Form SSP1
If you are an employer section (Employer to complete)
Q1. Please tick one of the following boxes
Options: I have enclosed medical information that covers a period I cannot pay SSP; I have not enclosed medical information
Guidance: If you are an employer, please tick one of the following boxes. When you have completed this form, you must give it to the employee. For more information about SSP go to www.gov.uk/employers-sick-pay. Or you can contact HM Revenue and Customs Employer helpline on 0300 200 3200.
If you are an employer section (Employer to complete)
Q2. I declare that the information I have given on this form is correct and complete as far as I know and believe.
Guidance: I understand that if this employee has been getting SSP, I must continue to pay SSP up to and including the day before the date I have written in the About your employee section of this form.
If you are an employer section (Employer to complete)
Q3. 01 Employer’s name
If you are an employer section (Employer to complete)
Q4. 02 Employer’s signature
If you are an employer section (Employer to complete)
Q5. 03 Date
If you are an employer section (Employer to complete)
Q6. 04 Position in firm
If you are an employer section (Employer to complete)
Q7. 05 Phone number
If you are an employer section (Employer to complete)
Q8. 06 Fax number
If you are an employer section (Employer to complete)
Q9. 07 Email address
If you are an employer section (Employer to complete)
Q10. 08 Employer’s address
If you are an employer section (Employer to complete)
Q11. 09 Employer’s stamp
About your employee (Employer to complete)
Q12. 10 Title
Guidance: For example Mr, Mrs, Miss, Ms or other
About your employee (Employer to complete)
Q13. 11 Surname or family name
About your employee (Employer to complete)
Q14. 12 All other names, in full
About your employee (Employer to complete)
Q15. 13 Address
About your employee (Employer to complete)
Q16. Postcode
About your employee (Employer to complete)
Q17. 14 National Insurance (NI) number
About your employee (Employer to complete)
Q18. 15 Clock, payroll or employee number
About your employee (Employer to complete)
Q19. 16 Tax reference number
Guidance: This is also known as the Employee PAYE reference.
About your employee (Employer to complete)
Q20. 17 Have you been paying your employee SSP?
Options: No; Yes
Guidance: Please tell us the start and end dates of the payment. From To If payment has not ended yet, please tell us the date when it will end.
About your employee (Employer to complete)
Q21. From
About your employee (Employer to complete)
Q22. To
About your employee (Employer to complete)
Q23. If payment has not ended yet, please tell us the date when it will end.
Why you cannot get Statutory Sick Pay (Employer to complete)
Q24. You cannot get SSP on or after this date
Guidance: This is because: You got Employment and Support Allowance during the last 12 weeks. Your contract of employment has ended or were coming to an end. You became sick after your contract of employment ended. You were away from work because of a trade dispute which started before the first day you were sick. (Note for employee: Your employer will have to pay you SSP if they ended your contract solely or mainly to avoid paying SSP.) You were sick while in legal custody. Or you are now in legal custody or have been given a prison sentence. (Note for employee: You may get SSP if you were already getting it when the dispute began you may get SSP if you can show you were sick and had no direct involvement in the dispute – for example this could be a strike, a walkout or a lockout. You are expecting a baby soon or you have just had a baby. You were working outside the UK on the day you first became sick and your employer did not have to pay employer’s class 1 National Insurance contributions on your earnings on that day. You have not started working for your employer yet. You did not tell your employer about your sickness.
If you are an employer section (Employer to complete)
Q1. Please tick one of the following boxes
Options: I have enclosed medical information that covers a period I cannot pay SSP; I have not enclosed medical information
Guidance: If you are an employer, please tick one of the following boxes. When you have completed this form, you must give it to the employee. For more information about SSP go to www.gov.uk/employers-sick-pay. Or you can contact HM Revenue and Customs Employer helpline on 0300 200 3200.
If you are an employer section (Employer to complete)
Q2. I declare that the information I have given on this form is correct and complete as far as I know and believe.
