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Last updated:
30/01/2018

What questions are on the ‘How your disability affects you’ form?

  1. Overview
  2. What is PIP?
  3. What if I claim Disability Living Allowance (DLA)?
  4. Who can get Personal Independence Payment (PIP)?
  5. How will I be assessed for Personal Independence Payment (PIP)?
  6. How do I claim?
  7. What questions are on the ‘How your disability affects you’ form?
  8. Should I get supporting evidence?
  9. Will I have to go to a face to face medical assessment?
  10. Can I appeal if I think a decision is wrong?
  11. Do I need to speak to a welfare advisor?
  12. What happens if my health changes when I’m getting Personal Independence Payment (PIP)?
  13. Can someone claim Personal Independence Payment (PIP) for me?
  14. Information on Personal Independence Payment (PIP)
  15. Next steps

You will be sent the ‘How your disability affects you’ form when you make a claim for Personal Independence Payment (PIP). Here we have gone through the questions this form asks.

Q1 - Contact details of healthcare professionals

This could be your GP, community psychiatric nurse (CPN), social worker, occupational therapist, support worker, or any other health care professional or specialist that works with you.

The Department for Work and Pensions (DWP) could ask for more information from your professionals if they need it.

Q2a - Your health conditions

Give your most recent diagnosis and say when the symptoms started. You could give information about any previous conditions if they are relevant. If you do not have a diagnosis, explain why and give the main symptoms of your condition.

Q2b - Medication or treatments

It can help to send an up to date prescription list if you have one. List any private treatments you get as well as NHS treatments.

Questions 3-15 - How your conditions affect you

Each of these questions is about an activity in the daily living and mobility test. You should answer them carefully and thoroughly.

  • Questions 3–12 are for the daily living component.
  • Question 13 and 14 are for the mobility component
  • Question 15 is for additional information. You can write any extra information here which you think will help your claim.

Always use the ‘extra information’ boxes to explain exactly how your illness affects you.

When you answer the questions remember the following:

  • Always use the ‘extra information’ boxes to explain exactly how your illness affects you.
  • Don’t feel you have to fit your answer into the box provided. You can use the space at the end of the form or extra sheets of paper if you need to. 
  • If you use extra paper, add your name and National Insurance number and staple it to the form securely.
  • Try to give clear, short explanations and examples that are relevant to the activity.
  • You do not have to get treatment or support to meet the criteria for PIP.  If you don’t get all the support you need, think about how your life could be improved if someone could encourage, help or prompt you with the activity.
  • Think about how you can do each activity.
    • Safely - Can you do the activity without causing danger to yourself or someone else?
    • Well enough - For example, you may be able to make a meal, but you will not be able to eat it if it is undercooked.
    • More than once - Can you repeat the activity as many times as you need to?
    • In a reasonable time - Does it take you a lot longer to do the activity than it would take most people?
  • To qualify for PIP, you need to show that you need help with the activities on more than half the days in a year. Make it clear on the form how often you have problems with the activities.
  • If your health changes, explain how often this happens and the effect it has on you. It may help to keep a diary.

Definition of some key words and phrases

The DWP use the following words and phrases in the activities test.

Supervision means you need another person watching over you all the time to make sure you are safe.

Prompting means another person has to remind or encourage you to do something or explain something to you.

Assistance means another person is there to physically help you to do something. This does not include someone else speaking for you.

Psychological distress means mental distress such as, anxiety, confused emotions, hallucination, rage or depression.

Below we have set out:

  • A summary of each activity
  • The questions the application form asks
  • Tips and suggestions to think about when filling in the form

 

Q3 Preparing Food

This activity is about your ability to make a simple meal. It looks at whether you need any help to make yourself regular cooked food on a daily basis.

It will look at whether you can:

  • open packaging,
  • peel, chop and serve food, and
  • use a cooker, hob or microwave to cook or heat food.

It does not look at your cooking skills but does look at if you need help to make meals. This includes physical help or needing someone else to prompt you.

A simple meal is a ‘cooked one course meal for one person made from fresh ingredients’. An aid or appliance might include things like a stool or lightweight pots and pans.

The questions on the form

The scores

Q3a) Do you use an aid or appliance to prepare or cook a simple meal?

Q3b) Do you need help from another person to prepare or cook a simple meal?

Q3) extra information

Can prepare and cook a simple meal unaided =0

Needs to use an aid or appliance to be able to either prepare or cook a simple meal =2

Cannot cook a simple meal using a conventional cooker but is able to do so using a microwave =2

Needs prompting to be able to either prepare or cook a simple meal =2

Needs supervision or assistance to either prepare or cook a simple meal =4

Cannot prepare and cook food = 8

Q3 tips & suggestions

  • Does your illness or medication affect your ability to make meals?
  • Do you often lack motivation to make meals?
  • Do you become distracted when cooking?
  • Do you need to sit on a stool when you cook?
  • Does your illness or medication affect your ability to use a cooker or hot pans safely?  For example, by making you tired or confused.
  • Do you need someone to remind or help you to make meals?
  • Do you need someone to cook for you?
  • Do you need help to follow cooking instructions?

