OPEN - ESDS

●
To all
Refer Informant to Prompt Card M
51 Are you at present receiving any of the
state benefits shown on Card M?
PFNE B Z
~l,mc...
.............. .............. .............. .............. .............
~t=ii::~c)
Exclude Income Support/Supplementary ‘
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benefit from (a) - (c)
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Exclude Christmas Bonus from (a) - (c) :
(a) Child benefit
Include one parent
benefit
(i) What was the amount
you last receivedv .~
of benefit
(ii) How long did this cover?
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1-= I I
(4
::=~:~::(ii) o
Enter
period _
P u 1 1
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- Ask (ii)
............................ . ..................+........
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.......................... ............................. ............................
m~cw5 (M+ Qosl:$ 1 ............................. ............................. .............................
N.I retirement pension
Wbf3ml (*)
Qosla )
If code 9,
specify period
Old person’s pension ::=m-A@).(ii) a
No to both _ 3 3 3 - Go to (c)
Include additional pension
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(i) What was the amount of benefit
you last received? -—
(ii) How long did this cover?
Enter
period
code
INTERVIEW R CHECK
Is informant consulting a payment
-.
t I I
Q051E$ 2