Blank Pip Form PDF Details

Navigating the complexities of benefits for individuals with disabilities can be a daunting task. However, the Personal Independence Payment (PIP) form serves as a critical tool in this process, offering financial assistance to those whose health condition or disability affects their daily lives. Required to be filled out and returned promptly, this form asks for detailed information, including the full name and National Insurance (NI) number of the applicant, to accurately assess the impact of one's health condition or disability. To assist applicants, an Information Booklet is provided, offering guidance on how to complete the form, advice on where to find help, explanations of the questions asked, instructions on how to answer, and examples of additional information that can be shared to strengthen the application. The booklet emphasizes the importance of returning the form to avoid the termination of the claim and outlines the steps for its completion: reading the form and booklet, filling out the form in pen, signing the declaration, and submitting it along with photocopies of any supporting documents. Furthermore, it specifies the type of additional information that can significantly support a claim, such as documents that illustrate how one's condition affects day-to-day activities, and advises against including general information about the condition. The PIP form also inquires about health professionals who can provide insights into how the applicant's condition affects them, ensuring a comprehensive evaluation of the applicant's needs.

QuestionAnswer
Form NameBlank Pip Form
Form Length37 pages
Fillable?No
Fillable fields0
Avg. time to fill out9 min 15 sec
Other namespip form, dwp pip application form download, pip application form pdf, pip application form download pdf 2020

Form Preview Example

Personal Independence Payment

How your disability affects you

Full name

National Insurance (NI) number

only

Please fill in this form and return it to us straightaway.

We’ve sent you an Information Booklet to help you complete the

form. In the Information Booklet we:

If you need to ask for more time to compl te this form please call suse on 0800 121 4433 (0800 121 4493 if using a t xtphon ).

• give advice on where you can get help to complete the f rm

• explain the questions we ask

• tell you how to answer the questions, and

• give you examples of other things you can tell us

If you don't return this form to us and we don't hear from you to ask for more time to complete t, we ay end your claim to PIP.

If you don't want to ont nue w th your claim and w n’t be etu ning this form, please call us on 0800 121 4433 (0800 121 4493 if using a textphone).

What you n d to do

Step 1

– Read through this form and the Inf

rma ion Booklet.

Step 2

– Fill in this form (in pen) to tell us h

for

w y ur health condition

 

or disability affects you.

 

tep 3

– Read and sign the declarati n n page 32.

tep 4

– Return the form to us with photocopies of any additional

Specimeninformation. Not

PIP2 June 2018

1 of 33

Additional information to support your claim

As well as completing this form it is important that you help us to understand your needs by providing additional information. This should explain how your health condition or disability affects your daily life.

Do send information that shows how your health condition or disability affects you carrying out day-to-day activities.

Don’t send general information about your condition like fact sheets or information from the internet.

Only send us photocopies of information you already have available to you. We can’t return any documents to you.

There is more information, including examples of what to send us in the Information Booklet we sent you with this form.

only

Please put your name and National Insurance number

n the t p f

use

each document.

 

 

 

 

 

Specimen

 

Section 1 – About your health prof ssio

als

 

If we need additional information we may contact the h

alth professionals that upport you.

Q1 Tell us about the professional(s) best placed to advise s on how your health condition or d sab l ty affects you

For example, a GP, hospital doctor, spec alist nurse, community psychiatric nurse, occupational

therapist, physiotherapist, so

al worker, counsell

r, r supp t w

ker.

Name

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

for

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postcode

Profession

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone number including the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dialling code

 

 

 

 

 

 

When did you last see them?

 

 

 

 

 

 

/

/

 

 

(approximate date)

Not

 

 

 

 

 

 

 

 

PIP2 June 2018

2 of 33

Section 1 – About your health professionals continued

Name

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postcode

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Profession

 

 

 

 

only

 

 

 

 

 

 

 

Phone number including the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dialling code

 

 

 

 

 

 

 

When did you last see them?

 

 

 

 

 

 

 

/

/

 

 

 

(approximate date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Specimen

 

 

 

Name

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Po tcode

Profession

 

 

 

 

 

 

 

Phone number including the

 

 

for

use

dialling code

 

 

 

 

 

 

 

When did you last s th m?

 

/

/

 

 

 

(approximate dat )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Not

 

 

 

 

If you need to add more please c

ntinue at Q15 Additional information.

PIP2 June 2018

3 of 33

Section 2 - About your health condition or disability

iUse page 7 of the Information Booklet to help you answer these questions.

Q2a - Tell us in the space below:

•what your health conditions or disabilities are, and

•approximately when each of these started

 

 

 

 

Health condition or disability

 

only

 

 

Approximate start date

 

Example: Diabetes

 

May 2010

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Specimen

 

 

 

for

 

We will ask you how your health ond t ons or disabilities affect h w useyou

carry out day-to-day a tivities in the rest of the

rm.

If you need to add more pl ase ontinue at Q15 Additional inf rmation.

Not

 

 

 

PIP2 June 2018

4 of 33

Section 2 - About your health condition or disability continued

Q2b - Tell us about:

•tablets or other medication you’re taking or will be taking and the dosage

•any treatments you’re having or will be having, such as chemotherapy, physiotherapy or dialysis

•any side effects these have on you

 

only

Specimen

use

Not

for

 

If you need to add more please continue at Q15 Additional information.

PIP2 June 2018

5 of 33

Watch Blank Pip Form Video Instruction

Blank Pip Form isn’t the one you’re looking for?

Related Documents

  • Blood Glucose Monitoring

    "... Eastern Carolina Family Practice Center Annette Peer rn. msn.cde.98 flow sheet home glucose monitoring. Name physician-recommended frequency of monitoring. Fasting hours for the monitoring of blood sugar after fasting. ..."

  • Blank Mri Medical Form

    "... Approved by the United States Department of Agriculture Animal and Plant Health Inspection Service Veterinary Services National Veterinary Accreditation Program app lica Ti on form block 15, 16 or last suffix maiden Name accreditation category ..."

  • Block Style Letter

    "... Refer to the reference guide Business letter Block Style Friends and Neighbors 516 Iowa Street Dermott Ar 71638 2039 8070 555 0183 December 200 Mr. Alex Perk La Homemade Construction 571 Pecan Street Dermott Ar ..."

  • Blood Glucose Log

    "... make one copy of this page if you have high blood glucose make notes in your log and talk toolkit no 29 with your healthcare team about whether you need to change your meal plan physical activity or diabetes medicines blood glucose log having low blood glucose means that your blood glucose level name is too low below 70 gdl low blood glucose can be dangerous symptoms include being date from to hungry lightheaded or confused my doctor nervous and shaky sleepy name sweaty phone if you think your blood glucose is too low check it if its below ol 70 gdl have of these items right away to raise your blood my diabetes educator glucose level en amer or glucose tablets phone serving of glucose gel the amount equal to 15 grams of carbohydrate ada targets for my usual my cup ounces of fruit juice blood glucose results targets cup ounces of regular not diet soft drink before meals ounces of milk 70 to 130 gdl to to or pieces of hard candy hours after start of tablespoon of sugar or honey meal below 180 gdl below below after 15 minutes check your blood glucose again if its still to make more monthly logs make one copy of this page and below 70 gdl have another serving repeat these steps until two copies of the next page cut the pages in half placing this page on top staple in the upper lefthand corner and fold to fit in your ..."

Please rate Blank Pip Form

2 Votes

Related Resources

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .