DWP · Official form

AA1: Attendance Allowance claim form

Form AA1 is the claim form for Attendance Allowance, the benefit that helps with personal care costs if you are State Pension age or over and have a disability or health condition. Fill in the official PDF below and download it.

Fill out AA1 in the editor Download the blank PDF Quick fill on this page

This is the genuine DWP PDF, unmodified. Source: DWP official page.

What is AA1?

Attendance Allowance is paid to people who have reached State Pension age and need help with personal care or supervision because of a physical or mental health condition. It is not means tested and it does not depend on your National Insurance record, so savings and most other income do not affect it. The AA1 claim form is how DWP collects the detail it needs to decide the claim.

The form runs to 32 pages. It asks about your condition, the medicines and treatments you have, and then works through the help you need with things such as getting up, washing, dressing, eating, moving around indoors, and being kept safe during the day and at night. There is a separate AA1 notes booklet published alongside it that explains each section, and DWP publishes a Welsh version.

Who files AA1?

People of State Pension age or over in England and Wales who need help with personal care
Someone helping a parent, partner or friend fill in a claim on their behalf
People claiming under the special rules because they are nearing the end of life
Anyone who needs a paper claim because they cannot use a PDF reader on a desktop or laptop

How to fill out AA1

Read the AA1 notes booklet first. It explains what DWP counts as help and how to describe the care you need.
Answer question 1 about the special rules. If you are claiming under them you can skip the care questions and should send an SR1 form from your doctor or specialist.
Work through the questions about your condition, your medicines and treatments, and any professionals involved in your care.
Describe the help you need with each daily activity, both during the day and at night. Give examples and say how long the help takes, rather than only ticking boxes.
List any supporting documents at question 65, sign the declaration, then post the claim in the pre-addressed envelope DWP sent you, or to Freepost DWP Attendance Allowance. No stamp is needed.

Worth knowing: AA1 applies in England and Wales. Claimants in Scotland should apply for Pension Age Disability Payment instead, and Northern Ireland has its own process. Send copies of supporting documents, not originals, because DWP does not return them.

Quick fill AA1 on this page

Prefer to see the form itself while you type? Open AA1 in the editor to fill it on the actual pages, add a signature, and download.

These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to DWP.

Page 2 2 fields

Are you claiming for a child under the special rules?

Page 3 15 fields

Your surname or family name

All other names in full

Your title

National Insurance (NI) number

Your date of birth, DD / MM / Y Y Y Y

Your sex

Your address line 1

Your address line 2

Your address line 3

Address postcode

Your daytime phone number, including the dialling code

Your mobile phone number

What is your nationality?

If you are a Swiss or a European Economic Area (EEA) national, were you living in the United Kingdom (UK) before 1 January 2021?

Page 4 14 fields

Do you normally live in Great Britain?

If you live in Wales and would like us to contact you in Welsh in future, tick this box.

Have you been abroad for more than 4 weeks at a time in the last 3 years? Abroad means out of Great Britain.

What date did you go abroad for more than 4 weeks at a time in the last 3 years? DD / MM / Y Y Y Y

What date did you return from abroad for more than 4 weeks at a time in the last 3 years? DD / MM / Y Y Y Y

Have you been abroad for more than 4 weeks at a time in the last 3 years? If yes, please tell us where you went

Have you been abroad for more than 4 weeks at a time in the last 3 years? If yes, please tell us why you went

Are you, your wife, husband or civil partner receiving any pensions or benefits from an EEA state or Switzerland?

Are you, your wife, husband or civil partner working in or paying insurance to an EEA state or Switzerland? By insurance we mean connected

Have you moved from Scotland to live in England or Wales?

What date did you move to live in England or Wales? D D / M M / Y Y Y Y

Are you getting or have you made a claim for Pension Age Disability Payment?

Page 5 4 fields

Are you signing this form for someone else?

If yes, why are you signing the form for them?

If you hold Power of Attorney for Property and Finance, Do you have an online account?

If you are a Corporate Acting Body or Corporate Appointee, please tell us the name of your organisation. For example, an organisation

Page 6 8 fields

Your name if you are signing the form for someone else

Your National Insurance number if you are signing the form for someone else

Your date of birth, DD / MM / Y Y Y Y

Your full address if you are signing the form for someone else, address line 1

Your full address if you are signing the form for someone else, address line 2

Your full address if you are signing the form for someone else, address line 3

Your postcode if you are signing the form for someone else

Your contact phone number if you are signing the form for someone else

Page 7 24 fields

Illness or disability 1, tell us the name of the illness or disability, you can tell us about other illnesses or disabilities later in this

Illness or disability 1, tell us how long you have had this illness or disability, for example 10 years.

