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Failure to participate with the Health Care Provider											                                  Please note that this form may be shown to the participant 	

Part 1 About the participant	

Participants name 

Participants NINO	Date of Birth

Participants phone

Participants address

	
Part 2 Benefit details	

Employment and Support Allowance
(Please delete Yes or No as appropriate) 

1) Is their attendance at an interview with the Health Care Provider mandatory?                      YES/ NO                             

2) Has their vulnerable group status been checked?                                                                  YES/ NO                                                                                        
If yes, was action taken to contact the participant to ensure they understood
the mandatory requirement of attending the interview?                                                              YES/ NO                                        

3) The interview the participant was asked to attend was reasonable, taking into account 
their circumstances?                                                                                                                   YES/ NO                                                                                                       
	
If the answer to any of the above questions is no this form should not be referred for a decision	
	
Part 3 Mandatory Interview Notification (MIN) details	

Date MIN issued to participant

Method of written notification issued

If posted what class of post was used

Date they failed to attend the
mandatory interview

HCP08 (continued)	
	
Part 4 Non participation details	
Statement from HCP Contact
Please complete the fields below to give a factual account of exactly how the participant failed to participate
(It is important that no details of any medical condition/ treatment is mentioned here)	
A.  Include details of the interview they were mandated to attend 	

	
B. Include any information/ evidence relating to non- compliance to attend the mandatory interview provided (unprompted)  by the participant 	

	
C. What have you done to notify the participant to attend an alternative interview? What must they do to comply?	

	
D. Any other relevant information	

	
Part 5 Health Care Provider details	

I confirm that the above is a full and accurate statement

Name of HCP contact                                                Date

E mail address                                                    Phone

Name of Provider                                         Prime          Subcontractor

Provider
Correspondence Address

HCP08
Produced by the Department for Work and Pensions	

Guidance

Please note that in order to strengthen the link between failure to comply with a mandatory process and the sanction that can be applied, this form should be completed and sent to DWP Labour Market Decision Maker on the day of non-attendance by the participant. 	

Part 1
Please enter the participant's full name, National Insurance number, date of birth, telephone number and the address you sent the Mandatory Interview Notification (MIN) to in the fields provided.	

Part 2
There are three statements to confirm. The first statement asks you to confirm that the attendance of an interview for the participant is mandatory. The second statement asks for confirmation of whether the participant is in a vulnerable group or not. If 'yes', you are satisfied with the action taken to contact the participant to ensure they understand the requirement to attend the mandatory interview. If the participant is not in a vulnerable group, please enter 'N/A'. For the third statement, confirm that attendance by the participant was reasonable, taking into account their circumstances.
If the answer to any statement in Part 2 is 'no', a sanction referral cannot be made.	

Part 3
Please enter the date that the participant's Mandatory Interview Notification (MIN) was issued (by hand or posted etc) to the participant. Please state by which method the MIN was sent to the participant (letter, text, email, proforma or other). Also, if sent by post please indicate which class of post was used. 	

Part 4
In this section, you are asked to provide full and specific details of the interview that the participant was expected to attend and why/how they did not attend as specified. Please provide as much relevant detail as possible.   
A. Include details of the interview they were mandated to attend
Please provide specific details of:
• The interview that the participant was directed to attend, including date and time of the interview.
• The reasons for directing the participant to attend the interview. Such an explanation may include why or how the participant would benefit from attending the interview.
• The timescales notified to the participant by or within which the interview had to be completed.
B. Include any information/ evidence relating to non- compliance to attend the mandatory interview provided (unprompted)  by the participant
Please provide any explanation given by the participant for failing to attend the interview. This must only be included if the reason is volunteered to you, as you should not be collecting information relating to good cause. If a reason is volunteered to you after the HCP08 has been sent, pass this information to the relevant Decision Making and Appeal team. If no reason provided please insert N/A.
  
C. What have you done to notify the participant to attend an alternative Interview? What must they do to comply?
Please provide details of what you have asked the participant to do, if you are considering an alternative interview to the original mandated interview, you must have informed the customer in writing of the alternative interview. 

D.  Any other relevant information
Please provide details such as: 
• Any other information that you feel is relevant to this referral.
• Any history of previous compliance or non-compliance that is relevant to this referral. 	

Part 5
Please enter the contact details of the person/provider completing this form and by so doing, you are confirming that the form has been completed fully and accurately. It is important that you complete the provider correspondence address as this is where the sanction decision will be sent to.