Fill - Free fillable Sure Start Maternity Grant from the Social Fund (Cabinet Office) PDF form

Sure Start

Maternity Grant

SF100 10/19

Before you fill in this claim form, please take a few minutes to read these notes.

They contain important information and help explain some of the questions we

ask you and why we are asking them.

We have many different ways we can communicate

with you

Please tell us if you would like Braille, British Sign Language, a hearing loop,

translations, large print or something else.

To contact us please use the phone number at the end of this form.

What is a Sure Start Maternity Grant?

A Sure Start Maternity Grant is a one off payment to help towards the cost of

having a child.

If you live in Scotland

On 10 December 2018 Best Start Grant, Pregnancy and Baby Payment replaced

Sure Start Maternity Grant for claimants living in Scotland:

• you will no longer be able to get Sure Start Maternity Grant from that date

• if you claimed before 10 December 2018, we will process your claim as

normal

For more information about Best Start Grant, including information on how to

claim, go to:

www.mygov.scot

Can I get a Sure Start Maternity Grant?

You may be able to get a Sure Start Maternity Grant if

you live in England or

Wales and:

• your new baby is the only child under 16 years of age in your family, or

•

you already have a child or children under 16 years of age in your family and

you are having a multiple birth, for example twins or triplets, or

• you already have a child under 16 years of age living with you who is not your

own, such as a younger brother or sister, that you are looking after because he

or she is not able to be looked after by his or her own parents and they were

over 12 months old when this arrangement started. Stepchildren or partner’s

children under 16 years of age are counted as children living with you so if you

have stepchildren or partner’s children under 16 years of age living with you,

you may not be able to get a Sure Start Maternity Grant, and you or your

partner are getting one of the following benefits:

• Universal Credit

• Child Tax Credit

• Working Tax Credit which includes a disability or severe disability element

• Income Support

• Income-based Jobseeker’s Allowance

• Income-based Employment and Support Allowance

• Pension Credit

You may also qualify for a Sure Start Maternity Grant if you are getting a Support

for Mortgage Interest loan. If you get Maternity Allowance you could also apply for

a Sure Start Maternity Grant if you get one of the benefits listed above.

You will not qualify for a Sure Start Maternity Grant if:

• there are any children under 16 years of age living with you, regardless of

where

they were born, except in circumstances as listed above

• the Best Start Maternity Grant, Pregnancy and Baby Payment has already

been

paid to you or someone else for this baby or babies

from the Social Fund

Important information

If you are getting one of the benefits listed above, and you need help with buying things for a baby that:

Please note - if the claim is being submitted by the father or partner of an expectant mother before the birth of the

baby, a Sure Start Maternity Grant can only be paid if the couple are living together. Claims from a single person other

than the expectant mother cannot be paid before the birth of a baby.

If you receive Universal Credit, we will make a decision on your Sure Start Maternity Grant claim after your next

Universal Credit payment.

We use partner to mean:

• a person you live with who is your husband, wife or civil partner, or

• a person you live with as if you are a married couple

Kinship Carers

You will be a kinship carer if you are a relative or family friend looking after a child who cannot be looked after by

their birth parents and you are expecting your first child. You will not be a kinship carer if the child living with you is

your partner’s biological child.

If you live in Scotland

On 10 December 2018 Best Start Grant replaced Sure Start Maternity Grant for claimants living in Scotland.

Claimants living in Scotland can no longer get Sure Start Maternity Grants from that date.

For more information about Best Start Grants, including information on how to claim, go to: www.mygov.scot/

When can I claim a Sure Start Maternity Grant?

• If you, your partner, or dependent child, are expecting a baby or have just had a baby

claim in the period 11 weeks before the week your baby is due until 6 months after your baby is born.

• If you are not the mother but have become the responsible parent of a baby

claim within 6 months of becoming responsible. The baby must not be more than 1 year old when you claim.

• If you have been granted an adoption order or residence order for a baby

claim within 6 months of the date on the order. The baby must not be more than 1 year old when you claim.

• If you have been granted a parental order with your partner for a baby

claim within 6 months of the date on the order. The baby must not be more than 1 year old when you claim.

• If you have been appointed guardian of a baby

claim within 6 months of the date the guardianship takes effect. The baby must not be more than 1 year old when

you claim.

• If you have had a baby placed with you for adoption

claim within 6 months of the date the baby is placed with you. The baby must not be more than 1 year old when you

claim.

• If you have adopted a baby overseas

claim within 6 months of the adoption taking effect or being recognised. The baby must not be more than 1 year old

when you claim.

