1

Child's Personal Details

Basic information about your child. Factual questions — fill in exactly as asked.

Q1Child's full name
Q2Child's date of birth
Q3Child's home address
Q4Child's nationality
Important: Child must be habitually resident in England or Wales and must not be subject to immigration control to receive DLA.
Q5How long have the child's care or mobility needs existed?
DWP Rule: Needs must have existed for at least 3 months before the claim and be expected to last at least 6 months more. Terminal illness is exempt from both conditions.
Your own words Type naturally
2

Claimant / Appointee Details

Who is making the claim. This person will be contacted by DWP and will receive the payments.

Q6Who is completing this form?
Q7Your full name and contact details
Q9Does the child normally live with you?
Q10Bank account details for payment
DLA is paid every 4 weeks directly into a bank or building society account.
3

Condition & Diagnosis

Select all conditions. This tailors the AI translation to use condition-specific DWP language for each answer.

No diagnosis needed to claim
Q11What is your child's diagnosis or condition? (Select all that apply)
DLA is awarded on care needs, not diagnosis. Even without a formal diagnosis you can claim successfully.
🧩
Autism / ASD
⚡
ADHD
🦽
Physical Disability
📚
Learning Disability
🧠
Epilepsy / Seizures
👂
Deaf / Hearing Loss
👁️
Visual Impairment
💙
Mental Health
💊
Medical Condition
🌟
Down's Syndrome
🔵
Cerebral Palsy
➕
Other / Undiagnosed
Q12Describe your child's condition and how it affects their daily life
Compare to other children the same age. Focus on what they cannot do, struggle to do, or need help with — not what they can do on a good day.
Your own words Spelling does not matter
4

Time Abroad & Hospital / Residential Care

These questions affect whether DLA can be paid. They contain disqualifying rules — answer accurately.

⚖️These are disqualification questions. Time abroad over 13 weeks or NHS-funded residential/hospital care over 84 days can stop or suspend DLA. Answer truthfully.
Q13Has your child been outside Great Britain in the last 3 years?
DWP Rule: Absences of up to 13 weeks for a temporary purpose (holiday, medical treatment) do not usually affect the claim. Absences over 26 weeks normally end the claim.
Q14Has your child been in hospital in the last 3 years?
DWP Rule: DLA care component normally stops after 84 days (12 weeks) in NHS-funded hospital. Mobility component continues. Private hospital stays do not affect DLA. Breaks at home of 28+ days reset the clock.
Q15Does your child attend a residential school or care home?
DWP Rule: If the local authority funds a residential placement, the care component may be affected. Mobility component is not affected. If parents pay the full cost, DLA continues normally.
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GP & Hospital Specialists

DWP will write to your child's GP and may contact specialists. Give full, accurate details — incomplete details cause delays.

Q16Child's GP details
Tip: Let your GP know you are making a DLA claim. A supportive GP letter submitted with the form is very helpful.
Q17Hospital specialists / consultants — add all involved in your child's care
Include: Paediatrician, neurologist, cardiologist, orthopaedic consultant — anyone your child sees at a hospital clinic.
Q18Are there any pending hospital appointments or awaited test results?
If yes: write on the form that further evidence will follow under separate cover — this holds your claim date without delaying submission.
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Other Health & Care Professionals

All professionals involved in your child's care. Each one strengthens the picture of your child's needs.

Q19Add all other professionals involved in your child's care
Include: Occupational therapist, speech & language therapist, physiotherapist, community nurse, health visitor, social worker, CAMHS worker, dietitian, audiologist — anyone professionally involved.
Q20Do you have any written reports or letters from these professionals?
Include copies with the form. They are not mandatory but significantly increase your chances. If you do not have them yet, write on the form that they will follow.
7

Personal Care Needs

Washing, dressing, eating, toileting. Compare your child to a non-disabled child of the same age throughout.

🏆 Highest Rate Trigger
⚠️Describe your child's WORST DAYS — not average or good days. DWP assesses on worst-day need.
Q21Does your child need help with washing or bathing? Describe exactly what you have to do.Highest Rate
Think about: Can they wash themselves at all? Do they need reminding, physical help? Do they refuse or become aggressive? How long does it take compared to children their age?
Your own words Type naturally
Q22Does your child need help getting dressed or undressed?Highest Rate
Think about: Sensory issues with fabrics or fastenings, refusal, meltdowns around clothing, physical help needed, time taken.
Your own words Type naturally
Q23Does your child need help with eating and drinking?Middle Rate
Think about: Can they feed themselves? Choking, food refusal, eating inedible objects, time mealtimes take, need for constant adult presence.
Your own words Type naturally
Q24Does your child need help using the toilet or managing continence?Highest Rate
Think about: Toilet training for their age, accidents, reminding needed, can they clean themselves, sensory processing issues (not recognising the need).
Your own words Type naturally
Q25Any other personal care needs not covered above?
Include: skin care, stoma care, tube feeding, managing medical equipment, oral hygiene difficulties, hair care — anything requiring more adult help than a child their age normally needs.
Your own words Type naturally — or write N/A
8

Supervision During the Day

Continual daytime supervision = Middle Rate. Day AND Night = Highest Rate. "Continual" means frequent and regular — not literally non-stop without any break.

