Statutory Sick Pay (SSP) Enhancement Scheme claim form for Personal Assistant paid through direct payments

Before you begin

You'll need to complete this claim form for each absence.

Before you can claim for any absences, you'll need to provide us with an SSP declaration form. You will only need to provide us with a declaration form once.
Have you provided us with an SSP declaration form previously?
YesNo

Declaration form

The employee declaration form is to obtain the employee’s consent to the sharing of their personal data.

Employees only need to submit one form, and this will cover any subsequent periods of absence from work.
Please upload your declaration form

Details of absence being claimed
Please provide us with the details of the absence you would like to claim the SSP enhancement scheme for.
Your name (Name of personal assistant)
Your email address
Your National Insurance Number
Name of direct payment recipient (employer)
Your reasons for absence (select all that apply)
Undertaking a PCR test and awaiting results due to; symptoms of COVID-19, a person you reside with having symptoms of COVID-19 or being identified as a contact by the NHS Wales Test Trace Protect or via the app, where you are fully vaccinatedSelf-isolating due to; testing positive for COVID-19 or being identified as a contact by the NHS Wales Test Trace Protect service or via the app, where you are not fully vaccinatedYour employer requires you to stay off work because you were identified as a contact by the NHS Wales Test Trace Protect service or via the app and: you are living with the person who has tested positive for COVID-19, your employer cannot redeploy you to non-service user facing duties and you are fully vaccinated or, you are working with people who are immunosuppressed and/or are clinically extremely vulnerable
Dates of absence
The payment is payable from the first day of absence and continues for the maximum period of 10 days (the current period of self-isolation). The duration of absence will often be less than 10 days due to the calculation of ‘day one’. In many instances it will often be a very brief period awaiting a test result to allow a return to work.
Date of start of absence
Date at end of absence
Number of hours of absence

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Statutory Sick Pay (SSP) Enhancement Scheme claim form for Personal Assistant paid through direct payments

What happens to my information?