Illness or disability 1, tell us what medicines or treatments (or both) have you been prescribed for this illness or disability.

Illness or disability 1, tell us the dosage and how often you take each of the medicines or receive treatment.

Illness or disability 2, tell us the name of the illness or disability, you can tell us about other illnesses or disabilities later in this

Illness or disability 2, tell us how long you have had this illness or disability, for example 10 years.

Illness or disability 2, tell us what medicines or treatments (or both) have you been prescribed for this illness or disability.

Illness or disability 2, tell us the dosage and how often you take each of the medicines or receive treatment.

Illness or disability 3, tell us the name of the illness or disability, you can tell us about other illnesses or disabilities later in this

Illness or disability 3, tell us how long you have had this illness or disability, for example 10 years.

Illness or disability 3, tell us what medicines or treatments (or both) have you been prescribed for this illness or disability.

Illness or disability 3, tell us the dosage and how often you take each of the medicines or receive treatment.

Illness or disability 4, tell us the name of the illness or disability, you can tell us about other illnesses or disabilities later in this

Illness or disability 4, tell us how long you have had this illness or disability, for example 10 years.

Illness or disability 4, tell us what medicines or treatments (or both) have you been prescribed for this illness or disability.

Illness or disability 4, tell us the dosage and how often you take each of the medicines or receive treatment.

Illness or disability 5, tell us the name of the illness or disability, you can tell us about other illnesses or disabilities later in this

Illness or disability 5, tell us how long you have had this illness or disability, for example 10 years.

Illness or disability 5, tell us what medicines or treatments (or both) have you been prescribed for this illness or disability.

Illness or disability 5, tell us the dosage and how often you take each of the medicines or receive treatment.

Illness or disability 6, tell us the name of the illness or disability, you can tell us about other illnesses or disabilities later in this

Illness or disability 6, tell us how long you have had this illness or disability, for example 10 years.

Illness or disability 6, tell us what medicines or treatments (or both) have you been prescribed for this illness or disability.

Illness or disability 6, tell us the dosage and how often you take each of the medicines or receive treatment.

Page 8 20 fields

Apart from your GP, in the last 12 months, have you seen anyone about your illnesses or disabilities? For example, a hospital doctor or

Phone number of the person you have seen about your illnesses or disabilities in the last 12 months (not your GP). of the person you have

Full address of where you see the person you have seen about your illnesses or disabilities in the last 12 months (not your GP). For

Address postcode

Phone number of the person you have seen about your illnesses or disabilities in the last 12 months (not your GP). of the person you have

Your hospital record number. You can find this on your appointment card or letter.

Which of your illnesses or disabilities do you see them about?

How often do you usually see them because of your illness or disabilities? For example, every 3 months.

When did you last see them because of your illnesses or disabilities? DD / MM / Y Y Y Y

Does anyone else help you because of your illnesses or disabilities?

Phone number of the person you have seen about your illnesses or disabilities in the last 12 months (not your GP). of the person you have

Full address of where you see the person you have seen about your illnesses or disabilities in the last 12 months (not your GP). For

Address postcode

Phone number of the person you have seen about your illnesses or disabilities in the last 12 months (not your GP). of the person you have

Which of your illnesses or disabilities do you see them about?

Page 9 11 fields

What is your GP’s name or the name of your surgery?

Full address of your GP or surgery , address line 1

Full address of your GP or surgery , address line 2

Full address of your GP or surgery , address line 3

Full address of your GP or surgery , postcode

Phone number of your GP or surgery

When did you last see them because of your illnesses or disabilities? DD / MM / Y Y Y Y

Do you agree to DWP contacting the people or organisations described in the Consent statement

Date of signature, DD / MM / Y Y Y Y

Page 10 13 fields

Do you have any reports about your illnesses or disabilities? These may be from a person who treats you, for example, an occupational

Are you on a waiting list for surgery?

Surgery 1, what date were you put on the waiting list for surgery?

Surgery 1, what surgery are you going to have? For example, operation to replace my right hip

Surgery 1, what date is the surgery planned for, if you know this?

Surgery 2, what date were you put on the waiting list for surgery?

Surgery 2, what surgery are you going to have? For example, operation to replace my right hip

Surgery 2, what date is the surgery planned for, if you know this?

Have you had any tests for your illnesses or disabilities?