⭐ Middle → Highest Rate
⚠️Describe the WORST DAYS. On bad days supervision needs are always greater — describe those, not the better days.
Q26Does your child need someone watching over them during the day to keep them safe? What would happen if left unsupervised?Middle Rate
Key DWP test: Would your child be in substantial danger without supervision? Think: running into roads, harming themselves, no danger awareness, swallowing objects, wandering.
Your own words Type naturally
Q27Describe a typical BAD day from waking to bedtime — every time you help, supervise or interveneHighest Rate
This is one of the most powerful sections on the form. A timed day diary demonstrating every intervention throughout the day is compelling evidence. Include times where you can.
Walk through a bad day As much detail and as many times as possible
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Night-time Supervision & Care

Regular help day AND night = Highest Rate Care. Night-time care is the most commonly underestimated section — every time you get up counts.

🏆 Highest Rate Trigger
🌙Every time you get up at night counts. Every check, every intervention — it all counts toward highest rate.
Q28Does your child have difficulty getting to sleep? What do you have to do to settle them?Highest Rate
Think about: How long to fall asleep? Do you stay with them? Sleep medication? Refuses bedtime routine? How does this compare to children their age?
Your own words Type naturally
Q29Does your child wake during the night? How many times, how long, and what do you have to do?Highest Rate
Be specific: How many times per night? How long are you up each time? What does the child need? Do they wander, harm themselves, have seizures, leave the house?
Your own words Type naturally
Q30Does your child need any physical care at night — changing, repositioning, medication?Highest Rate
Include: nappy or pad changes, repositioning due to physical disability, overnight medication, tube feeding, stoma care, seizure management overnight.
Your own words Type naturally — or write N/A
10

Behaviour & Safety

One of the most critical sections for highest rate care. Dangerous behaviour, self-harm and lack of danger awareness are key triggers. Be thorough and specific.

🏆 Highest Rate Trigger
Q31Does your child show any of the following behaviours? Tick all that apply.
Tick everything that applies. Do not minimise — if it happens even occasionally on bad days, tick it and describe it below.
Runs away / bolts without warning
Runs into road / no road sense
Head banging / hitting head on walls
Biting themselves or others
Scratching / cutting themselves
Hitting / kicking / punching others
Throwing objects dangerously
Putting objects in mouth / swallowing
Eating inedible items (PICA)
Smearing / inappropriate toileting
Meltdowns / extreme distress episodes
Climbing dangerously
Dangerous behaviour near water
Stripping in public
No awareness of strangers / danger from others
Property destruction during episodes
Q32Describe the most serious or frequent dangerous behaviour in detail — what happens, how often, how long, what you have to doHighest Rate
Be very specific: What does it look like? How long does an episode last? How often per day or week? Physical intervention needed? Has anyone been injured? Does it happen without warning?
Your own words The more detail, the stronger the claim
Q33Can your child recognise and respond appropriately to danger — traffic, electricity, hot surfaces, water, strangers?Highest Rate
Lack of danger awareness is one of the strongest triggers for highest rate — it directly establishes that the child cannot be left unsupervised safely at any time.
Your own words Type naturally
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Medical Needs & Medication

Medications, seizures, medical equipment, therapy attendance. Every medical intervention is part of the total care picture.

Q34Does your child take any prescribed medications? Who gives them, how often, do they cooperate?Middle Rate
Name, dose, frequency, who administers, any monitoring required, what happens if a dose is missed.
Your own words Type naturally
Q35Does your child have seizures, fits or medical episodes? Describe fully.Highest Rate
How often? How long? Types? Emergency medication needed? Have they been injured? Do you supervise continuously because of seizure risk? Write N/A if not applicable.
Your own words Type naturally — or write N/A
Q36Does your child use any medical equipment or receive ongoing treatments?
Include: feeding tubes, oxygen, suction equipment, splints/orthoses, hearing aids, communication devices, physiotherapy, hydrotherapy, specialist diet preparation.
Your own words Type naturally — or write N/A
12

School, Education & Communication

DWP compares your child to children their age in school settings. School-based needs and communication difficulties both support the claim.

