Sf100 Form Online – Fill Out and Use This PDF

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

lapart from other babies from the same pregnancy

–your new baby is the only child under 16 in your family, or

–your dependant’s new baby is her only child under 16 in your family.

lyou or your partner are getting

–Income Support, or

–income-based Jobseeker’s Allowance, or

–income-related Employment and Support Allowance, or

–Universal Credit, or

–Pension Credit, or

–Working Tax Credit which includes a disability or severe disability element, or

–Child Tax Credit at a rate higher than the family element.

From April 2013 to April 2014 this means a rate of £548 a year or more. These figures are for a whole year and will be less for part-years. Your tax credits award notice will include a breakdown of your award. If your Child Tax Credit total is greater than the amounts shown as the family elements you may qualify for a Sure Start Maternity Grant.

SF100 04/13

and

lyou need help with buying things for a baby that

–has recently been born, or

–is expected to be born in the next 11 weeks, or

–was recently born and you have become the responsible parent but are not the mother’s partner, 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 guardian of, or

–you have adopted overseas.

We use partner to mean

la person you are married to or a person you live with as if you are married to them, or

la civil partner or a person you live with as if you are civil partners.

But you must

lbe the mother or expectant mother of the baby and you must be aged 16 or over, or

lbe the partner of the mother or expectant mother, or

lbe getting benefit for the mother or expectant mother aged under 20 of a baby, or

lbe the responsible parent (but not the mother) of a baby, and not be the mother’s partner, or

lhave been granted an adoption or residence order for a baby, or

lhave been granted a parental order with your partner under section 30 of the Human Fertilisation and Embryology Act 1990 or section 54 of the Human Fertilisation and Embryology Act 2008, or

lhave had a baby placed with you for adoption by an agency, or

lhave been appointed the guardian of a baby, or

lhave adopted a baby overseas and this falls within section 66(1)(c)–(e) of the Adoption and Children Act 2002.

When to claim

l If you are waiting for a decision on a qualifying

benefit or entitlement, or you have asked for your

Child Tax Credit award to be reviewed, you must still

claim within the time limits.

l If you are expecting a baby or have recently had a

baby, you must claim in the period from 11 weeks

before the week the baby is due until 3 months after

the baby is born.

l If you are not the mother but have become the

responsible parent of a baby, you must claim within

3 months of becoming responsible. The baby must

not be more than one year old when you claim.

l If you have been granted an adoption order or

residence order for a baby

You must claim within 3 months of the date on the

order. The baby must not be more than one year old

when you claim.

l If you have been granted a parental order with your

partner for a baby

You must claim within 3 months of the date on the

order. The baby must not be more than one year old

when you claim.

l If you have been appointed guardian of a baby

You must claim within 3 months of the date the

guardianship takes effect. The baby must not be more

than one year old when you claim.

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

You must claim within 3 months of the date the baby

is placed with you. The baby must not be more than

one year old when you claim.

l If you have adopted a baby overseas

You must claim within 3 months of the adoption

taking effect or being recognised. The baby must not

be more than one year old when you claim.

Help and advice

If you want more information

lget in touch with Jobcentre Plus. You can find the phone number and address in the business section of the phone book. Look under Jobcentre Plus.

You can also get more information from our website. The address is www.gov.uk

or

lget in touch with an advice centre like the Citizens Advice Bureau.

Our service standards

At Jobcentre Plus we aim to provide a high standard of customer service at all times. Details of the standard of service you can expect

from us can be found on our website at www.dwp.gov.uk/about-dwp/customer-delivery

You can access our website from many libraries.

For more information please contact Jobcentre Plus.

How we collect and use information

The information we collect about you and how we use it depends mainly on the reason for your business with us. But we may use it for any of the Department’s purposes, which include

lsocial security benefits and allowances

lchild support

lemployment and training

lprivate pensions policy, and

lretirement planning.

We may get information from others to check the information you give to us and to improve our services. We may give information to other organisations as the law allows, for example to safeguard against crime.

To find out more about how we use information, visit our website www.dwp.gov.uk/privacy-policy or contact any of our offices.

These notes give general guidance only and should not be treated as a complete and authoritative statement of the law.

lPlease use this form to claim a Sure Start Maternity Grant from the Social Fund. Fill in this form in ink and sign and date any alterations you make.

Make sure that you read the notes before you fill in this form.

lTell us about yourself and your partner, if you have one. We use partner to mean

–a person you are married to or a person you live with as if you are married to them, or

–a civil partner or a person you live with as if you are civil partners.

lFill in the form fully by answering all the questions and requests for information. Your claim may be delayed if we do not have all the information we need.

lRemember, if you are waiting for a decision on a qualifying benefit or entitlement, or have asked for your Child Tax Credit award to be reviewed, you must still claim within the time limits. These are:

–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 3 months after your baby is born

–if you are not the mother but have become the responsible parent of a baby, claim within 3 months of becoming responsible

–if you have an adoption order, a residence order or a parental order for the baby, claim within 3 months of its date

–if you have been appointed guardian of a baby, claim within 3 months of the guardianship taking effect

–if a baby has been placed with you for adoption, claim within 3 months of this

–if you have adopted a baby overseas, claim within 3 months of the adoption taking effect or being recognised.

Surname or family name

All other names in full

Date of birth

Your address

Please tell us your address. Tell us your partner’s address, if different.

You

Mr / Mrs / Miss / Ms

/ /

Your partner

Mr / Mrs / Miss / Ms

/ /

Sure Start Maternity Grant from the Social Fund

National Insurance (NI) number

If you do not know your NI number, have you ever had one or used one at any time?

