Can I just check, do you currently receive disability benefits of any kind?

Which ones do you receive?

Part 1:
Yes
No

Part 2:
Severe Disablement Allowance.
Industrial Injury
Disablement Allowance
Disability Living Allowance /
Care Component
Disability Living Allowance /
Mobility Component
Disability Living Allowance /
Components not known
Attendance Allowance
Carer’s Allowance
(formerly Invalid Care Allowance)
War Disability Pension.
Incapacity Benefit

Problems or disability connected with: arms, legs, hands,
feet back, or neck (including arthritis and rheumatism)
Difficulty in seeing (other than needing
glasses to read normal size print).
Difficulty in hearing
Skin conditions/allergies
Chest/breathing problems, asthma, bronchitis
Heart/high blood pressure or blood circulation problems
Stomach/liver/kidneys or digestive problems
Diabetes
Anxiety, depression or bad nerves, psychiatric problems
Alcohol or drug related problems Epilepsy.
Migraine or frequent headaches
Cancer
Stroke
Other health problems (PLEASE GIVE DETAILS).