It is important that you retain these guidance notes for your records.

Transcription

1 NMH/CF/13 DISABLED STUDENTS ALLOWANCE HOW TO CLAIM PAYMENT FOR SUPPORTING A DISABLED STUDENT Please note that your contract to provide Non-medical assistance is between yourself and the student you are supporting. There is no contractual arrangement between you and the Open University or the DSA Office. The DSA Office is the funding body only and cannot intervene in disputes between students and helpers. This form should be completed by Non-Medical Helpers (NMH) claiming payment for supporting a student in receipt of a Disabled Students Allowance (DSA). Please ensure all sections of this form are completed and that both declarations are signed and dated. To ensure that you receive payment at the end of each month your claim form must be correctly completed and received in the DSA Office by the 1 st of each month If you provided support at an OU study activity, make sure each session claimed for is signed by the student s OU tutor confirming the student s attendance. If you are claiming travel costs, please include the postcodes for your journey s start and end locations. Car mileage is paid at 30p per mile. Receipts should be provided for bus or train fares. If you are under the age of 16 you must contact your local authority for guidance as there are strict rules governing the employment of children under 16. If you are treated under PAYE, payment will be made through a University payroll into your bank/building society account and taxed at source at the appropriate rate. If you are treated by HM Revenue and Customs as self-employed and wish to be paid without deduction of tax at source, please indicate your self employed status overleaf Send your completed claim form to the DSA Office, The Open University, Hammerwood Gate, Kents Hill, Milton Keynes, MK7 6BR. It is important that you retain these guidance notes for your records. Contact Details DSA Office: Staff Payments Office Tel: For queries about tax, National Insurance or VAT Fax: Tel: / Dsa-Queries@open.ac.uk finance-staff-payments@open.ac.uk Please be aware that the Open University DSA Office must protect the public funds it administers and we may use the information you provide to prevent and detect fraud. We are obliged to make you aware that if you provide false information or fail to give complete information your application will be cancelled, future applications may be rejected, financial support may be withdrawn and you may be prosecuted.

2 Please insert the Personal Identifier of the student you are supporting here Please insert the name of the student you are supporting here Non-Medical Helpers personal details Title First name Surname Date of birth Address OU Staff number (This can be found on your pay advice slip if you have previously been paid by the OU). Daytime telephone number Post code National Insurance Number If you are treated by HMRC as self-employed please tick this box: The Open University is now required to report to HM Revenue & Customs payments made to selfemployed persons. To meet this requirement all such payments will in future be made untaxed through a University payroll and then extracted and reported to HMRC at the end of the tax year. Non-Medical Helpers Bank Account details Name of bank /building society Bank sort code Account number Please only submit your bank details if this is the first claim you are submitting or if your bank account details have changed. Please only tick this box if your bank account details have changed.

3 Details of your claim Details of support provided to student e.g. Dyslexia tuition, note-taking, mobility support at tutorials etc. (Please refer to the student s DSA award letter for details of the support approved) If you have provided specialist support to this student e.g. dyslexia or mentoring support you must submit details of your qualifications and relevant experience for approval prior to receiving payment. You will only need to submit this information once. Fee rate (Amount charged per hour ). If the hourly rate quoted in the student s award letter is for a professional body (e.g. Randstad/Clearlinks) but the student has chosen you as their non medical helper, the rate will be different. You must contact this Office to confirm the revised hourly rate (if you have not already done so). Your declaration in support of this claim I confirm I have provided the service(s) as described above to the OU student identified overleaf and that the details of this claim are correct. Signed...Date..... Student s declaration confirming support received I confirm that I have received the service(s) described above on the dates outlined and for the OU study activities described overleaf. Signed. Date..... DSA OFFICE USE ONLY Personal Identifier NMH Staff Number.. CVP Check Staff Record Created on CIRCE Copy form sent to Staff Payments P46 Sent Self Employed Helper Course Code C436 C437 C439 Claim input by (Staff Initials): Date: Claim authorised by: (Staff initials): Date:

4 Date of study Course Code OU Study Activity/Support No of hours Support cost ***OU Tutor signature confirming attendance at tutorial/day school*** Travel Costs (petrol costs can be 30p per mile) if you travel by bus or train please attach receipts Date of travel From To Travel method e.g. train, bus, car No of miles Travel cost

5 Date of study Course Code OU Study Activity/Support No of hours Support cost ***OU Tutor signature confirming attendance at tutorial/day school*** Travel Costs (petrol costs can be 30p per mile) if you travel by bus or train please attach receipts Date of travel From To Travel method e.g. train, bus, car No of miles Travel cost