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If you cannot apply online for the NHS Low Income Scheme

If we have told you that you cannot apply online, you need to complete an application for help with health costs (HC1 form) and post it back to us.

Evidence to support your application

You must include proof of your income with your HC1 application form.

Employed

If you're employed, you must send proof of your earnings:

  • if you get paid weekly or fortnightly, you must send your 5 most recent payslips
  • if you get paid monthly or four-weekly, you must send your 2 most recent payslips

If you cannot send these payslips, complete the LIS82 proof of income form (PDF: 253KB) and send it with your application.

Self-employed

If you're self-employed, you must send your profit and loss accounts for a period representing at least 6 months. The period they cover must end within 12 months of the date of your claim. If you're also claiming a refund, the period they cover must end within 12 months of the date you paid the charges.

If you cannot send profit and loss accounts, you can send a trading account showing your business receipts and expenses for the period ending within 12 months before the date of the claim.

You'll also need to complete self-employment proof of income form LIS61 (PDF: 251KB) and send it with your application.

If the business has been trading for less than a year, or the trading pattern has recently changed, the assessment period will be adjusted to reflect this.

Students

If you're a student, you must send:

  • an award notice or other evidence of all the money you get from grants, bursaries and awards
  • a copy of the financial assessment that was carried out if you applied for a student loan - even if you did not get the loan

If you work while studying, you must also send proof of your employed or self-employed earnings.

If you live in England

You can order an HC1 form online and we will post it to you. Or you can download and print:

Application for help with health costs: HC1 (PDF: 634KB)

If you live in Scotland

You can download and print:

Application for help with health costs (Scotland): HC1(SC) (PDF: 124KB)

Or you can get a form from Jobcentres, GP practices, pharmacies and Citizens Advice.

If you live in Wales

You can download an HC1 form from the Welsh Government (GOV.WALES) website.

You can also telephone: 0345 603 1108. Select the option for health publications to get a copy sent to you.

You may also be able to get an HC1 form from Jobcentres, NHS hospitals, dentists and opticians.

If you live in Northern Ireland

You can download a form from the nidirect website.

You may also be able to get a form from a Jobs and Benefits office, your local doctor, dentist, pharmacist, optician or hospital.

If you need help

If you need any help making your claim, telephone: 0300 330 1343.

Find out about call charges

Where to send your application form

Send your completed application form with supporting evidence to:

NHS Low Income Scheme
NHS Business Services Authority
Bridge House
152 Pilgrim Street
Newcastle upon Tyne
NE1 6SN

This is not a freepost address. You will need a stamp.

Renew your certificate

If you already have an HC2 or HC3 certificate through the NHS Low Income Scheme and would like to renew it, you must complete a new HC1 form.