SF100 04/13

Postcode

Postcode

Letters Numbers

Letter

Letters Numbers

Letter

You can find the number on a National Insurance (NI) numbercard, letters about benefit, or payslips

No		No
Yes		Yes

1

Any other surnames or family names you have been known by or are using now.

Include maiden name, all former married or civil partnership names and all changes of family name.

Daytime phone number

What is this number? Please tick

You

Code

Number

Home

work

mobile

fax

Your partner

Code

Number

Home

work

mobile

fax

Are you or your partner getting

Universal Credit?

Are you or your partner waiting to hear about a claim for Universal Credit?

Are you or your partner getting

Income Support?

Are you or your partner waiting to hear about a claim for Income Support?

Are you or your partner getting income-based Jobseeker’s Allowance?

Are you or your partner waiting to hear about a claim for income-based Jobseeker’s Allowance?

Are you or your partner getting income-related Employment and Support Allowance?

Are you or your partner waiting to hear about an application for income-related Employment and Support Allowance?

You

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

Your partner

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

Part 3 If a baby is expected

Please tell us the date the baby is expected

Is more than one baby expected?

If the baby has not been born yet, now go to Part 6.

/ /

So that we can consider your claim for a Sure Start Maternity Grant, the certificate (SSMG cert) which is on the back page of this claim form must be filled in by a health professional. For example,

your midwife.

No

Yes How many babies are expected?

Please make sure that the document you are sending with this claim form tells us the number of babies that are expected.

For office use

SSMG cert received			No
			Yes
Other approved docs			No
			Yes
Initials	.................................
Date	/	/

Please tell us the date the baby was born

Was more than one baby born?

/ /

So that we can consider your claim for a Sure Start Maternity Grant, the certificate (SSMG cert) which is on the back page 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 certificate (SSMG cert) but, so that we can consider your claim, you must provide us with evidence of the birth.

No

Yes How many babies were born?

For office use

SSMG cert received			No
			Yes
Other approved docs			No
			Yes
Initials	.................................
Date	/	/

Are you the parent, but not the mother, of a baby you now care for?

Have you or your partner been granted an adoption order or a residence order?

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?

No
Yes	When did the baby start to live with you?
			/	/
		When did you get Child Benefit?
			/	/

Who got the Child Benefit before?

No
Yes		What is the date of the order?
				/	/
			For how many children?
			Please send the order with this claim form.
No
Yes		What is the date of the order?
				/	/
			For how many children?

Have you or your partner been appointed a legal guardian?

Have you or your partner had a child placed with you for adoption?

Have you or your partner adopted a baby from overseas?

No
Yes	What date did this take effect?
			/	/
		For how many children?

Please send the evidence of appointment with this claim form.

No
Yes	What date was the placement?
			/	/

How many children were placed?

Please send the evidence of placement with this claim form.

No
Yes	What date did this take effect?
			/	/

How many children were adopted?

Please send evidence that the adoption is recognised in Great Britain with this claim form.

Apart from the baby you have told us about in Part 3, Part 4 or Part 5, are there any other children under the age of 16 in your household?

No Go to Part 7.

Yes Tell us about the children below. If you need to tell us about more than 6 children, please use the space in Part 9.

Name of child	Date of birth	Relationship to you or	Benefits or tax credits you or
		your partner	your partner get for the child

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?

No
Yes	Who was it paid to?

We can only pay another Sure Start Maternity Grant if:

lyou are not the mother but have become the parent who cares for the baby

lyou have been granted an adoption or residence order, or

lyou 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

lyou have been appointed the guardian

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

lyou have adopted overseas within section 66(1)(c)–(e) of the Adoption and Children Act 2002.

No		If you want to claim Child Benefit, claim forms are available direct
Yes		from HM Revenue & Customs. Phone 0845 302 1444 or visit
		www.hmrc.gov.uk

Part 8 Making payments to you continued

About the account you want to use

Please tell us your account details below. It is very important you complete ALL boxes correctly including the 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 are not sure about the details, ask the bank, building society or other account provider.

About the account you want to use

You can use

lan account in your name

la joint account, or

lsomeone else’s account,

–subject to the terms and conditions of the account, and

–as long as you have the other person’s permission and authorise them to use the money in the way you tell them.

lIf you are an Appointee or a legal representative acting on behalf of the claimant, the account should be in your name only.

lTo be paid into a credit union account you must provide the credit union’s account details. Your credit union will be able to help you with this.

Have you filled this form in for someone else?	No
	Yes

Go to Part 11.

Please tell us about yourself.

Please tell us why you are filling in and signing	I am sending a letter signed by
this form for someone else.	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
	Full name
	Date of birth
	Address

Now sign this form in Part 11.

Mr / Mrs / Miss / Ms

/ /

This is my claim for a Sure Start Maternity Grant. Signature

Date

/

/

Part 12 What to do now

lLook through this form and check that you have answered all the questions and given all the information requested. Your application may be delayed if we do not have all the information we need.

lCheck that you have signed this form.

lCheck that the health professionals’ statement has been completed by your midwife, or other health professional.

lCheck 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.

lSend or take this form to Jobcentre Plus. You can find the phone number and address in the business section of the phone book. Look under Jobcentre Plus.

lYou 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 3 months old.

lYou must send us this form within 3 months of the date

–you become the responsible parent of the baby if you are not the mother

–of an adoption, residence or parental order

–the guardianship takes effect

–the baby is placed with you for adoption

–the overseas adoption takes effect or is recognised.

But remember, you must claim before the baby is more than 12 months old.

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 telephone number, contact telephone number if different, and UKCC PIN.