Regulation 5(1)
SCHEDULE 1N.I.APPLICATION FOR BENEFIT
Information needed for application for benefitN.I.
1. A claim for benefit in respect of a pregnant woman, mother or child pursuant to regulation 4 shall contain the following information—
(a)the name and address of the pregnant woman, mother or child;
(b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(c)the national insurance number of the pregnant woman or mother, or, if the person in respect of whom the claim is made is aged under 18, that person’s date of birth ; ...
[(d)where the pregnant woman or mother is not entitled to a social security benefit or tax credit mentioned in regulation 4, the name, address and national insurance number of—
(i)the member of the family of the pregnant woman, mother or child described in regulation 4(3)(a), [4(3)(c),] 4(3)(d) or 4(3)(e);
(ii)the other member of the couple described in regulation 4(3)(ab)(ii) or 4(3)(db)(ii); or
(iii)the person responsible for the pregnant woman, mother or child described in regulation 4(3)(aa)(ii), 4(3)(ab)(iii), 4(3)(da)(ii), 4(3)(db)(iii) or 4(3)(f). [and]]
[(e)the estimated date of delivery of the pregnant woman.]
Textual Amendments
Commencement Information
Evidence in writing needed for application for benefitN.I.
2. [A claim in respect of a pregnant woman shall be accompanied by evidence in writing of the estimated date of delivery of the pregnant woman signed by a health professional]
3. [A claim in respect of a child under the age of four months shall be accompanied by evidence in writing of the existence and age of the child, unless the claim is made by telephone as provided in regulation 5(2).]
Declaration needed for application for benefitN.I.
4.—(1) A claim in respect of a [pregnant woman described in regulation 4(3)(a) or (b), mother described in regulation 4(3)(c) or (d) or child described in regulation 4(3)(e)] shall include a declaration ...by the claimant that:—
(a)the person in respect of whom the claim is made or a member of that person’s family is entitled to—
(i)income support;
(ii)an income based jobseeker’s allowance; ...
[(iii)child tax credit, where the relevant income of the person or persons to whom the award of child tax credit is made under section 14 of the Tax Credit Act 2002 is determined at the time of the award not to exceed [£16,190,] and the person is either not entitled to working tax credit or is treated as not being so entitled by virtue of regulation 4(7); and]
[(iv)an income-related employment and support allowance; and]
(b)the claimant understands the rules of the Healthy Start scheme and will abide by his obligations under the scheme.
[(1A) A claim in respect of a pregnant woman described in regulation 4(3)(aa)(i) or a mother described in regulation 4(3)(da)(i) must include a declaration ...by the claimant that—
(a)the pregnant woman or mother, as the case may be, is entitled to universal credit; and
(b)the pregnant woman or mother, as the case may be, satisfies the condition in regulation 4(8).
[(1AA) A claim in respect of a pregnant woman described in regulation 4(3)(ab)(i) must include a declaration ...by the claimant that the pregnant woman is entitled to state pension credit.
(1AB) A claim in respect of a pregnant woman who is a member of a couple described in regulation 4(3)(ab)(ii) must include a declaration... by the claimant that the other member of that couple is entitled to state pension credit.
(1AC) A claim in respect of a mother described in regulation 4(3)(db)(i) must include a declaration ...by the claimant that the mother is entitled to state pension credit which includes the additional amount for a child or qualifying young person.
(1AD) A claim in respect of a mother who is a member of a couple described in regulation 4(3)(db)(ii) must include a declaration ...by the claimant that the other member of that couple is entitled to state pension credit which includes the additional amount for a child or qualifying young person.]
(1B) A claim in respect of a pregnant woman described in regulation 4(3)(aa)(ii) or a mother described in regulation 4(3)(da)(ii) must include a declaration... by the claimant that—
(a)the pregnant woman or mother, as the case may be, is the responsibility (within the meaning of regulation 4 of the Universal Credit Regulations (Northern Ireland) 2016) of a person entitled to universal credit; and
(b)the person entitled to universal credit mentioned in paragraph (a) satisfies the condition in regulation 4(8).
[(1BA) A claim in respect of a pregnant woman described in regulation 4(3)(ab)(iii), or a mother described in regulation 4(3)(db)(iii), must include a declaration ...by the claimant that the pregnant woman, or mother, as the case may be, is the responsibility (within the meaning of paragraphs 3 to 7 of Schedule 2A to the State Pension Credit Regulations (Northern Ireland) 2003) of a person entitled to state pension credit which includes the additional amount for a child or qualifying young person.]
(1C) A claim in respect of a child described in regulation 4(3)(f)(i) must include a declaration ...by the claimant that—
(a)the child is the responsibility (within the meaning of regulation 4 of the Universal Credit Regulations (Northern Ireland) 2016) of a person entitled to universal credit; and
(b)the person entitled to universal credit mentioned in paragraph (a) satisfies the condition in regulation 4(8).
[(1CA) A claim in respect of a child described in regulation 4(3)(f)(ii) must include a declaration ...by the claimant that the child is the responsibility (within the meaning of paragraphs 3 to 7 of Schedule 2A to the State Pension Credit Regulations (Northern Ireland) 2003) of a person entitled to state pension credit which includes the additional amount for a child or qualifying young person.]
(1D) A claim in respect of a child under the age of 4 years in respect of whom a relevant child has parental responsibility (within the meaning of regulation [regulation 4(3)(f)(iii)] ) must include a declaration ...by the claimant that the relevant child in relation to the child—
(a)is the responsibility of, and member of the same household as, a person who is entitled to—
(i)income support;
(ii)an income based jobseeker’s allowance; or
(iii)child tax credit, where the relevant income of the person or persons to whom the award of child tax credit is made under section 14 of the Tax Credit Act 2002 is determined at the time of the award not to exceed £16,190, and the person is not entitled to working tax credit or is treated as not being so entitled by virtue of regulation 4(7); ...
(b)is the responsibility (within the meaning of regulation 4 of the Universal Credit Regulations (Northern Ireland) 2016) of a person entitled to universal credit [;or]
[(c)is the responsibility (within the meaning of paragraphs 3 to 7 of Schedule 2A to the State Pension Credit Regulations (Northern Ireland) 2003) of a person entitled to state pension credit which includes the additional amount for a child or qualifying young person.]
(1E) Where the claimant provides a ...declaration under sub-paragraph (1D)(b), the claimant must also provide a ...declaration that the person entitled to universal credit mentioned in that paragraph satisfies the condition in regulation 4(8).
(1F) Where the claimant provides a ...declaration under sub-paragraph (1A) [, (1AA), (1AB), (1AC), (1AD)] , (1B) [(1BA)] , (1C) [, (1CA)] or (1D), the claimant must also provide a ...declaration that the claimant understands the rules of the Healthy Start scheme and will abide by the claimant’s obligations under that scheme.]
(2) If a claim is made by a pregnant woman under the age of 18, the [declarations described in sub-paragraphs (1) to (1D) are] is not necessary.
[(3) A declaration provided under this paragraph must be in the format that the Department requires.]
Textual Amendments
Commencement Information
Countersignature of a health professionalN.I.
5. [A claim pursuant to regulation 5 must be countersigned by a health professional.]