Self-Isolation Support Payment Form

Application Information

If you have been contacted by TTP and have been told to self-isolate, you may be entitled to financial support.

Self-Isolation Support Payment
If you meet ALL of the eligibility criteria, you are entitled to an Isolation Payment of £500

You have been told to self-isolate by NHS Wales, Test, Trace, Protect service (TTP) on or after 23 October 2020
You are employed or self-employed
You cannot work from home and will lose income as a result
You or your partner are currently receiving at least one of the following benefits: Universal Credit, Working Tax Credit, income-based Employment and Support Allowance, income-based Job Seekers Allowance, Income Support, Housing Benefit and/or Pension Credit

Discretionary Payment
You may be eligible for a £500 Discretionary Payment if you meet all of the other eligibility criteria above, but:

You or your partner Do Not currently receive Universal Credit, Working Tax Credit, income-based Employment and Support Allowance, income-based Job Seekers Allowance, Income Support, Housing Benefit and/or Pension Credit
You will face financial Hardship as a result of not being able to work while you are self- isolating.

This application is for one person only and any further applications within the same household must be made by each individual

Please ensure that you have the information below available before starting your application

National Insurance Number
Confirmation of the date given by NHS Wales Test, Trace, Protect service (TTP)
Your most recent Bank Statement, wage slip or proof of self-employment

Applicant details

Employment Details

Benefits

Do you receive any of the benefits/support below? Universal Credit Working Tax Credit Jobseeker’s Allowance Income Support Employment and Support Allowance Housing Benefit Pension Credit None of these

Bank Details

Please provide the following details of the bank account you wish the payment to go into.

To Enable your application to be processed quickly, please upload your evidence documents. If you are employed this should also include proof of employment e.g. Wages being paid into your Bank Account, or your most recent Wage Slip or Bank Statement

If you are self-employed – please provide evidence of this, such as self-employed accounts which show recent trading or SA302 self-assessment form

If you do not provide evidence which supports your application it will lead to a delay in processing your claim.

In either case please provide your latest bank statements.

Evidence documents Please select all files at once.

Declarations

I confirm that the information is true and accurate.
I agree to stay at home and self-isolate for the required period, I understand that if I fail to do so, I will be required to pay the funds back and my contact details may be passed on to the police for further action.

I can confirm to all the statements above.

If you are unable to confirm to all the statements above, you are not eligible for the fund.

As part of making this application, please note that Welsh Government, or a research company employed by them may invite you to take part in follow up research. This would involve passing your contact details to Welsh Government. Your details will only be used for research purposes and your personal details will be kept completely confidential. If you are re-contacted there will be no obligation to take part.

Equality Data (Optional)

The next set of questions asks about your personal characteristics. This is to help us understand the take up of the scheme among different groups of the population. Where possible, these questions have been aligned with those used by the Office for National Statistics (ONS).

What is your ethnic group? Choose one option that best describes your ethnic group or background.

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