Q37Does your child attend school, nursery or any educational setting?
Q38Does the school provide extra support, a teaching assistant or any additional help?
Key point: If your child has a full-time 1:1 teaching assistant, this powerfully demonstrates that their needs are substantially greater than non-disabled peers. EHCP-funded support is particularly relevant.
Your own words Type naturally
Q39Does the school provide any personal care — toileting, meals, medication?
⚠️ DLA care component is normally calculated only for hours the child is at home under your care — not during school hours if the school provides personal care. Describe your child's needs at home: evenings, weekends, school holidays, before and after school.
Q40Can your child make their needs known to others? How do they communicate?
Communication difficulties directly affect the ability to seek help, report pain or distress, and manage in unfamiliar environments — all relevant to supervision and care needs.
Your own words Type naturally
Q41Can your child understand what is said to them? Do they follow instructions?
Difficulty understanding instructions affects safety awareness and the ability to learn safe behaviours — directly relevant to supervision needs.
Your own words Type naturally
13

Mobility Component

Higher rate (age 3+): cannot walk, virtually unable to walk, or severe mental impairment with severe behavioural problems. Lower rate (age 5+): needs guidance outdoors.

Higher / Lower Rate
Q42Can your child physically walk? If yes — how far, how fast, does it cause pain or breathlessness?Higher Rate
"Virtually unable to walk" means: can only walk a very short distance, walks with severe discomfort, or whose behaviour when walking makes it effectively impossible to do so safely. Also applies to severe mental impairment with severe behavioural problems — bolting, refusing to walk, being unpredictably dangerous outdoors all count.
Your own words Type naturally
Q43Does your child refuse to walk? What happens when you try to make them walk outdoors?Higher Rate
Persistent refusal to walk that results in the child being unable to walk is treated similarly to physical inability for higher rate mobility purposes.
Your own words Type naturally — or N/A
Q44Does your child need guidance or supervision when walking outdoors in unfamiliar places?Lower Rate
Lower rate mobility is for children aged 5+ who can walk but need guidance or supervision from another person most of the time outdoors in unfamiliar surroundings.
Your own words Type naturally
14

Benefits Currently in Payment

DWP needs to know about other benefits in payment. Some benefits interact with or are affected by DLA.

Q45Is anyone currently receiving Child Benefit for this child?
Q46Are you or your partner receiving any of the following benefits?
Note: Receiving DLA for your child may entitle you to additional amounts within Universal Credit. Always check with a benefits adviser after a DLA award.
After DLA is awarded: If your child is awarded middle or highest rate care, you may be entitled to Carer's Allowance (if you care for 35+ hours per week and meet the income rules). Ask at your local Citizens Advice on 0800 144 8848.
Q47Has DLA ever been claimed for this child before?
15

Evidence Checklist

Supporting evidence significantly strengthens your claim. Tick what you have. Do not delay submitting — write that further evidence will follow under separate cover.

📎 Your Evidence Checklist

GP letter confirming diagnosis and ongoing care needs Essential
Paediatrician / consultant report or clinic letters Essential
Diagnostic assessment (autism, ADHD, etc.) Essential
Education Health Care Plan (EHCP) or SEN Support Plan Essential
SENCO / school letter describing child's additional needs Essential
3-day diary of a typical bad week (timed care interventions) Essential
Supporting statement from someone who knows the child (teacher, health professional, social worker) Essential
Occupational therapy assessment Helpful
Speech and language therapy (SALT) assessment Helpful
Physiotherapy reports (if mobility affected) Helpful
Community nurse / health visitor letters Helpful
Prescription list / medication record Helpful
A&E / hospital records if child has been injured during a behaviour episode Helpful
Social care / children's services reports or assessments Helpful
📝How to reference evidence without delaying your submission
Write in the additional information box: "Further supporting evidence from [name / role] will follow under separate cover."

Critical: DLA cannot be backdated. Your claim date is the date DWP posted the form pack to you — not when you return it. Phone 0800 121 4600 now to get the pack posted, even if you are not yet ready to complete it.
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Review & Export

All your professionally-worded answers in one place. Review, then copy onto your DLA1 Child form or print.

Estimated Award Potential Based on Your Answers

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Complete all sections to see your estimated award potential
Care Component
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Mobility Component
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⚠️Before You Post — Final Checklist
1. Photocopy the entire completed form before posting.
2. Send by tracked or recorded post — keep the receipt.
3. Address: "Freepost DWP DLA Child" — no stamp needed.
4. Processing time is currently up to 25 weeks — do not be discouraged by delays.
5. If refused or awarded too low: request Mandatory Reconsideration within 1 month.
6. Never accept the first decision without checking it against what you are entitled to.