 

Q4 Eating and drinking 

This activity is about your ability to eat and drink.

It will look at whether you can:

  • cut food,
  • put it in your mouth,
  • chew and swallow, and
  • recognise when, and how much, you need to eat and drink.

 An aid or appliance in this section might be a straw or cutlery that has been changed for your needs.

The questions on the form

The descriptors & scores

Q4a) Do you use an aid or appliance to eat and drink? 

Q4b) Do you use a feeding tube or similar device to eat or drink?

Q4c) Do you need help from another person to eat and drink? 

Q4) Extra information

Can take nutrition unaided =0

Needs 
(i) to use an aid or appliance to be able to take nutrition; or 
(ii) supervision to be able to take nutrition; or 
(iii) assistance to be able to cut up food =2

Needs a therapeutic source to be able to take nutrition =2

Needs prompting to be able to take nutrition =4

Needs assistance to be able to manage a therapeutic source to take nutrition =6

Cannot convey food and drink to their mouth and needs another person to do so =10

Q4 tips & suggestions

  • Do you often miss meals?
  • Do you refuse or forget to eat or drink?
  • Does your medication cause tremors or spasms which make eating or drinking difficult?
  • Do you need someone to remind, prompt, supervise or help to make sure you eat and drink?

Q5 Managing therapy or monitoring a health condition

This activity is about being able to take medications, notice changes in your health condition and manage treatments or therapy that you have at home.

An aid or appliance in this section might be a pill box or organiser. Help from another person could include someone that monitors your health or makes sure you take medication as prescribed by your doctor.

Since 16 March 2017, this activity has changed.  “Managing therapy” and “managing medication” are now treated as two separate activities.  Previously, managing medication came under the same definition as managing therapy.

The questions on the form

The descriptors & scores

Q5a) Do you use an aid or appliance to monitor your health conditions, take medication or manage home treatments?
Q5b) Do you need help from another person to monitor your health conditions, take medication or manage home treatments? 
Q5) Extra information

Either
(i) does not receive medication or therapy or need to monitor a health condition; or 
(ii) can manage medication or therapy or monitor a health condition unaided
=0

Needs any one or more of the following 
(i) to use an aid or appliance to be able to manage medication;
(ii) supervision, prompting or assistance to be able to manage medication;
(iii) supervision, prompting, or assistance to be able to monitor a health condition
=1

Needs supervision, prompting or assistance to be able to manage therapy that takes no more than 3.5 hours a week
=2

Needs supervision, prompting or assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week
=4

Needs supervision, prompting or assistance to be able to manage therapy that takes more than 7 but no more than 14 hours a week
=6

Needs supervision, prompting or assistance to be able to manage therapy that takes more than 14 hours a week
=8

Q5 tips & suggestions

  • Do you notice when your mental health changes?
  • Can you get help to avoid becoming more unwell?
  • Can you manage your medication or home therapies (such as relaxation techniques or meditation)?
  • Do you need a pill organiser to remind you what medication to take?
  • Does someone need to supervise you to make sure you take the right medication?
  • Do you often forget to take medication?
  • Have you taken a deliberate overdose?
  • Do you self harm?

Q6 Washing and bathing

This includes getting in and out of an un-adapted bath or shower and washing your whole body. It also covers when some of the symptoms of your mental health problems mean you don’t wash and bathe every day. Aids and appliances in this section could be a shower seat or hand rail. Help could be someone to remind or help you to wash and bathe.

The questions on the form

The scores

Q6a) Do you use an aid or appliance to wash and bathe yourself, including using a bath or shower?

Q6b) Do you need help from another person to wash and bathe?

Q6) Extra information

Can wash and bathe unaided =0

Needs to use an aid or appliance to be able to wash or bathe. =2

Needs supervision or prompting to be able to wash or bathe =2

Needs assistance to be able to wash either their hair or body below the waist =2

Needs assistance to be able to get in or out of a bath or shower =3

Needs assistance to be able to wash their body between the shoulders and waist =4

Cannot wash and bathe at all and needs another person to wash their entire body =8

Q6 tips & suggestions

  • Does your illness or medication mean you do not regularly wash and bathe?
  • Do you often lack the motivation to wash or bathe?
  • Do you need to sit down in the shower because your medication causes light-headedness?
  • Do you need someone to remind or help you to wash or bathe?

Q7 Managing toilet needs or incontinence

This activity is about your ability to get on and off and use the toilet and to clean yourself afterwards.