If you are waiting for a decision on a claim for a benefit listed on the first page of this form, or you have asked for

your Child Tax Credit award to be reviewed, you must still claim within 6 months.

Filling in the form

Fill in the form fully by answering all the questions and requests for information.

Your application may be delayed if we do not have all the information we need.

Note - Please note that we can only give you a Sure Start Maternity Grant if:

• a health professional such as your doctor or midwife has filled in section 13, and

• we receive your completed form by the dates shown above.

Keep these pages for your information

• has recently been born or is expected to be born in the next 11 weeks and

• you are the mother, father or expectant mother or their partner, or you are getting benefit for the mother or

expectant mother and they are under 20 years of age, or

• was recently born and you have become responsible for that child but you are not the mother (for example you

are the child’s father, grandparent), or

• is the subject of an adoption or residence order, or

• is the subject of a parental order in respect of a surrogate birth, or

• has been placed with you for adoption, or

• you have been appointed the child’s guardian, or

• you have adopted overseas, or

• you have been granted a parental order with your partner under section 30 of the Human Fertilisation and

Embryology Act 1990 or section 54 of the 2008 Act

You can find the number on a National Insurance numbercard, letters

about benefit, or payslips.

Please also provide the same details on the health professional’s

statement on Page 10.

Letters Numbers Letter Letters Numbers Letter

Part 1: About you and your partner

Please complete this form on line and sign with BLACK INK after printing.

Are you or your partner involved in a

trade dispute?

We use trade dispute to mean a

strike, a walkout, a lockout or another

dispute at work.

Yes

temporary

permanent

temporary

permanent

How long have you or your

partner not been working

because of a trade dispute?

If this is less than 6 weeks,

we may not be able to make

a payment.

Yes

How long have you or your

partner not been working

because of a trade dispute?

If this is less than 6 weeks,

we may not be able to make

a payment.

You Your partner

Surname or family name including title

All other names, in full

Date of birth

Current address including postcode

Date you or your partner moved into

this address

Tell us if this address is

Previous address

Please tell us your previous address,

and tell us your partner’s previous

address, if it is different.

National Insurance number

Daytime phone number, if you have one.

Mobile phone number if you have one.

Your email address, if you have one.

SF100 10/19

We may need to contact you by phone to get more information or to let

you know when we have made a decision on your claim. Please note that

our number may show as 0800, unknown or withheld.

We will send you a text message when we have made a decision on your

application.

Part 2: About benefits, entitlements and payments

Are you or your partner getting any

of the following:

• Universal Credit

• Child Tax Credit

• Working Tax Credit which includes a

disability or severe disability element

• Income Support

• Income-based Jobseeker’s

Allowance

• Income-related Employment and

Support Allowance

• Pension Credit

• Support for Mortgage Interest

loan

• Maternity Allowance (we can only

pay Sure Start Maternity Grant if you

are also getting one of the benefits

listed above)

Yes

Are you or your partner waiting

to hear about a claim for any of

the following:

• Universal Credit

• Child Tax Credit

• Working Tax Credit which includes a

disability or severe disability element

• Income Support

• Income-based Jobseeker’s

Allowance

• Income-related Employment and

Support Allowance

• Pension Credit

• Support for Mortgage Interest

loan

• Maternity Allowance (we can only

pay Sure Start Maternity Grant if you

are also getting one of the benefits

listed above)

Yes

Please tell us which benefits you are getting.

Please tell us which benefits you are waiting to hear about.

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Part 3: Expecting a baby

Please tell us the date the

baby is expected

So that we can consider your claim for a Sure Start Maternity Grant,

the health professional’s statement which is on Page 10 of this

claim form must be filled in by a health professional. For example,

your midwife.

Is more than one baby expected?

Yes

How many babies are expected?

Part 5: About a baby already born that you have become responsible for

Are you receiving benefit for the

parent of the baby because they are

under 20 years of age?

Yes

Please tell us their name.

Yes

When did the baby

start to live with you?

Are you the parent, but not the

mother, of a baby you now care for?

When did you get

Child Beneﬁt?

Who got Child Benefit

before?

Have you or your partner been

granted an adoption order or a

residence order?

Yes

What is the date of

the order?

For how many children?

Please send the order with this form.

Have you and your partner been

granted a parental order under

section 30 of the Human Fertilisation

and Embryology Act or section 54

of the Human Fertilisation and

Embryology Act 2008?

Yes

What is the date of

the order?

