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Are you being transferred from Incapacity Benefit to Employment and Support Allowance? Or from Disability Living Allowance to Personal Independence Payment? Are you making a fresh claim or renewal claim? Or pursuing a mandatory reconsideration or appeal for ESA, PIP or DLA?

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 The form is based on the new DLA claim pack and, if adopted< will see the AA pack increasing in size by over a third.

The AA pilot form is 26 pages long, a rise of 7 pages on the current form. The main increase is in relation to care needs. Instead of a single box for providing information about help needed during the day, there are now numerous questions in a similar format to the DLA form.

For example, in relation to getting in and out of bed there are tick boxes to say 'Yes' to:

I have difficulty or need help:
Getting into bed
Getting out of bed

I lack motivation and need:
Encouraging to get out of bed in the morning
Encouraging to go to bed at night.

For some activities there are simply tick boxes to indicate Yes for each named problem, as above. For others, there is instead a box to complete for 'How often' the claimant needs help.

Getting in and out of bed. 'Yes' boxes.
Toilet needs. 'How often' boxes.
Washing, bathing, showering. 'How often' boxes.
Dressing and undressing. 'How often' boxes.
Moving around indoors. 'Yes' boxes.
Falls or stumbles. 'Why', 'How often' and 'Do you need help to get up' boxes.
Eating and drinking. 'How often' boxes.
Medication. 'How often' boxes.
Communicating. 'Yes' boxes.
Hobbies. 'How often' boxes.
Someone to keep an eye on you. 'Yes' boxes for different hazards such self neglect and confusion.

Each activity has an additional 'anything else you want to tell us' box.

There is also a page for help needed at night, with boxes for 'How often' and 'How long each time you need help' with such things as toilet needs and turning over
Finally, there is a page on needing someone to watch over you at night with tick boxes for different hazards.

No indication has yet been given as to whether the pilot form will be introduced nationally. But, given that such a form would work effectively with the computer led decision making system being introduced for DLA, it seems probable that the days of the short AA form are numbered.

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