OPEN - ESDS

To all
36
WqE B36
Refer i.nfo~nt to Prompt Card R Per No. Per No. Per No.
I
I I
58 In‘ the last 12 months, that is
.............. ..............
since ............... have you received any of I
I I BENchl@~
the state benefits shown on Card R? I
I
me I ; / Q058
(a) Death Grant/Grant frnm ‘st=~”c(a”d)
Social Fund for
Funeral Expenses?
~EQ~R6~ (S&)Q058fi I
(i) What was the total
‘------:~~:=:b,
amount of
grant you have received in the
last 12 months?
(b) Christmas bonus?
Yes _&
No ~,
(i) What was the total amount of
Christmas Bonus you have
received in the last 12 months?_
(c) Invalid Care Allowance?
lmLLWbfS @F)) Qo5~
(i) What was the total number of
weeks you have received this
benefit?
(ii) Are you receiving benefit
at present?
If motrcccivhg at prcscn~ ask
(cl) What was the amount of
benefit you last received?~
(c2) How long did
this cover? Enter period
code .~,
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