East Sussex DP Support Service Referral Form

Please use the form below if you are social care worker and would like to refer someone to our East Sussex Direct Payment Support Service. If you have any questions or need any support then please email advice@independentlives.org.

If you are receiving a Direct Payment funded by East Sussex and require our support, please contact us on 01903 219482 and select option three.

East Sussex DP Support Service Referral Form

Client Information

Name
Permanent address
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Client Group

Is this for a DP or DPSP (Direct Payment to a Suitable Person)?

If this is for a DPSP, who is the appointed nominated person?

Name:
Address of contact
If this is for a DP is the client to receive and manage the DP themselves?

If the client is to receive and manage the DP with assistance please indicate who is assisting the client

Name of person assisting
Does the client already have a Direct Payment and need support to review employment practice and find a PA?

In all cases except DP information enquiries, please provide details of agreed outcomes and Indicative budget so that we can support to develop job descriptions and detailed budgets

Reason for referral (please tick boxes)
Agreed outcomes attached?(Required)
Without the outcomes we cannot support clients to create Job Descriptions/Adverts or manage expectations.
Please attach agreed outcomes here
Drop files here or
Max. file size: 16 MB.
    Indicative budget attached or detailed below?(Required)
    The indicative budget is needed to support clients to work out employment costs and PA hours.
    Please attach indicative budget here unless detailed below.
    Drop files here or
    Max. file size: 16 MB.
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      A woman in a yellow cardigan using a laptop at a desk, seated in a wheelchair.