The questions on the form

The scores

Q7a) Do you use an aid or appliance to go to the toilet or manage incontinence?

Q7b) Do you need help from another person to go to the toilet or manage incontinence?

Q7) Extra information

Can manage toilet needs or incontinence unaided =0

Needs to use an aid or appliance to be able to manage toilet needs or incontinence =2

Needs supervision or prompting to be able to manage toilet needs =2

Needs assistance to be able to manage toilet needs =4

Needs assistance to be able to manage incontinence of either bladder or bowel =6

Needs assistance to be able to manage incontinence of both bladder and bowel =8

Q7 tips & suggestions

  • People who just have a mental illness do not usually score any points here. 
  • It may be possible to score points in some cases if your illness or medication causes incontinence.
  • You may score points if you have a physical health condition that affects toilet needs.

Q8 Dressing and undressing

This activity looks at your ability to choose, put on and take off suitable, un-adapted clothing.

The questions on the form

The scores

Q8a) Do you use an aid or appliance to dress or undress?

Q8b) Do you need help from another person to dress or undress?

Q8) Extra information

Can dress and undress unaided =0

Needs to use an aid or appliance to be able to dress or undress =2

Needs either 
(i) prompting to be able to dress, undress or determine appropriate circumstances for remaining clothed; or 
(ii) prompting or assistance to be able to select appropriate clothing =2

Needs assistance to be able to dress or undress their lower body =2

Needs assistance to be able to dress or undress their upper body =4

Cannot dress or undress at all =8

Q8 tips & suggestions

  • Does your illness affect your ability or motivation to dress yourself?
  • Do you need someone to prompt you to get dressed or undressed?
  • Do you find it difficult to decide what clothing is appropriate for the time of day or weather conditions?
  • Can you keep your clothes clean so that you are can dress appropriately?

Q9 Communicating verbally

This includes understanding what someone says and being understood by others.

‘Basic’ verbal information means giving information in a single sentence.

‘Complex’ verbal information means giving information in more than one sentence, or in a complicated single sentence.

Communication support means help from a person that is trained or experienced in helping people with communication needs, for example a sign language interpreter.

An aid or appliance could be a hearing aid or electrolarynx.

The questions on the form

The scores

Q9a) Do you use an aid or appliance to communicate with others?

Q9b) Do you need help from another person to communicate with others?

Q9) Extra information

Can express and understand verbal information unaided =0

Needs to use an aid or appliance to be able to speak or hear =2

Needs communication support to be able to express or understand complex verbal information =4

Needs communication support to be able to express or understand basic verbal information =8

Cannot express or understand verbal information at all even with communication support =12

Q9 tips & suggestions

  • Does your illness or medication make it difficult for people to understand you?
  • Can you understand other people?
  • Is it hard for you to concentrate when you are speaking to people?
  • Do you get easily confused when someone is explaining things to you?

Q10 Reading and understanding signs, symbols and words

This activity looks at your ability to read and understand written or printed information.

‘Basic’ information means signs, symbols or dates.

‘Complex’ information is more than one sentence of written or printed standard size text.

The questions on the form

The scores

Q10a) Do you use an aid or appliance other than spectacles or contact lenses to read signs, symbols and words?

Q10b) Do you need help from another person to read or understand signs, symbols and words?

Q10) Extra information

Can read and understand basic and complex written information either unaided or using spectacles or contact lenses =0

Needs to use an aid or appliance, other than spectacles or contact lenses, to be able to read or understand either basic or complex written information =2

Needs prompting to be able to read or understand complex written information =2

Needs prompting to be able to read or understand basic written information =4

Cannot read or understand signs, symbols or words at all =8

Q10 tips & suggestions

  • Does your illness affect your ability to read?
  • Can you read and understand your gas bill or bank statement?
  • Can you follow simple written instructions? For example the guidance on your medication which explains how much and when you should take it.

Q11 Engaging with other people face to face

This includes understanding body language and building relationships with other people.

When looking at this activity the DWP should think about your ability to be around people generally not just people you know.

The questions on the form

The scores

Q11a) Do you need another person to help you to mix with other people?

Q11b) Do you find it difficult to mix with other people because of severe anxiety or distress?

Q11) Extra information

Can engage with other people unaided =0

Needs prompting to be able to engage with other people =2

Needs social support to be able to engage with other people =4

Cannot engage with other people due to such engagement causing either – 
(i) overwhelming
psychological distress to the claimant; or 
(ii) the claimant to exhibit behaviour which would result in a substantial risk of harm to the claimant or another person =8

Q11 tips & suggestions

  • Do you socialise with other people? If not, why?
  • What happens when you do?  Can you give examples?
  • How does it make you feel when you meet a stranger?
  • Can you only meet new people if you’re with a carer?
  • Do you need someone to help you go to appointments?
  • Do you spend a lot of time at home because of anxiety or paranoia?
  • How often do you have problems with meeting others?

