not guarantee your customer access to housing and does not constitute a homelessness application. Once we receive a completed form, we aim to contact your customer within five working days and, if required, arrange an appointment. The information contained in this form is personal and/or special data as defined under the General Data Protection Regulations 2017. For urgent enquiries, please call our Community Advice and Support Team on (01788) 533833. Save and continue If you have registered with our web site and are signed in, you can leave a form at any time to complete later. You can also view all of your saved and completed forms from your Account page.