For how many children?

Please send the order with this form.

SF100 10/19

Part 4: If the baby has already been born

Please tell us the date the

baby was born.

Was more than one baby born?

Yes

How many babies were born?

So that we can consider your claim for a Sure Start Maternity Grant,

the health professional’s statement which is on Page 10 of this

claim form must be filled in by a health professional. For example,

your midwife.

In case of a still birth you do not have to send the health professional’s

statement but, so that we can consider your claim, you must provide us

with evidence of the birth, for example the death certiﬁcate.

Have you or your partner been

appointed a legal guardian?

Yes

When did this take effect?

For how many children?

Please send the evidence of appointment with this claim form.

Part 6: About other children under 16 years of age in your household

Apart from the baby you have told us

about in Part 3, Part 4 or Part 5, are

there any other children under 16

years of age living with you?

Please note there is an exception to

the child under 16 rule in the case of

multiple births and for some kinship

carers.

Yes

Go to Part 7.

Tell us about the children below. If you need to tell us about more

than 4 children, please use the space in Part 8.

You cannot usually get a grant unless your new baby is the only

child under 16 in your family, your dependant’s new baby is the

only baby under 16 in your family, or you care for a child in your

household who is not your own. Please clearly indicate your

relationship, including if you are a kinship carer, for any other child

under 16 living with you.

Stepchildren or partner’s children under 16 are counted as children

living with you so if you have stepchildren or partner’s children under

16 years of age living with you, you, then you will not usually be able

to get a Sure Start Maternity Grant.

SF100 10/19

Name of child Date of birth

Relationship to you

or your partner

Beneﬁts or tax credits you or

your partner get for the child

If you are a kinship carer for any of the children listed above, please tell us about the children below:

Name of child

Names of

biological parents

Address of biological

parents

Age of child

when kinship

arrangement

started

Reason why biological

parents are unable to

care for this child, for

example deceased,

living abroad

Have you or your partner had a child

placed with you for adoption?

Yes

What date was the

placement?

How many children were

placed?

Please send the evidence of placement with this claim form.

Have you or your partner adopted a

baby from overseas?

Yes

When did this take effect?

How many children were

adopted?

Please send evidence that the adoption is recognised in Great

Britain with this claim form.

Part 5: About a baby already born continued

Part 9: How we pay you

We will pay your money directly into the account where we normally pay your benefit

Many banks and building societies will let you collect your money at the Post Office. We will tell you when your Social

Fund payment will be made and how much it will be for.

Finding out how much we have paid into the account

You can check your payments on account statements. The statements may show your National Insurance number next

to any payments we have made. If you think your payment is wrong, get in touch with the office that pays you straight

away.

Part 8: Other information

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. Make

sure that you put your full name and

National Insurance number on each

separate sheet of paper you use.

What to do now

Go to:

• Part 10 if you have ﬁlled in this form for yourself, or

• Part 11 if you are filling in and signing this form for someone else

SF100 10/19

Part 7: General information

Has a Sure Start Maternity Grant

from the Social Fund already been

paid to either you or someone else

for this baby or babies?

Are you or your partner already

getting Child Benefit?

Yes

Who was it paid to?

We can only pay another Sure Start Maternity Grant if:

• you are not the mother but have become the parent who cares for the

baby

• you have been granted an adoption or residence order, or

• you and your partner have been granted a parental order under section

30 of the Human Fertilisation and Embryology Act 1990 or section 54 of

the Human Fertilisation and Embryology Act 2008

• you have been appointed the guardian

• you have had a baby placed with you for adoption by an agency

• you have adopted overseas within section 66(1)(c)–(e) of the

Adoption and Children Act 2002

If you want to claim Child Beneﬁt, claim forms are available

direct from HM Revenue & Customs. Phone the Child Beneﬁt

helpline on 0300 200 3100 or visit www.gov.uk

Yes

Has a Best Start Grant from the

Scottish Government already been

paid to either you or someone else

for this baby or babies?

Yes

Who was it paid to?

Part 10: Making payment if you are getting or waiting to hear about a

claim for Working Tax Credit or Child Tax Credit

About the account you want to use for this payment

• You can use an account in your name, or a joint account.

• You can use someone else’s account if:

– the terms and conditions of their account allow this, and

– they agree to let you use their account, and

– you are sure they will use your money in the way you tell them.

• You can use a credit union account. You must tell us the credit union’s account details. Your credit union will be able

to help you with this.

• If you are an appointee or a legal representative acting on behalf of the claimant, the account should be in your

name only.