Guidance: I understand that if this employee has been getting SSP, I must continue to pay SSP up to and including the day before the date I have written in the About your employee section of this form.
If you are an employer section (Employer to complete)
Q3. 01 Employer’s name
If you are an employer section (Employer to complete)
Q4. 02 Employer’s signature
If you are an employer section (Employer to complete)
Q5. 03 Date
If you are an employer section (Employer to complete)
Q6. 04 Position in firm
If you are an employer section (Employer to complete)
Q7. 05 Phone number
If you are an employer section (Employer to complete)
Q8. 06 Fax number
If you are an employer section (Employer to complete)
Q9. 07 Email address
If you are an employer section (Employer to complete)
Q10. 08 Employer’s address
If you are an employer section (Employer to complete)
Q11. 09 Employer’s stamp
About your employee (Employer to complete)
Q12. 10 Title
Guidance: For example Mr, Mrs, Miss, Ms or other
About your employee (Employer to complete)
Q13. 11 Surname or family name
About your employee (Employer to complete)
Q14. 12 All other names, in full
About your employee (Employer to complete)
Q15. 13 Address
About your employee (Employer to complete)
Q16. 14 National Insurance (NI) number
About your employee (Employer to complete)
Q17. 15 Clock, payroll or employee number
About your employee (Employer to complete)
Q18. 16 Tax reference number
Guidance: This is also known as the Employee PAYE reference.
About your employee (Employer to complete)
Q19. 17 Have you been paying your employee SSP?
Options: Yes; No
Guidance: Please tell us the start and end dates of the payment. From To If payment has not ended yet, please tell us the date when it will end.
About your employee (Employer to complete)
Q20. From
About your employee (Employer to complete)
Q21. To
About your employee (Employer to complete)
Q22. Postcode
Why you cannot get Statutory Sick Pay (Employer to complete)
Q23. Why you cannot get Statutory Sick Pay
Guidance: You cannot get SSP on or after this date. This is because: You got Employment and Support Allowance during the last 12 weeks. Your contract of employment has ended or were coming to an end. You became sick after your contract of employment ended. You were away from work because of a trade dispute which started before the first day you were sick. (Note for employee: Your employer will have to pay you SSP if they ended your contract solely or mainly to avoid paying SSP.) You were sick while in legal custody. Or you are now in legal custody or have been given a prison sentence. (Note for employee: You may get SSP if you were already getting it when the dispute began. You may get SSP if you can show you were sick and had no direct involvement in the dispute – for example this could be a strike, a walkout or a lockout. You are expecting a baby soon or you have just had a baby. You were working outside the UK on the day you first became sick and your employer did not have to pay employer’s class 1 National Insurance contributions on your earnings on that day. You have not started working for your employer yet. You did not tell your employer about your sickness.
Employee - what to do now
Q24. Employee - what to do now
Guidance: If you disagree with your employer’s decision not to pay you SSP, ask your employer to explain it to you. If, after talking to your employer, you are still unsure about this decision you can visit www.gov.uk/statutory-sick-pay for more information. Ask your employer for a reason if you think: • their decision not to pay you SSP is wrong • you are not getting the right amount of SSP. If you still disagree, you can phone HM Revenue & Customs Statutory Payments Dispute team for advice. Telephone: 0300 322 9422. If you are still off work because of an illness or disability you may be able to get money and support: • to help you get back to work, or • if you are not able to work in the long term. You may be able to apply for Universal Credit or get help with housing costs. Your employer will return any medical information they have to you for future benefit applications. If you have paid enough National Insurance contributions, usually in the last 2 full tax years you may be able to apply for: • New Style Jobseeker’s Allowance • New Style Employment and Support Allowance. Please visit www.gov.uk/browse/benefits to find out more. You could ask your family, or someone you know, if you can use their internet access. You can also get access to the internet in your local jobcentre. If you need more information on what benefits you might be able to apply for, local welfare advice services, such as Citizens Advice, may be able to help you. Please note, this form is not an application for benefit.