If you live in Aberdeen City, Argyll and Bute, Highland, Orkney Islands or the Shetland Islands, you need to apply for Pension Age Disability Payment instead of Attendance Allowance.

Read the Attendance Allowance guidance before you apply.

You cannot complete the form using a mobile phone or tablet. You have to either:

Call the Attendance Allowance helpline to ask for a paper form.

Use a PDF reader to open and fill in this form. You can download a free PDF reader online.

If you are using screen reader software to access the form, we recommend that you review all of the notes and the questions on the form before you complete it. As you complete the form, you will be guided through the questions based on the responses you provide.

Do not use your computer’s browser or, if you are an Apple Macintosh user, the Preview application.

You can save data typed into this form if you use a PDF reader. This means that you do not have to fill in the form in one session.

There are reliability issues with some assistive software, which may mean the form will not save properly.

This form will only save if it is both:

The form will not save in:

For help and advice on the information you need to put on the form or about the benefit you want to claim, contact the Attendance Allowance helpline.

Contact the DWP Online Helpdesk, if you are having technical difficulties:

Find out about call charges

Send the completed form to:

Do not write anything except the freepost address on the envelope. You do not need a postcode or a stamp.

Contact the Attendance Allowance helpline to ask for: