Partial Capacity Benefit Application Form (PCB1)

Published date07 June 2022
IssuerDepartment of Social Protection
Application form for
Partial Capacity Benefit
What is Partial Capacity Benefit?
Partial Capacity Benet (PCB) is a scheme available to people who have a restriction on their capacity to
work. They can be medically assessed as having a mild, moderate, severe or profound restriction.
Mild restriction: they do not qualify for payment
Moderate restriction: receive 50% of their underlying entitlement
Severe restriction: receive 75% of their underlying entitlement
Profound restriction: receive 100% of their underlying entitlement
There is no restriction as to the number of hours or days worked.
How to complete this application form?
There is an example on the back of this page that can be used as a guide to ll in this form. Please:
Write with a black ballpoint pen, use capital letters and place an X in the relevant boxes;
Answer all questions;
Remember to include any supporting medical evidence as requested in Part 7;
Ensure that you sign Part 1, Part 8 and Part 9, giving your doctor permission to give this department
the necessary medical information required for your application; and
Ensure that your doctor completes Part 10 and supplies any supporting medical evidence which should
be returned with your application form.
How can I get help and further information?
If you need any help to complete this form, please contact your local Intreo Centre, Branch Oce or any
Citizens Information Centre. You can nd the name and address of your local Intreo Centre or Branch
Oce by visiting www.gov.ie/intreocentres. For more information, visit www.gov.ie/PCB.
Data Classification R
Social Welfare Services
PCB 1
What are the qualifying criteria?
Partial Capacity Benet (PCB) has two qualifying schemes:
Customers who qualify having been in receipt of Invalidity Pension; and
Customers who qualify having been in receipt of Illness Benet for a minimum of 6 months.
To qualify for PCB, a customer:
Must be in receipt of either Invalidity Pension (no minimum period), or Illness Benet for a period of 6
months;
Must have a moderate, severe or profound restriction on their capacity to work. This is determined by a
Department Medical Assessor who reviews information provided by your doctor and makes an
assessment on your capacity to work.
Your application must be received prior to you starting work. The department may accept your
application if it is received within 21 days of starting work.
How long does entitlement last?
For Invalidity Pension customers entitlement lasts for 156 weeks. Once this period has elapsed,
customers can re-apply for a further 156 weeks. Partial Capacity Benet with Invalidity Pension as the
underlying scheme can only be paid to the age of 66.
For Illness Benet (IB) recipients entitlement to PCB lasts for as long as entitlement to Illness Benet
remains. IB can be paid for 624 days. A customer must be on IB for 6 months before applying; therefore,
the maximum duration that an Illness Benet customer can remain on IB is 468 days, or 18 months.
Doctor:
Please fill in the medical report at Part 10 and enclose any up to date medical evidence in support of
this application. Also please make sure you sign and stamp Part 10.
Your detailsPart 1
To help us process this form please write letters and numbers clearly and use one box for
each. See examples below.
How to fill in this form
SAMPLE
MURPHY
M A U R E E N
MARY
XMr Mrs Ms Other
M C D E R M O T T
1234567T ID Verified Yes No
X
2 8 0 2 1 97 0
D D M M Y Y Y Y
K E L L Y
1N E W S TR E E T
OL D T O W N
DON E G A L T O W N
DON E G A L C1 5 A 9 6V
Eircode
County
0881234567
M M U R P H Y@ W E L F A R E .I E
053931234 5
M O B I L E
L A N D L I N E
1. PPS Number:
3. Surname:
4. First names:
2. Title, insert an X or specify:
6. Birth surname if different:
8. Date of birth:
5. First name as
it appears on your birth
certificate:
7. Mother’s birth
surname:
9. Address:
10. Telephone number:
11. Email address:

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