{
"form_type": "lettings",
"start_year": 2021,
"end_year": 2022,
"sections": {
"about_this_log": {
"label": "About this log",
"subsections": {
"about_this_log": {
"label": "About this log",
"pages": {
"gdpr_acceptance": {
"header": "",
"description": "",
"questions": {
"gdpr_acceptance": {
"check_answer_label": "Privacy notice seen",
"header": "Has the tenant or buyer seen the Department for Levelling Up, