DWP · Official form

DLA1A Child: Disability Living Allowance (DLA) for children claim form

This is the DWP claim form for Disability Living Allowance for a child under 16 who needs much more looking after, or has much more difficulty getting about, than other children of the same age.

Fill out DLA1A Child 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 DLA1A Child?

Disability Living Allowance for children is a benefit for a child under 16 in England and Wales. It has a care component and a mobility component, and the questions in the form are there to build a picture of the help the child needs during the day and at night, and how they manage getting around. The form runs to 40 pages and comes with a separate information booklet that explains the questions and the evidence to send.

DWP asks you to read the information booklet before you start, to answer everything as fully as you can, and to send the documents it asks for, because missing information delays the claim. If you complete it in a PDF reader on a desktop or laptop you can save your answers as you go, then print it to sign and post. Where a child is nearing the end of life the special rules apply and an SR1 form from the child's doctor or specialist should be sent as well.

Who files DLA1A Child?

Parents claiming for a child under 16 who needs extra care or has walking difficulties
Step-parents, guardians, grandparents, foster parents or older siblings who look after the child
Families claiming under the special rules for a child nearing the end of life
Anyone in England or Wales; children in Scotland claim Child Disability Payment instead

How to fill out DLA1A Child

Read the information booklet that comes with the form, then answer question 1 on whether you are claiming under the special rules.
Fill in the child's details in block capitals, along with your own details as the person making the claim.
Work through the care questions on the help the child needs by day and at night, and the mobility questions on how they get about, giving examples rather than one word answers.
Add the details of the doctors, hospitals, schools and other professionals who know about the child's condition, and gather the supporting evidence the booklet lists.
Sign the form yourself, then print it and post it to Freepost DWP DLA Child. Write only that address on the envelope; no postcode and no stamp are needed.

Worth knowing: DLA for children applies in England and Wales. In Scotland, apply for Child Disability Payment instead, and in Northern Ireland apply through nidirect. Under the special rules, send an SR1 form from the child's doctor, and do not hold the claim back waiting for it.

Quick fill DLA1A Child on this page

Prefer to see the form itself while you type? Open DLA1A Child 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 1 1 fields

If you would like to be sent a text message confirming we have received this form, please provide a mobile number.

Page 2 12 fields

Are you claiming for a child under the special rules?

The child's sex

The child's home address where they normally live.

second line of their home address

Third line of their home address

Postcode

The child's surname or family name

All the child's other names in full

Any other names the child has had

The child's National Insurance (NI) number

The child's date of birth. D D / M M / Y Y Y Y

The child's nationality.

Page 3 8 fields

If the child is Swiss or European Economic Area (EEA) national, were they living in the United Kingdom (UK) before 1 January 2021?

Does the child normally live in England or Wales?

Has the child moved from Scotland to live in England or Wales since 1 July 2021?

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

Is the child getting or have they made a claim for Child Disability Payment?

Has the child moved from another country in the last 3 years to live in Great Britain (GB)?

What date did they arrive in GB? D D / M M / Y Y Y Y

Please tell us the child’s Passport Number, if known

Page 4 23 fields

Has the child been abroad in the last 3 years?

Row 1 - Date the child left GB. D D / M M / Y Y Y Y

Row 1 - Date the child arrived back in GB. D D / M M / Y Y Y Y

Row 1 - Where they went?

Row 1 - Why they went?

Row 2 - Date the child left GB. D D / M M / Y Y Y Y

Row 2 - Date the child arrived back in GB. D D / M M / Y Y Y Y

Row 2 - Where they went?

Row 2 - Why they went?

Row 3 - Date the child left GB. D D / M M / Y Y Y Y

Row 3 - Date the child arrived back in GB. D D / M M / Y Y Y Y

Row 3 - Where they went?

Row 3 - Why they went?

Row 4 - Date the child left GB. D D / M M / Y Y Y Y

Row 4 - Date the child arrived back in GB. D D / M M / Y Y Y Y

Row 4 - Where they went?

Row 4 - Why they went?

Row 5 - Date the child left GB. D D / M M / Y Y Y Y

Row 5 - Date the child arrived back in GB. D D / M M / Y Y Y Y

Row 5 - Where they went?

Row 5 - Why they went?

Is the child’s parent or guardian getting any pensions or benefits from a European Economic Area (EEA) state or Switzerland?

Is the child’s parent or guardian working in or paying insurance to an EEA state or Switzerland?

Page 5 19 fields

Is the child currently in a hospital?

Please tell us the date they went in. D D / M M / Y Y Y Y

Please tell us the full name and address of the hospital.

Second line of the address

Third line of the address

Postcode

Phone number of the hospital.

Why did they go in?

Is the NHS paying the costs for their stay?

Has the child had any overnight stays at a hospice, residential college or similar accommodation in the last 12 months?

Please tell us the date they went into the overnight accommodation. D D / M M / Y Y Y Y

Please tell us the date they came out of the overnight accommodation. D D / M M / Y Y Y Y

Please tell us the full name and address of the accommodation.

Second line of the address

Third line of the address

Postcode

Phone number of accommodation, if you know it.

Did any of the following pay any of the costs towards them living there?

Name of authority or department

Page 6 16 fields

Has the child had or are they due to have any assessments by a health professional or specialist to help diagnose, manage or monitor their

Test 1 - Date and type of test.

Test 1 - What did the test show?

Test 1 - Are they waiting for results?

Test 2 - Date and type of test.

Test 2 - What did the test show?

Test 2 - Are they waiting for results?

Test 3 - Date and type of test.

Test 3 - What did the test show?

Test 3 - Are they waiting for results?

Test 4 - Date and type of test.

Test 4 - What did the test show?

Test 4 - Are they waiting for results?

Test 5 - Date and type of test.

Test 5 - What did the test show?

Test 5 - Are they waiting for results?

Page 7 2 fields

Do you have any letters or assessment reports about the child’s health conditions or disabilities that you can send us a copy of?

Tell us what reports you have.

Page 8 23 fields

Does the child have any health professionals, who are not their GP, who supports them with their health condition or disabilities?

Health professional’s name in full

Their relationship to the child?

First line of the Health Professionals work address

Second line of their address

Third line of their address

Postcode

A phone number we can contact them on, if you know it

The child’s hospital record number.

Which condition or disability did they see the child about?

What date did the child last have contact with them about their health condition or disabilities? D D / M M / Y Y Y Y

Child’s GP’s name

First line of GP's surgery address

Second line of the address

Third line of the address

Postcode

Surgery phone number, if you know it

Tell us the date the child last had contact with their GP about their health condition or disabilities. D D / M M / Y Y Y Y

Name of the school or nursery the child attends

First line of school or nursery's address

Second line of the address

Third line of the address

Postcode

Page 9 13 fields

Please tell us the name of someone we can contact at the school if we need more information

A phone number we can contact them on, if you know it

Their email address, if you know it

Is this a mainstream school?

Is this a specialist school?

What type of school is it?

Educational Health Care Plan

Individual Education Plan

Individual Behaviour Plan

A letter, note in lieu or a statement of Special Educational Needs from the local authority

Co-ordinated Support Plan

I am waiting to hear about one of the above

The child does not have any of the above reports, plans or statements

Page 10 4 fields

Is there anyone else who knows the child and can tell us about their difficulties?

The person giving their statement completes this box with the name of the child

The person giving their statement completes this box with the child's date of birth.

Statement of the person who knows the child

Page 11 10 fields

Name

Date of the signature. D D / M M / Y Y Y Y

The job or profession of the person giving the statement.

The phone number of the person giving the statement.

First line of the address of the person giving the statement.

Second line of the address

Third line of the address

Postcode

The person giving the statement's relationship to the child, if applicable.

When did the person giving the statement last see the child? D D / M M / Y Y Y Y

Page 12 2 fields

Do you give consent for the child’s doctor or other relevant professionals to give DWP more information about their health condition?

Date of signature. D D / M M / Y Y Y Y

Page 13 20 fields

Row 1 - Child's health condition or disability

Row 1 - How long has the child had the health condition or disability?

