How regularly does the carer stay overnight to provide care? (tick as applicable)
State the number of nights weekly monthly other
Do you, or the person being cared for, receive any of the following:
• Attendance Allowance (AA) Yes No
• daily living component of Personal
Independence Payments (PIP) Yes No
• Armed Forces Independence Payment (AFIP) Yes No
• care component of Disability Living Allowance (DLA)
at the middle or high rate Yes No
Have you (or the person receiving non-residential
overnight care) claimed for PIP, AFIP, AA or DLA? Yes No
If you’ve answered yes to the previous question and the claim was rejected,
please explain why in the space below.
If PIP, AFIP, AA or DLA has not been claimed please explain why you have not made
a claim in the space below.
If you (or the person receiving overnight care) do not receive PIP, AFIP, AA or DLA
please provide evidence from a GP/social services/mental health worker etc. to
support the need for an overnight carer. Please enclose this with your application.