SSP Form – Fill Out and Use This PDF

The Statutory Sick Pay (SSP) is compensation provided by employers to employees who meet certain conditions for payment during periods of illness when they are unable to work. This form serves as an employee's declaration of sickness, requiring completion if the employee has been ill for four days or more consecutively. To ensure you receive the SSP you might be entitled to, or to take the necessary next steps if you're not eligible, click the button below to fill out the form.

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SSP Form PDF Details

Navigating the complexities of health-related absences from work, the Statutory Sick Pay (SSP) form serves as a crucial bridge between employees and their right to sickness benefits. Designed to streamline the process of claiming these benefits, the SSP form is to be completed by employees who have been sick for four consecutive days or more. This form not only facilitates the documentation of an employee's sickness absence but also outlines specific details regarding the duration and nature of the illness. It further delves into whether the sickness was a result of an accident at work, potentially opening avenues for claiming Industrial Injuries Disablement Benefit. As part of a broader framework to support employees during times of ill health, the completion and submission of this form to one’s employer are the initial steps toward securing SSP. In instances where SSP is not applicable, the employer must provide form SSP1, which is pivotal for the employee's claim for Employment and Support Allowance. Furthermore, the form highlights the importance of adhering to the submission timelines and provides guidance on seeking further assistance through HM Revenue & Customs or exploring additional financial support options. The nuances captured in the SSP employee's statement of sickness reflect the broader systemic measures in place to ensure employees are not left vulnerable due to sickness-related work absences.

Question	Answer
Form Name	SSP Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	self certification form 2020 pdf, self certification form 2020 pdf download, self certification form pdf, self certification form

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Statutory Sick Pay (SSP)

Employee’s statement of sickness

About this form

Statutory Sick Pay (SSP) is money paid by employers to their employees who satisfy the conditions for payments when they are ill and unable to work.

Please fill in ‘Your statement’ below when you have been sick for four days or more in a row.

Your statement

About you

Surname or family name

First name(s)

Title – enter MR, MRS, MISS, MS, or other title

National Insurance number

Date of birth DD MM YYYY

Clock or payroll number

About your sickness. Please give brief details

What date did your sickness begin? DD MM YYYY

What date did your sickness end?

If you do not know, please leave this blank.

DD MM YYYY

The dates you put in these two boxes may be days you do not normally work. If you are sick for more than seven days, your employer may ask you for a medical statement of fitness for work ‘fit note’ from your doctor.

What date did you last work before your sickness began?

DD MM YYYY

What time did you finish work on that date? (enter time in 24 hours)

Was your sickness caused by an accident at work or an industrial disease?

Yes

If you answered ‘Yes’, you may be able to get Industrial Injuries Disablement Benefit. If you want information about claiming this benefit, ask at any Jobcentre Plus office or go to www.dwp.gov.uk

Signature

Date DD MM YYYY

Phone number

What to do next

Please:

•give your completed form to your employer. It will help them to decide if you can get SSP

•keep a copy for your own information.

If you can get SSP, your employer will pay you in the same way they usually pay your wages.

If you cannot get SSP, your employer must give you form SSP1 to tell you why. You can use form SSP1 to support a claim for Employment and Support Allowance.

If you disagree with your employer’s decision and you have also looked at the further information on the HMRC website, you can ask HM Revenue & Customs for a decision about your entitlement. You must do this

within six months of the first day that you are notified of your employer’s decision. Phone our DisputesPlease turn over Team on 0191 225 5221.

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HMRC 10/12

Other help while you are sick

•You can get more information about other help while you are sick in leaflet DWP1026 Help if you’re ill or disabled.

You can get leaflet DWP1026 from:

–any Jobcentre Plus office

–most advice centres like the Citizens Advice Bureau, or

–any post office (except in Northern Ireland), or

–go to www.dwp.gov.uk

•If you do not have much money coming in while you are sick, you may be able to get a Social Security benefit. You should contact any Jobcentre Plus office or, go to www.dwp.gov.uk

You can also phone the Benefit Enquiry Line for people with disabilities. The phone call is free. The number is 0800 882 200 or in Northern Ireland 0800 220 674.

If you have any problems with hearing or speaking and use a textphone, phone 0800 243 355. The phone call is free.

If you do not have your own textphone system, they are available to use at the Citizens Advice Bureau and main libraries.

•If you want to know more about SSP go to www.gov.uk

Penalties

We may charge penalties where a person, either fraudulently or negligently, gives incorrect information or makes a false statement or declaration for the purpose of claiming entitlement to Statutory Sick Pay.

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