Supplementary Welfare Allowance Application Form (SWA1)

• Published date: 12 February 2020
• Issuer: Department of Social Protection

Application form for

Supplementary Welfare Allowance Data Classification R

Social Welfare Services

SWA 1

What is Supplementary Welfare Allowance?

Supplementary Welfare Allowance (SWA) is a scheme to provide nancial assistance to you when your

means are not enough to meet your needs.

The SWA payment can be made weekly, monthly or you may get a once o payment. The information you

provide on this form will determine the type of payment that you may receive.

Some examples of payments are:

Basic Supplementary Allowance - weekly payment while waiting on another payment, or if you don’t

qualify for another payment.

Additional Needs Payment - a payment available to you if you have expenses that you cannot pay from

your weekly income. You may get this payment even if you are not getting a social welfare payment. It also

may be available to you if you are working and on a low income.

Additional Needs Payment can include assistance with:

• fuel and electricity bills;

• essential repairs to property and replacing household appliances and

furniture;

• deposits for private rented accommodation;

• furniture, bedding and other items if you are setting up a home for the rst time;

• funeral costs;

• recurring travel expenses such as for hospital appointments or visiting relatives in hospital or prison;

and

• payment to meet immediate needs in case of an emergency event, for example a house re.

How do I qualify for Supplementary Welfare Allowance?

To get Supplementary Welfare Allowance you must:

• be living in Ireland; and

• need help to provide for your needs and those of your family.

How do I complete this 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 that apply to you; and

• read the checklist in Part 8 and sign the declaration in Part 7.

Note: You will need your Personal Public Service (PPS) Number along with information on where you

live, your children, your relationship status and where you want payment to issue. You may be asked for

additional information and to provide written evidence to support your application.

How do I apply?

To apply please send or bring this completed application form, along with the relevant supporting

documents, to your local Intreo Centre or an oce administering Supplementary Welfare Allowance.

If you need help in completing this form, please visit your local Intreo Centre, Social Welfare Oce or any

Citizens Information Centre. The name and address of your local Intreo Centre or Social Welfare Oce

can be found by visiting www.gov.ie/intreocentres.

For more information, please visit www.gov.ie/SWA.

You can apply for certain Additional Needs Payment at MyWelfare.ie.

To help us process this form please write letters and numbers clearly and use one box for each.

Please see examples below.

How to fill in this form

Your detailsPart 1

1. Which payment you are applying for: Other Assistance

Weekly Income Support

THERE WAS A FIRE IN MY HOUSE AND MY HOURS OF WORK WERE REDUCED.

2. Are you getting or have you applied for any social protection payment

in Ireland or another country? Yes No

If yes, please state

name of payment: CARERS BENEF I T

3. PPS Number: 1234567T

Mr Mrs Ms4. Title, insert an X or specify:

6. First names: M A U R E E N

5. Surname: M C B R I D E

7. Birth surname, if different: M U R P H Y

8. Date of birth: 1 0 0 5 1 9 7 0

D D M M Y Y Y Y

X

X

Please give the reasons why you are applying for Supplementary Welfare Allowance in the box below

and any other information that you believe will help us process your application. Please use capital

letters:

Other

or

For Oce Use

BASI

ENP

SUPP

UNP

SAMPLE

X