OPEN - ESDS

Refer Informant to Prompt Card P
56 In the last 12 months, that is
s~nce..................... have you received
any of the state benefits
I
V-Hk ~~~
shown on Card P? Itp:sp; sp :
Yes ,_W 1 1 1
No —d 2 2 2 -*57
Exclude In@me Sapport/Supplementary I I I I
benefit from (a) - (c) I I I I
IExclude Christmas Bonus from(a) to (d) I
(a) Industrial injury disablement
1
I
I
I
I
I
I
I
benefit
; lNDbIS ~ ~5zl 1 QO!156H I
(1.ncludc Reduced
Yes _c
1 1 1 - Ask (i) - (iv)
Earnings Allowance)
1?48 205 (S22) Q-$1 I
No —-
I
2
2 2 -Go to(b)
(i) For how many weeks d>
~
you receive this benefit? ._O .............. ............. .............. ............. .............. ............. - Ask (ii)
(ii) What was the amount of benefit
you last received? -z - Ask (iii)
lNDDISB~ (=3) Qo56h 2 ~ I I I I
(iii) How long did
this cover?
cOde—H=F=l
Enter period
.“””. ”””.””. ””.”.--”””. ””.””.“”.”””00.o””oss”.0””””””.0” .“”.”””.””””.””. ””””s””””s”s specify period
(iv) Are you receiving benefit
at present? I I I I
Yes —a 1 1 1
1-Ask (b)
2 2 2
1Nf123~ (525) Q056R 4 ‘: ‘/ H
. I I I I
(b) N.I. Unemployment Benefit
I I I I
‘uNEMBEhj i ~S2SA I Q056B o
Yes ,—~ 1 1 1 -ti (i)-
INM22 (5%) Q056B 1- No .. . 2 2 2 - Go to (c)
(i) For how many weeks did you
receive N.I. unemployment
benefit?
UBf7WWlT C52Y) Q0568 2
(ii) What was the amount of be=
.............
—>
- Ask (ii)
you last received? -~ - Ask (iii)
(iii) How long did Enter period
this cover? PERC 527 (528) Q056B 3 If Co&9,
code ............................. ............................ ............................ specify period
I I I I
(iv) Are you receiving
at present?
benefit
Yes ,—w
No z.
: IN f)223
1
2
~ (Szq>
1
2
~QOSGB
1
2
4 ~
1-Ask (C)
.- If coded 6 or 7 at l(b)
recode as 3 at l(b) and
““ ask relevant questions
8
(iv)