From (Agency Name)Client Ref:

North Staffs Advice NetworkESA Sanctions Client Questionnaire

  1. Client Background

Please give a brief description of the client (age, gender, disability, ethnic origin,marital status) and their family circumstances(if s/he has children or partner).

  1. How long has the client been receiving ESA or receiving N I Credits?

Less than 6 months

6- 12 months

Over 1 year

  1. Is the client in the Assessment Phase, Work Related Activity Group or Support Group?

Assessment Phase

Work Related Activity Group

Support Group

Unknown

  1. Is client on a Work Programme?

Yes

No

If client is on a Work Programme please answer the following questions (if not go to Q9)

  1. What is the name of the Work Programme provider

SERCO

ESG (Employment and Skills Group)

Other – please state

Unknown

  1. Does the client understand that failure to attend interviews with the Work Programme provider or carry out activities as part of the Work Programme will lead to a sanction?

Yes

No

  1. How does the client feel about being on the Work Programme (tick all that apply)?

Confused – they do not understand what the Work Programme is and why they are on it

Anxious – they are concerned that they could be sanctioned if they do not do everything they are told do

Not bothered about it – the Work Programme provider is not bothering them very much and they are happy to attend interviews

Encouraged – they feel the Work Programme provider is helping them to overcome barriers to work by helping them to gain new skills

Other – please give more information

  1. How has being on the Work Programme affected their health?

Health has improvedas a result of the support received under the Work Programme

No change

Health problems have deteriorated due to the stress of being on the Work Programme

If the client is not on a Work Programme please answer the following questions

  1. Are they being asked to attend Work Focussed interviews at the Jobcentre?

Yes

No

  1. Does the client understand that failure to attend interviews with the Jobcentre provider or carry out work-related activities will lead to a sanction?

Yes

No

Sanctions

  1. Has the client ever received an ESA sanction?

Yes

No

  1. Why were they sanctioned? (tick one)

Client doesn’t know why

Missed appointment with the Jobcentre/Work Programme Provider

Failed to carry out a work-related activity such as attending a training programme

Other please state

  1. How long did the sanction last for?

State number of days/weeks -

  1. Was this the first sanction?

Yes

No

If no please give more information about previous sanctions

  1. Does the client understand how the sanction process works?

Yes

No

  1. Does the client know what s/he could have done to avoid the sanction?

Yes

No

  1. Has the client requested a Mandatory Reconsideration or appealed the sanction?

Yes

No

Did not know s/he could appeal the sanction

  1. Is the client aware of financial assistance such as Local Welfare Provision or ESA hardship payments that could be available to him/her and how to access this assistance?

Yes

No

Was referred to the Foodbank

  1. How has the sanction affected the client and his/her family? (tick all that apply)

Has had to use a Foodbank/Soup kitchen

Is going without meals to feed children

Has no money for gas and electricity

Health of client and family has worsened

Has taken out a Payday loan/used a pawnbroker

Has borrowed from family

Has no money for travel to get to a Jobcentre/Work Programme Provider

Other – please state

20.Please use this box to tell us more about the client’s experiences

Please returnto:

Deborah Williamson, Staffordshire North and Stoke Citizens Advice Bureau, Advice House; Cheapside, Hanley, Stoke-on-Trent ST1 1HL

By 31stMay 2015