Most of the claim-form consists of a series of questions relating to your care and supervision needs. The questions have a tick-box format. Each question looks at a different area of day-to-day life. They generally follow a similar pattern. You are first asked to tick ‘yes’ or ‘no’ to confirm whether or not you have difficulty or need help with that area of day-to-day life; read the whole page before answering this. You are then asked more specific questions on each subject, including how often you need help.

Some questions ask if you have difficulty concentrating or motivating yourself and therefore need encouragement to carry out a task. You might need such encouragement because of a mental health problem (such as depression) or a condition affecting your mental capacity (such as dementia).

At the end of each question there is space to provide details of your difficulties. You may live alone and manage because you have no choice,