Form SSCS4
| Published date | 21 March 2018 |
| Subject Matter | Social security and child support forms |
Page 1
Social Security and Child Suppor t
Notice of appeal against a decision of the
Department for Work and Pensions –
Recovery of NHS Charges in England and Wales
Section 1 ABOUT THE DECISION YOU ARE APPEALING AGAINST
/ /
SSCS4 - Notice of appeal agains t a decision of the Department f or Work and Pensions - Recovery of NHS Charges i n England and Wales (01.19)
© Crown copyright 2019
You should use this form to appeal against a decision made by the Compensation Recovery Unit of the Department
for Work and Pensions (DWP) regarding recovery of NHS charges. For decisions regarding social security benets, you
should use form SSCS1. For decisions regarding child support or maintenance, you should use form SSCS2. For decisions
regarding recovery of benets from compensation payments, you should use form SSCS3.
About this form
This form helps you provide all the information the tribunal requires to register your appeal. It will also ensure that your
appeal contains all the necessary details which the law requires.
How to ll in this form
You must complete Sections 1, 2, 4, 5 and 7.
If you want to attend a hearing, you must also complete Section 6.
If you have a representative, you must also complete Section 3.
What to include with this form
You must include a copy of the Certicate of NHS Charges which shows the decision you are appealing against. You do
not need to include evidence/information you have already sent to the Compensation Recovery Unit as they will send it
to us as part of their response.
SSCS4
This section is about your Certicate of NHS Charges. This is
the document sent to you by the Compensation Recovery Unit
explaining what NHS charges are recoverable from you.
Please tick this box to conrm that you have attached a copy of the
Certicate of NHS Charges with your appeal form.
Please write here the date on your NHS Certicate
Remember to include a copy of your certicat e of NHS Charges
with your appeal form. If you do not do so, we will be unable to
register your appeal until this is provided.
Section 2 ABOUT THE APPELLANT
Name of rm or organisation
Address
Postcode
Your Compensation Recovery Unit reference number
—
Your compensator/representative reference number
Phone number
Now go to Section 3
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