Row 1 - What treatment has the child had for their health condition or disability?

Row 1 - How often does the child have treatment?

Row 2 - Child's health condition or disability

Row 2 - How long has the child had the health condition or disability?

Row 2 - What treatment has the child had for their health condition or disability?

Row 2 - How often does the child have treatment?

Row 3 - Child's health condition or disability

Row 3 - How long has the child had the health condition or disability?

Row 3 - What treatment has the child had for their health condition or disability?

Row 3 - How often does the child have treatment?

Row 4 - Child's health condition or disability

Row 4 - How long has the child had the health condition or disability?

Row 4 - What treatment has the child had for their health condition or disability?

Row 4 - How often does the child have treatment?

Row 5 - Child's health condition or disability

Row 5 - How long has the child had the health condition or disability?

Row 5 - What treatment has the child had for their health condition or disability?

Row 5 - How often does the child have treatment?

Page 14 19 fields

Does the child use, or have they been prescribed or had an occupational health assessment for any aids or adaptations?

Row 1 - Aids and adaptations

Row 1 - What help does the child need to use the aid or adaptation?

Row 1 - Was this aid or adaptation prescribed by a healthcare professional?

Row 2 - Aids and adaptations

Row 2 - What help does the child need to use the aid or adaptation?

Row 2 - Was this aid or adaptation prescribed by a healthcare professional?

Row 3 - Aids and adaptations

Row 3 - What help does the child need to use the aid or adaptation?

Row 3 - Was this aid or adaptation prescribed by a healthcare professional?

Row 4 - Aids and adaptations

Row 4 - What help does the child need to use the aid or adaptation?

Row 4 - Was this aid or adaptation prescribed by a healthcare professional?

Row 5 - Aids and adaptations

Row 5 - What help does the child need to use the aid or adaptation?

Row 5 - Was this aid or adaptation prescribed by a healthcare professional?

Row 6 - Aids and adaptations

Row 6 - What help does the child need to use the aid or adaptation?

Row 6 - Was this aid or adaptation prescribed by a healthcare professional?

Page 15 2 fields

Does the child’s needs stay the same on the majority of the days or does it change from day to day?

Tell us how their needs change from day to day.

Page 16 5 fields

Can the child physically walk?

Does the child have any difficulties with standing and moving around due to a health condition or disability?

How far can they walk?

How long does it take them?

Please tell us about their walking speed

Page 17 5 fields

Please tell us about the way they walk

Please tell us about this.

Does the child have any other difficulties either during or after standing and moving around that affects their health?

Please tell us about this.

Do they need guidance or supervision most of the time when they walk outdoors?

Page 18 14 fields

Can they find their way around places they know?

Can they ask for and follow directions?

Can they walk safely next to a busy road?

Can they cross a road safely?

Can they understand common dangers outdoors?

Do they regularly become anxious, display distressed behaviours, show confusion and become disorientated?

Do they regularly display unpredictable behaviour?

Do they regularly need physical restraint?

Do they fall due to their health condition or disability?

Tell us the number of falls each month

When they fall, can they get up without help or assistance?

Have they had injuries from the falls needing hospital treatment?

Please tell us the date their mobility needs started. D D / M M / Y Y Y Y

If the child is eligible for help from Motability, would you like us to send you information about the help they can offer?

Page 19 1 fields

Tell us anything else we need to know about their difficulties with standing and moving around or how their needs change from day to day.

Page 20 7 fields

Does the child need encouragement, prompting, or assistance to settle in bed during the day?

How often each day do they need encouragement, prompting or assistance to help them get out of bed?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to help to get into bed?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to help settle in bed?

How many minutes does this take each time?

Page 21 15 fields

Page 22 16 fields

Do they need encouragement, prompting, or assistance with washing, bathing, showering and cleaning themselves during the day?

How often each day do they need prompting or assistance to wash or bathe?

How many minutes does this take each time?

How often each day do they need prompting or assistance to clean their teeth?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to wash their hair?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to get in or out of the bath?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to get in or out of the shower?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to clean themselves in the bath or shower?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to dry themselves after a bath or shower?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to check their appearance?

