Completing the Income and Assets (SA369) 106-07110090

This document outlines how to complete an Income and Assets (SA369) form. The SA369 is used to assess a customer's entitlement to an income Support Payment (ISP) or Farm Household Allowance (FHA). It helps to establish if further information and investigation is required and asks the customer to provide supporting documents to confirm their income and assets.

Use of the SA369 form

The form gathers information about income, assets, real estate and compensation. Customers completing an online or assisted customer claim are asked the same questions as on the SA369 form.

Only one form is required for partnered customers, as all questions in the form include the partner's income and assets. Income and assets details for both the customer and their partner must be obtained even if the partner is not claiming. When completing the form, customers should decide who the applicant is and who the partner is. There is also an option on the front page where customers can indicate if they wish to complete separate forms.

If the customer's income and assets are complex, they may need expert help such as a financial adviser or accountant to help them complete this form, but the customer must sign it. A non-claimant spouse is not required to sign the form, but if both members of a couple are claiming a payment, the signature of both members of a couple is required.

If the customer and/or their partner have more than one property, and/or more than one claim for compensation, insurance or damages, additional MOD R and MOD C forms should be issued.

If the customer is partnered and Person Permitted to Enquire (PPE) is 'no' on the partner's record, the customer will be asked to provide a MOD iA at Next Steps when they submit their online claim.

The Resources page contains links to relevant forms.

Operational Information

Completing the Income and Assets (SA369) 106-07110090

Use of the SA369 form

Related links