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* 1. Which category of issue does your loved one have? (You can select more than one)

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* 2. What sort of care do you provide? (You can select more than one)

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* 3. Have you ever applied for (You can select more than one):

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* 4. Have you been successful in your carer related payment claim(s)?

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* 5. If you were successful, which benefits were you successful in claiming?

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* 6. If the answer is ‘No’ for any of the payments, which of the reasons were you given? (You can select more than one)

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* 7. How many hours per week do you spend on any kind of care (direct care / supervison or monitoring) with the person?

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* 8. How many hours per week do you work, study or train?

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* 9. How many hours per week you spend providing direct care or support to the person your care for?

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* 10. When can you leave the person you care for unattended or without support?

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* 11. How much of each week to you need to be available if required for your loved one’s unexpected needs? (i.e. “‘How often are you ‘on-call’”).

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* 12. Are you prevented from undertaking other major commitments with your time due to your caring role?

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* 13. If ‘Yes’, what types of things are you unable to do because of your caring role (you may pick more than one):

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* 14. Please comment on any other impacts on your life or commitments.

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