Page 23 12 fields

How many minutes does this take each time?

Do they need encouragement, prompting, or assistance to dress and undress during the day?

How often each day do they need encouragement, prompting or assistance to dress?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to undress?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to manage zips, buttons, or other fastenings?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to choose appropriate clothes?

How many minutes does this take each time?

Do they need encouragement, prompting, or assistance to eat and drink during the day?

How often each day do they need encouragement, prompting or assistance to eat?

Page 24 15 fields

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to use a spoon?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to cut up food on their plate?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to drink using a cup?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to be tube or pump fed?

How many minutes does this take each time?

Do they need encouragement, prompting, or assistance with managing their medication or monitoring or managing any treatments carried out at

How often each day do they need encouragement, prompting or assistance to take the correct medication?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to know when to take their medication?

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to manage their therapy?

Page 25 13 fields

How many minutes does this take each time?

How often each day do they need encouragement, prompting or assistance to remind them of when to do their therapy?

How many minutes does this take each time?

Do they have difficulty seeing?

Are they

Can they see computer keyboard keys or large print in a book?

Can they see a TV and follow the actions to a story?

Can they see the shape of furniture in a room?

Can they recognise someone’s face across a room?

Can they recognise someone across a street?

Do they have difficulty hearing?

Have they had an audiology test in the last 6 months?

Can they hear a whisper in a quiet room?

Page 26 21 fields

Page 27 14 fields

If they use another form of communication that has not been listed, please tell us.

Can they communicate with someone they know?

Can they communicate with someone they do not know?

Do they have fits, blackouts, seizures, or something similar?

Tell us what type they have and what happens:

Do they have any warning before a fit, blackout or seizure?

Can they recognise a warning and tell an adult?

Can they recognise a warning and take the appropriate action?

Have they had a serious injury in the last 6 months because of a fit, blackout or seizure?

Are they at risk of harm to themselves or others after a fit, blackout or seizure?

How many days on average does this happen each month?

How many fits do they have on average on these days?

How many nights on average does this happen each month?

How many fits do they have on average on these nights?

Page 28 12 fields

Have they had an episode of status epilepticus in the past 12 months?

Do they need to be supervised during the day to keep them safe?

Can they recognise and react to common dangers?

Can they cope with planned changes to daily routine?

Can they cope with unplanned changes to daily routine?

Do they regularly feel anxious or panic?

Do they regularly become upset or frustrated?

Do they regularly harm themselves or others?

Do they regularly feel someone may harm them?

Do they regularly become verbally abusive or display distressed behaviours that can cause harm to themselves or others?

Do they regularly act impulsively?

Do they regularly become overwhelmed or distressed?

Page 29 14 fields

Do they need extra help with their development?

Do they need help to understand the world around them?

Do they need help to recognise their surroundings?

Do they need help to follow instructions?

Do they need help to play with others?

Do they need help to play on their own?

Do they need help to join in activities with others?

Do they need help to behave appropriately?

Do they need help to understand, react and respond to other people’s behaviour?

Do they need encouragement, prompting or assistance at school or nursery?

Do they need encouragement, prompting or assistance to go to and use the toilet?

Do they need encouragement, prompting or assistance to safely move between lessons?

Do they need encouragement, prompting or assistance to change into different clothes for physical education and other school activities?

Do they need encouragement, prompting or assistance to eat meals?

Page 30 5 fields

Do they need encouragement, prompting or assistance to take medicine or manage their therapy?

Do they need encouragement, prompting or assistance to communicate?

What extra help do they need with their learning?

What is their behaviour like at school or nursery?

How do they usually get to and from school or nursery?

Page 31 25 fields

Do they need encouragement, prompting or assistance to take part in hobbies, interests, social or religious activities?

Activity 1

Help needed for activity 1

How often is the help needed for activity 1?

How long each time is the help needed for activity 1?

Activity 2

Help needed for activity 2

How often is the help needed for activity 2?

How long each time is the help needed for activity 2?