Q12 Making budgeting decisions

This includes buying items from a shop or paying bills.

‘Simple’ budgeting decisions include working out how much things cost and how much change you need when you buy something.

‘Complex’ budgeting decisions include working out budgets, paying bills and planning what to buy in the future.

The questions on the form

The scores

Q12a) Do you need someone else to help you to understand how much things cost when you buy them or how much change you'll receive?

Q12b) Do you need someone else to help you to manage your household budgets, pay bills or plan future purchases?

Q12) Extra Information

Can manage complex budgeting decisions unaided =0

Needs prompting or assistance to be able to make complex budgeting decisions =2

Needs prompting or assistance to be able to make simple budgeting decisions =4

Cannot make any budgeting decisions at all =6

Q12 tips & suggestions

  • Do you need help to make sure you pay your bills?
  • Can you budget to make sure you have money to buy essential items such as food?
  • Do you have problems with motivation which stop you paying bills?
  • Are you ever overly generous with your money? For example, do you give money to others when you cannot really afford to?
  • Do you need someone to go to the shops with you to help you with making payment and getting the right change?

Q13 Planning and following journeys

This activity covers mental distress caused by making a journey.

 On 16 March 2017, the government changed the rules. They said you can not be awarded points for mental distress caused by planning a journey, or following a familiar or unfamiliar route without assistance. But on 21 December 2017 there was a court case that said this was unfair and that the rules should not have been changed. This means that you can now be awarded points if you cannot plan or follow a journey because of psychological distress.

 The table below shows the rules from 21 December 2017 onwards. If you applied for PIP between 16 March 2017 and 21 December 2017 you may be entitled to a back payment. If you cannot use public transport, the DWP should not count you as able to plan and follow an unfamiliar journey alone.

 

The questions on the form

The scores

Q13a) Do you need help from another person to plan a route to somewhere you know well? Or do you need another person, guide dog or specialist aid to help you get there?

Q13b) Do you need help from another person, guide dog or specialist aid to get to a location that is unfamiliar to you?

Q13c) Are you unable to go out because of severe anxiety or distress?

Q13) Extra information

Can plan and follow the route of a journey unaided =0

Needs prompting to be able to undertake any journey to avoid overwhelming psychological distress to the claimant =4

Cannot plan the route of a journey=8

Cannot follow the route of an unfamiliar journey without another person, assistance dog or orientation aid =10

Cannot undertake any journey because it would cause overwhelming psychological distress to the claimant =10

Cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid=12

Q13 tips & suggestions

  • Can you go places you have been before?
  • Do you struggle to go somewhere new?
  • Can you use public transport?
  • Do you need someone with you when you go out?
  • How does going out and making a journey make you feel?
  • If there was a disruption to a journey you have planned, for example a closed road, would you be able to carry on with your journey?
  • Do you ever leave your house? Why not? What would happen if you did?

Q14 Moving around

This activity looks at your ability to physically move around.

The questions on the form

The scores

Q14a) How far can you walk taking into account any aids you use?

Q14b) Do you use an aid or appliance to walk?

Q14c) Do you use a wheelchair or similar device to move around safely, reliably and repeatedly and in a reasonable time period?

Q14) Extra information

Can stand and then move more than 200 metres, either aided or unaided =0

Can stand and then move more than 50 metres but no more than 200 metres, either aided or unaided =4

Can stand and then move unaided more than 20 metres but no more than 50 metres =8

Can stand and then move using an aid or appliance more than 20 metres but no more than 50 metres =10

Can stand and then move more than 1 metre but no more than 20 metres, either aided or unaided =12

Cannot, either aided or unaided, 
(i) stand; or 
(ii) move more than 1 metre =12

Q14 tips & suggestions

  • If you just have a mental illness, It is unlikely you would score points on this activity.
  • If you have a physical health issue that affects your ability to move around you may score points.

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Within this subject

  1. Overview
  2. What is PIP?
  3. What if I claim Disability Living Allowance (DLA)?
  4. Who can get Personal Independence Payment (PIP)?
  5. How will I be assessed for Personal Independence Payment (PIP)?
  6. How do I claim?
  7. What questions are on the ‘How your disability affects you’ form?
  8. Should I get supporting evidence?
  9. Will I have to go to a face to face medical assessment?
  10. Can I appeal if I think a decision is wrong?
  11. Do I need to speak to a welfare advisor?
  12. What happens if my health changes when I’m getting Personal Independence Payment (PIP)?
  13. Can someone claim Personal Independence Payment (PIP) for me?
  14. Information on Personal Independence Payment (PIP)
  15. Next steps
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