Are you (or is the person you live with) eligible for one of the following benefits (whether you actually claim it or not):

  • Personal independence payment (PIP) - the daily living component
  • Disability living allowance (DLA) - the middle or higher rate care component
  • Income-based jobseeker's allowance (JSA) - with a disability premium
  • Employment and support allowance (ESA)
  • Universal credit
  • Severe disablement allowance
  • Income support with a disability premium
  • Incapacity benefit
  • Attendance allowance
  • Constant attendance allowance
  • Armed forces independence payment
  • Unemployability supplement or unemployability allowance
  • Working tax credit - with a disability element and you previously received disabled person's tax credit, incapacity benefit, severe disablement allowance or income support with a disability premium

Yes No

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