Activity 3

Help needed for activity 3

How often is the help needed for activity 3?

How long each time is the help needed for activity 3?

Activity 1

Help needed for activity 1

How often is the help needed for activity 1?

How long each time is the help needed for activity 1?

Activity 2

Help needed for activity 2

How often is the help needed for activity 2?

How long each time is the help needed for activity 2?

Activity 3

Help needed for activity 3

How often is the help needed for activity 3?

How long each time is the help needed for activity 3?

Page 32 15 fields

Due to a health condition or disability do they wake and need assistance or supervision during the night?

On average how many nights each week do they need encouragement, prompting or assistance to get into, get out of or turn in bed?

How many minutes does this take each time?

How many times a night do they need the help?

On average how many nights each week do they need encouragement, prompting or assistance to get to and use the toilet, manage nappies or

How many minutes does this take each time?

How many times a night do they need the help?

On average how many nights each week do they need encouragement, prompting or assistance to have treatment?

How many minutes does this take each time?

How many times a night do they need the help?

On average how many nights each week do they need encouragement, prompting or assistance to settle or re-settle?

How many minutes does this take each time?

How many times a night do they need the help?

On average how many nights each week do they need supervision because they are unaware of danger or may harm themselves or others?

How many minutes does this take each time?

Page 33 8 fields

How many times a night do they need the help?

On average how many nights each week do they need supervision because they may wander about?

How many minutes does this take each time?

How many times a night do they need the help?

On average how many nights each week do they need supervision because they have behavioural problems?

How many minutes does this take each time?

How many times a night do they need the help?

What date did the child's difficulties with their care needs start? D D / M M / Y Y Y Y

Page 34 1 fields

Tell us anything else we need to know about their difficulties with their daily living and care needs or how their needs change from day to

Page 35 19 fields

What is your relationship to the child?

Your surname or family name

All other names in full

Title

Your date of birth. D D / M M / Y Y Y Y

Your National Insurance (NI) number

Your address, if different to the child’s

Second line of your address

Third line of your address

Postcode

If you live in Wales do you want us to communicate with you in Welsh?

Email address

Telephone number

What is your nationality?

Are you getting or waiting to hear about Income Support?

Is anyone within your household getting or waiting to hear about Income Support?

Please tell us their name

Their National Insurance number

Their relationship to you

Page 36 7 fields

Name of the account holder

Full name of the bank or building society

First and second numbers of the sort code

Third and forth numbers of the sort code

Fifth and sixth numbers of the sort code

Account number

Building society roll or reference number

Page 37 1 fields

Tell us anything else you think we should know about the child’s day to day difficulties. If you are sending this form back after the

Page 38 2 fields

Print your name

Date of signature. D D / M M / Y Y Y Y

Page 39 7 fields

You have included full details for anyone else you have seen about the child at question 25

You have included full details of your GP at question 26

The person who completed question 38 has signed the declaration on page 11

You have ticked the relevant box about sharing information at question 39, and signed the statement about how DWP uses information

The person whose details are in About You on page 35 is the person who signs the consent and declaration on page 38

You have given us any extra information at question 89

If your claim is going to be late getting to us, you have told us the reason at question 89

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Frequently asked questions

Can the claim be backdated?

No. DWP states DLA can be paid from the start of your claim and cannot be backdated. The claim starts on the date you phone the helpline, provided you return the form within 6 weeks, or on the date the completed form reaches DWP.

How do I get a paper copy of the form?

Call the Disability Living Allowance helpline on 0800 121 4600 and ask for one to be sent to you. If you live in Wales and want the form in Welsh, call 0800 328 1744.

Can someone help me fill it in?

Yes. DWP says you can ask a relative, a friend or someone at an advice centre to help, but you must sign the form yourself if you can.

DLA1A Child: Disability Living Allowance (DLA) for children claim form

What is DLA1A Child?

Who files DLA1A Child?

How to fill out DLA1A Child

Quick fill DLA1A Child on this page

Frequently asked questions

Related forms

AA1: Attendance Allowance claim form

DS700: Carer's Allowance claim form

CH2: Child Benefit claim form