Please tell us your account details below.

It is very important you fill in all the boxes correctly, including the bank, building society roll or reference number,

if you have one. If you tell us the wrong account details your payment may be delayed or you may lose money.

You can find the account details on your chequebook or bank statements. If you do not know the account details, ask

the bank or building society.

Name of the account holder

Please write the name of the account

holder exactly as it is shown on the

chequebook (if you have one) or

statement.

Full name of bank or building society

Sort code

Please tell us all 6 numbers, for

example: 123456.

Account number

Most account numbers are 8 numbers

long. If your account number has

fewer than 10 numbers, please fill in

the numbers from the left.

Building society roll or reference

number

If you are using a building society

account you may need to tell us a

roll or reference number. This may

be made up of letters and numbers,

and may be up to 18 characters long.

If you are not sure if the account has

a roll or reference number, ask the

building society.

What to do now

Go to:

l Part 11 if you are filling in and signing this form for someone else, or

l Part 12 if you have ﬁlled in this form for yourself

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Part 11: For people filling in and signing this form for someone else

I am sending a letter signed by the claimant with this form. The letter

tells you that they agree to me making the claim for them.

I am their appointee.

I have power of attorney.

Please tell us why you are filling

in and signing this form for

someone else.

Your full name

Your date

of birth

Your address

including postcode

Your phone number

What is this number? Please tick

Home Work

Mobile

Now read the declaration and sign in Part 12 below

Part 12: Declaration

By submitting this claim you agree

that the information you have given is

complete and correct; you will report

changes to your circumstances

straight away by calling 0800 169

0140. If you give wrong or

incomplete information, or you do not

report changes straightaway, you

may:

• be prosecuted

• need to pay a financial penalty

• have your claim reduced or stopped

• be paid too much and have to pay

the money back

If we pay you less than we should, we

may pay you the money that

we owe

you.

This is my claim for a Sure Start

Maternity Grant.

Signature

Date

Your application may be delayed if we do not have all the information we need, this includes

the completed health professional statement.

SF100 10/19

Part 13: Health professional’s statement

To be completed by the health professional only

Please complete the appropriate boxes below, the surgery or ofﬁce address, contact telephone number and NMC PIN.

l consulted me in respect of ................................. (insert words. For example: one) expected child or children:

(health professionals only).expected in the week that includes

born on .

l has received advice, as appropriate, on aspects of:

maternal health and the health and welfare of the child (pre-conﬁnement consultation).

the health and welfare of the new child (post-conﬁnement consultation).

Date of consultation Date of signing

Health professional’s signature Health professional’s name (please print or use a stamp)

Authentication stamp or,

for midwives or health visitors

who do not have an

authentication stamp, details

of surgery or ofﬁce address and

phone number, contact

phone number if different,

and NMC PIN.

Surgery or ofﬁce address

Contact phone number

NMC PIN

National Insurance number

Letters Numbers Letter

I certify that ............................................................................... (insert name of parent)

SF100 10/19

Part 14: What to do now

Please read through this form again and check that you have answered all the questions:

• if you have made any alterations, please make sure you initial and date them

• check you have signed and dated the form

• check that the health professional’s statement has been fully completed by your midwife, or another health

professional

• check that you are sending all the documents we have asked for. Please send the originals as we cannot

accept photocopies. But do not delay sending in this form

You must send this claim form to us from 11 weeks before the week your baby is due. But remember, you

must claim before the baby is 6 months old.

How the Department for Work and Pensions collects and uses

information

How DWP collects and uses information

When we collect information about you we may use it for any of our purposes. These include:

• social security benefits and allowances

• child maintenance

• employment and training

• investigating and prosecuting tax credits offences

• private pensions policy and

•

retirement planning

We may get information about you from other parties for any of our purposes as the law allows to check the

information you provide and improve our services. We may give information about you to other organisations as

the law allows, for example to protect against crime.

To find out more about our purposes, how we use personal information for those purposes and your information

rights, including how to request a copy of your information, please search for DWP Personal Information Charter on

www.gov.uk

Where to send this form

• Send it by post to:

Freepost DWP SSMG

• Take it to your nearest Jobcentre Plus office. You

can find the address on gov.uk Look under

Jobcentre Plus.

Help and advice

If you want more information:

• get in touch with Jobcentre Plus. Phone 0800 169 0140

• you can also get more information from www.gov.uk

Your application may be delayed if we do not have all the information we need. This includes the

health professional’s statement.

SF100 10/19

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