SICAP 2018-2023

IRIS INDIVIDUAL BENEFICIARY TEMPLATE (V1.6)

SICAP-2-Individual-Beneficiary-Template-Jan2023-v1.6

1. Personal Details

Click here to locate your eircode

No Official Address, if No, specify reason*:

2. Registration / Consent

Consent requests
How did the Individual hear about SICAP services:* (Select one option only)

3. Profile

Radio Buttons
Age Band:*

4. Status at Registration

PRINCIPAL ECONOMIC STATUS* AT REGISTRATION

(Select from one of the three options and answer any related questions)

(i) Unemployed (Select one of four options)
(ii) Economically Inactive due to (Select one of six options)
F-T Student
Retired
(iii) Employed: (Select one of four options and answer Low Income Worker/Household question)
Underemployed*
If you have selected an option under (iii) Employed, please complete the following question:
Low Income Worker/Household*:
Mandatory fields are marked with an asterisk (*). Do not leave blank. For pre-registration, complete the mandatory fields on IND 1 only.
Double asterisk (**) refers to sensitive questions on Disability and Ethnic/cultural background which are only mandatory if consent has been given.

4. Status at Registration (continued)

HIGHEST LEVEL OF EDUCATIONAL ATTAINMENT* AT REGISTRATION (Select one option only)

5. TARGET GROUP/BACKGROUND

Lone Parent*
Nationality/Region* (Select one option only)
New Communities*
If Yes specify* (Select one option only)
Foreign Background*
Person with a Disability**
Ethnic/Cultural Background** (Select one option only)
White Asian or Asian Irish Black or Black Irish
ethnic
Ethnic/Cultural Background** (Select one option only)

6. HOUSEHOLD SITUATION

Jobless Household:*
Homeless or Affected by Housing Exclusion:*
Is Transport a Barrier?*