diff --git a/app/models/form/lettings/pages/referral_value_check.rb b/app/models/form/lettings/pages/referral_value_check.rb
new file mode 100644
index 000000000..d98a17a5d
--- /dev/null
+++ b/app/models/form/lettings/pages/referral_value_check.rb
@@ -0,0 +1,19 @@
+class Form::Lettings::Pages::ReferralValueCheck < ::Form::Page
+  def initialize(id, hsh, subsection)
+    super
+    @id = "referral_value_check"
+    @depends_on = [{ "la_referral_for_general_needs?" => true }]
+    @title_text = {
+      "translation" => "soft_validations.referral.title_text",
+    }
+    @informative_text = ""
+  end
+
+  def questions
+    @questions ||= [Form::Lettings::Questions::ReferralValueCheck.new(nil, nil, self)]
+  end
+
+  def interruption_screen_question_ids
+    %w[needstype referral]
+  end
+end
diff --git a/app/models/form/lettings/questions/referral_value_check.rb b/app/models/form/lettings/questions/referral_value_check.rb
new file mode 100644
index 000000000..30aa45f4c
--- /dev/null
+++ b/app/models/form/lettings/questions/referral_value_check.rb
@@ -0,0 +1,14 @@
+class Form::Lettings::Questions::ReferralValueCheck < ::Form::Question
+  def initialize(id, hsh, page)
+    super
+    @id = "referral_value_check"
+    @check_answer_label = "Referral confirmation"
+    @header = "Are you sure?"
+    @type = "interruption_screen"
+    @check_answers_card_number = 0
+    @answer_options = ANSWER_OPTIONS
+    @hidden_in_check_answers = { "depends_on" => [{ "referral_value_check" => 0 }, { "referral_value_check" => 1 }] }
+  end
+
+  ANSWER_OPTIONS = { "0" => { "value" => "Yes" }, "1" => { "value" => "No" } }.freeze
+end
diff --git a/app/models/form/lettings/subsections/household_situation.rb b/app/models/form/lettings/subsections/household_situation.rb
index e09033563..9db7c1f04 100644
--- a/app/models/form/lettings/subsections/household_situation.rb
+++ b/app/models/form/lettings/subsections/household_situation.rb
@@ -24,6 +24,7 @@ class Form::Lettings::Subsections::HouseholdSituation < ::Form::Subsection
       Form::Lettings::Pages::ReferralPrp.new(nil, nil, self),
       Form::Lettings::Pages::ReferralSupportedHousing.new(nil, nil, self),
       Form::Lettings::Pages::ReferralSupportedHousingPrp.new(nil, nil, self),
+      Form::Lettings::Pages::ReferralValueCheck.new(nil, nil, self),
     ].compact
   end
 end
diff --git a/app/models/lettings_log.rb b/app/models/lettings_log.rb
index 6d15699cc..3d01c5284 100644
--- a/app/models/lettings_log.rb
+++ b/app/models/lettings_log.rb
@@ -568,6 +568,10 @@ class LettingsLog < Log
     end
   end
 
+  def la_referral_for_general_needs?
+    is_general_needs? && referral == 4
+  end
+
 private
 
   def reset_invalid_unresolved_log_fields!
diff --git a/spec/models/validations/soft_validations_spec.rb b/spec/models/validations/soft_validations_spec.rb
index acffc9cac..0a267b9e9 100644
--- a/spec/models/validations/soft_validations_spec.rb
+++ b/spec/models/validations/soft_validations_spec.rb
@@ -345,4 +345,34 @@ RSpec.describe Validations::SoftValidations do
       expect(record).to be_care_home_charge_expected_not_provided
     end
   end
+
+  describe "#la_referral_for_general_needs?" do
+    it "returns false if needstype is 'Supported Housing'" do
+      record.needstype = 2
+      record.referral = 4
+
+      expect(record).not_to be_la_referral_for_general_needs
+    end
+
+    it "returns false if needstype is not given" do
+      record.needstype = nil
+      record.referral = 4
+
+      expect(record).not_to be_la_referral_for_general_needs
+    end
+
+    it "returns false if referral is not given" do
+      record.needstype = 1
+      record.referral = nil
+
+      expect(record).not_to be_la_referral_for_general_needs
+    end
+
+    it "returns true if needstype is 'General needs' and referral is 4" do
+      record.needstype = 1
+      record.referral = 4
+
+      expect(record).to be_la_referral_for_general_needs
+    end
+  end
 end