Liverpool City Council

Details

First name

Middle name - optional

Last name

Date of birth

National Insurance number

Address

Postcode

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Contact number

Details

Are you

Employed
Self-employed
Unemployed

If you are both employed and self-employed, select the option where you will lose most income.

Sorry, you are not entitled to a Test & Trace Support Payment. Please do not continue with the form, as you will not be able to submit it when reaching the end of the form.

Job role

If you have more than one job, enter the role where you will lose most income.

Employer name

Employer address

Employer contact number

Payroll reference

Employer contact

I consent to Liverpool City Council contacting my employer to verify my loss of income.

You cannot continue with this application if you don’t give us consent to contact your employer.

Nature of business

Name of business/limited company

Upload proof of self-employed status

This can be a copy or photo of your most recent accounts, self-assessment return or business bank account statement no more than 2 months old.

Details

Your relationship to the child

First name

Middle name - optional

Last name

Date of birth

Home address

Postcode

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Place of education or care setting

Child’s year group

Contact name for place of education or care setting

Email for place of education or care setting

Phone number for place of education or care setting

Your child’s first day of self-isolation

Does your child have an Education, Health and Care Plan (this is to support applications from parents and guardians of young people between 16 and 25 who have additional support needs)

Yes
No

Sorry, you do not qualify for this payment.

Details

You must provide one of the following:

Does your child have an 8 digit NHS Test & Trace ID number?

Yes
No

This is for parents and guardians of children or young people who have received a notification directly from NHS Test and Trace telling them to self-isolate.

Enter their 8 digit NHS Test and Trace ID number

Upload a copy of the child or young person’s notification

Have you received a communication from the child or young person’s education or childcare setting confirming that they have to self-isolate?

Yes
No

This is for parents and guardians of children or young people who have been told to self-isolate by their education or childcare setting because they have been identified as a close contact of someone who has tested positive.

Upload a copy of the communication received from education or care setting

Are you able to provide a screenshot of the young person’s NHS COVID-19 App notification telling them to self-isolate?

Yes
No

This is for parents or guardians of young people aged 16-25 who have additional support needs and who have been notified to self-isolate by the NHS COVID-19 App.

Upload a copy of the screenshot of the young person’s NHS COVID-19 App notification telling them to self-isolate

Can you confirm your child has an Education, Health and Care Plan?

Yes
No

Please note that we are required to check with child or young person’s education or childcare setting that the self-declared information you have provide about them is accurate.

Sorry, we cannot accept applications without at least one of the three/four pieces of supporting evidence listed above.

Details

Name of bank or building society

Account holder's name

Account Number

Sort code

Upload a copy of a recent bank statement

This must be no more than 2 months old and can be a photo of the bank statement showing the account holder’s name, account number and sort code. If you are entitled to a payment, we will pay it into this bank account.

If you are employed, it must also include proof of wages being paid in.

Confirmation

By submitting this form:
• I confirm I meet the criteria for a Test and Trace Support Payment under the main scheme or discretionary scheme.
• I confirm that the information I have provided is true and accurate.
• I have read the government guidance for the Test & Trace Support Payment scheme and confirm I meet the criteria.
• I am the parent or guardian of a child or young person in the same household and need to take time off work to care for them while they self-isolate
• I am employed and not able to work from home and will lose income as a result OR I am self-employed, my business cannot be carried out during the period that my child is self-isolating and I will lose income as a result of this.

Confirmation

I confirm the above

Before you submit this form please review your answers below. If you need to change anything, use the 'previous' button on the bottom left to go back to a section. Then submit the form by selecting the 'Submit button' at the bottom of this page

Parent or Guardian Application for a Test and Trace Support Payment