Test 1, Have you had any tests for your illnesses or disabilities? - If yes, Date and type of test. For example, December 2014 treadmill

Test 1, Have you had any tests for your illnesses or disabilities? - If yes, What were the results? For example, 4 minutes (stage 2)

Test 2, Have you had any tests for your illnesses or disabilities? - If yes, Date and type of test. For example, December 2014 treadmill

Test 2, Have you had any tests for your illnesses or disabilities? - If yes, What were the results? For example, 4 minutes (stage 2)

Page 11 9 fields

What type of accommodation do you live in? For example, you may live in a house, bungalow, flat, supported housing, residential care home,

Where is there a toilet in your home? - Upstairs

Where is there a toilet in your home? - Downstairs

Where is there a toilet in your home? - Other

Where is there a toilet in your home? - Somewhere else, tell us where

Where do you sleep in your home? - Upstairs

Where do you sleep in your home? - Downstairs

Where do you sleep in your home? - Other

Where do you sleep in your home? - Somewhere else, tell us where

Page 12 24 fields

Aid or adaption 1, tell us what aids or adaptions you use

Aid or adaption 1, tick if this aid or adaptation you use is Prescribed by a health care professional, for example, an occupational

Aid or adaption 1, tell us how the aid or adaption you have told us about helps you

Aid or adaption 1, what difficulties do you have using the aid or adaptation you have told us about

Aid or adaption 2, tell us what aids or adaptions you use

Aid or adaption 2, tick if this aid or adaptation you use is Prescribed by a health care professional, for example, an occupational

Aid or adaption 2, tell us how the aid or adaption you have told us about helps you

Aid or adaption 2, what difficulties do you have using the aid or adaptation you have told us about

Aid or adaption 3, tell us what aids or adaptions you use

Aid or adaption 3, tick if this aid or adaptation you use is Prescribed by a health care professional, for example, an occupational

Aid or adaption 3, tell us how the aid or adaption you have told us about helps you

Aid or adaption 3, what difficulties do you have using the aid or adaptation you have told us about

Aid or adaption 4, tell us what aids or adaptions you use

Aid or adaption 4, tick if this aid or adaptation you use is Prescribed by a health care professional, for example, an occupational

Aid or adaption 4, tell us how the aid or adaption you have told us about helps you

Aid or adaption 4, what difficulties do you have using the aid or adaptation you have told us about

Aid or adaption 5, tell us what aids or adaptions you use

Aid or adaption 5, tick if this aid or adaptation you use is Prescribed by a health care professional, for example, an occupational

Aid or adaption 5, tell us how the aid or adaption you have told us about helps you

Aid or adaption 5, what difficulties do you have using the aid or adaptation you have told us about

Aid or adaption 6, tell us what aids or adaptions you use

Aid or adaption 6, tick if this aid or adaptation you use is Prescribed by a health care professional, for example, an occupational

Aid or adaption 6, tell us how the aid or adaption you have told us about helps you

Aid or adaption 6, what difficulties do you have using the aid or adaptation you have told us about

Page 13 10 fields

Please tell us the date your care needs started, DD / MM / Y Y Y Y

Your care needs during the day - Do you usually have difficulty or do you need help getting out of bed in the morning or getting into bed

Your care needs during the day - Tick if you have difficulty getting into bed

Your care needs during the day - Tick if you have difficulty getting out of bed

Your care needs during the day - Tick if you need help getting into bed

Your care needs during the day - Tick if you need help getting out of bed

Your care needs during the day - Tick if you have difficulty concentrating or motivating yourself and need encouraging to get out of bed in

Your care needs during the day - Tick if you have difficulty concentrating or motivating yourself and need encouraging to go to bed at night

Your care needs during the day - Is there anything else you want to tell us about the difficulty you have or the help you need getting in

If yes, tell us here.

Page 14 12 fields

Your care needs during the day - Do you usually have difficulty or do you need help with your toilet needs?

Your care needs during the day - If you have difficulty with your toilet needs, tell us how often each day?

Your care needs during the day - If you have difficulty with your incontinence needs, tell us how often each day?

Your care needs during the day - If you need help with your toilet needs, tell us how often each day?

Your care needs during the day - If you need help with your incontinence needs, tell us how often each day?

Your care needs during the day - If you have difficulty concentrating or motivating yourself and need encouraging with your toilet needs,

Your care needs during the day - Is there anything you want to tell us about the difficulty you have or the help you need with your toilet

If yes, tell us here.

Your care needs during the day - Do you usually have difficulty or do you need help with washing, bathing, showering or looking after your

Your care needs during the day - If you need help with your incontinence needs, tell us how often each day?

Page 15 14 fields