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Age and disability status

Age * Help icon

Date of birth Help icon

For example, 31 3 2010

Day
Month
Year

Gender

Which best describes your employment status? Help icon

If you are employed and self-employed, please select one answer and total your work hours when asked. If you are not employed but have worked in the last 2 years we will ask for more information to see if you could get help based on your national insurance contributions.

How many hours a week do you usually work? Help icon

Do you receive a disability or sickness benefit? Help icon

Please select 'Current claim' if you receive or have successfully applied for a disability or sickness benefit. Select 'Recent claim' if you received a disability benefit in the last six months. Common disability benefits are Attendance Allowance, Disability Living Allowance (DLA), Personal Independence Payment (PIP), Employment and Support Allowance (ESA) and Statutory Sick Pay (SSP).

Are you ill or disabled but not claiming benefit? Help icon

Answer 'yes' if you have have a health condition that affects your daily living or mobility but aren't claiming a disability benefit.

Do you care for someone who is sick or disabled?

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