OPEN - ESDS

To women aged under 51 only
/ ~ .............. .............. .............. .............. .............. .............
I
I&p; sp:sp :
mm 83+
DNA. Women aged 51 & over and all men N N N - Goto58
. I I I I
Refer informant to Prompt Card Q I I I I
57 In the last 12 months, that is
since ............... have you received any of ;
the state benefits shown on Card Q?
(a) Maternity allowance
~~t=’~:~:(:~)
I
,
I I I
~~=i=:=:~
IN~ Z3q (538) Q05Yfi I I I I
(i) For how many weeks did you
receive this benefit? — - Ask (ii)
P4mALRMT (539) Qo57/1 2 ‘ I I I
(ii) What was the amount of benefit
you last received? - Ask (iii)
(iii) How long did this
cover?
I
Enter period QosYfi 3 If code 9,
code .—a
(iv) Are you receiving benefit at
present? I I I I
Yes -—
1
1 1 1
WWW (SW) Q05YY -Ask
(b)
(b) N.I. Maternity Grant/Grant I
from Social Fund for
Maternity expenses? Yes .—N - Ask (i)
M~TQV)W(5@
No —.
Q05YB ] ~ ,
2
I
I
2
I
I
2“ - Go to (c)
I
(i) What was the total amount of
grant you have received in the
last 12 months? — ................... ........ ................... ........ .................. ........ - Ask (C)
(c)
Maternity pay from your employer ,
under. the Employment
Act
Protection
‘:=~]-~k(d)
I I I I
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99