Help using this PDF claim form
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If you are having technical difficulties:
downloading the form
navigating around the form, or
printing the form
please contact the DWP Online helpdesk
.
Phone: 0800 169 0154
Email: dwponline.helpdesk@dwp.gsi.gov.uk
Calls to 0345 numbers cost no more than a standard geographic call and
count towards any free or inclusive minutes in your landline or mobile phone
contract.
Opening hours
Monday to Friday: 8.00am - 6.00pm
Closed on weekends and all Public and Bank Holidays.
For help and advice on the information you need to put on the form or about
the benefit you want to claim, contact the office that deals with the benefit.
CRMR1 01/18
If you disagree with a decision for:
l Housing Benefit please contact your local authority
l Child Benefit, Guardian’s Allowance or Tax Credits please contact
Her Majesty’s Revenue & Customs
If you disagree with a decision made by the
Department for Work and Pensions
About this form
You can use this form to ask for a Mandatory Reconsideration if you
don’t agree with a decision. This means a decision maker will look at
your claim again and see if the decision was right or wrong.
It’s important we make the right decision. To help us do that, this form
will ask you to:
l tell us the reasons why you think the decision is wrong, and
l give us any new information that we haven’t seen already
It is easier to call
You can ask for a Mandatory Reconsideration over the phone. Your
claim will be looked at in exactly the same way. It’s much quicker and
you can explain why you think the decision is wrong over the phone,
without needing to fill anything in. The phone number to call is at the
top of your decision letter.
If you want to ask for a Mandatory
Reconsideration in writing
You can use this form to ask for a Mandatory Reconsideration. There is
a booklet to help you fill in this form called CRMR1A. It explains what
information you need to include and has examples of the types of
information we can consider. You can read it online at
www.gov.uk/mandatory-reconsideration
When you complete the form:
l Please use black ink to fill in the form and write in BLOCK CAPITALS
l You can type your information instead of writing if it is easier
for you
l Everyone must complete Parts 1, 4 and 5
l Only complete Part 2 if you are filling in the form for someone else,
such as a child or a person you represent
After you fill out the form
l Please print the form and sign it
l Post the form back to the address at the top of your decision letter
l Send any other relevant evidence at the same time
l We will send you a text message or letter to tell you we have
received your form
l A different decision maker will look at your claim and any new
information you provide. If they can change the decision, they will.
It’s important you understand that the amount you are awarded
could go up, down or stay the same. Your benefit could also be
stopped
l When we have made our decision, we will send you a letter called a
Mandatory Reconsideration Notice.
Part 1: About you - the person we have made the decision about
2
Surname
First name
National Insurance (NI) number*
You can find this on top of the
decision letter, your National
Insurance (NI) numbercard, payslips
or letters from the Department for
Work and Pensions.
* If you are asking for a Mandatory
Reconsideration on behalf of a child,
please provide their Child Reference
Number here.
Letters Numbers
Letter
Your current address
Mobile phone number
Telephone number
Which benefit are you asking for a
Mandatory Reconsideration of?
Postcode
CRMR1 01/18
Date of birth
We may need to call you for more
information. Please tell us when it’s
best to contact you.
Please fill in this form with BLACK INK and in CAPITALS.
Title
Monday
Tuesday
Wednesday
Thursday
Friday
am
am
am
am
am
pm
pm
pm
pm
pm
Child Reference Number
Part 2: If a representative is completing the form
3
We may need to call you for more
information. Please tell us when it’s
best to contact you.
CRMR1 01/18
Name of representative
You only need to fill out this section if you are a representative. Otherwise, please go to Part 3.
By representative, we mean someone who isn’t the person we have made a decision about. For
example, this could be someone’s carer, parent, relative, friend, legal Deputy etc.
Relationship to representative
(For example parent, carer, legal
Deputy etc.)
Surname
First name
Title
Representative’s address
Postcode
Representative’s contact number
Monday
Tuesday
Wednesday
Thursday
Friday
am
am
am
am
am
pm
pm
pm
pm
pm
Part 3: About the original decision
Are you asking us to look at your
decision again within one month of
the date on your decision letter?
Yes
If No, please tell us why below
No
(If necessary, use the extra space in Part 6)
Part 4: Why you disagree with the decision
4
What part(s) of your decision do
you disagree with and why?
Do you have any new information
we haven’t seen or heard of?
Yes
No
If Yes, please list it below
Have you attached all the evidence
listed?
No
Yes
If No, please tell us why below
CRMR1 01/18
Please explain in your own words why you disagree with the decision. Please be specific and provide as
much detail as you can. If you disagree with more than one part of the decision, you must say why you
disagree with each part.
Please read the booklet CRMR1A ‘How to disagree with a decision made by the Department for Work
and Pensions’ for examples of information that will help.
Please list all the new information
you are sending with this form.
We won’t be able to refund any
costs if you get new evidence.
Please read the booklet CRMR1A
‘How to disagree with a decision
made by the Department for Work
and Pensions’ for examples of
information that will help.
Details of why you haven’t
attached the additional
information. For example, you may
have asked for a medical report but
it hasn’t arrived yet.
(If necessary, use the extra space in Part 6)
(If necessary, use the extra space in Part 6)
(If necessary, use the extra space in Part 6)
Part 5: Check and sign
5
Check that you or your
representative have:
CRMR1 01/18
Signature Date
Name
Please sign below
Explained what parts of the decision you
disagree with and why
Attached all additional evidence
Signed this form
If you are signing this form on behalf of someone else
As well as this form, please send signed authority for you to act on the claimant’s behalf. You don’t
need to do this if you are:
l already registered as the claimant’s appointee or Deputy with DWP, or
l the claimant’s parents or legal guardian
Please sign the form here after printing
click to sign
signature
click to edit
Part 6: Further information
6
CRMR1 01/18
Please use this space to tell us anything else you think we might need to know. If there is not enough
space, please use a separate sheet of paper.
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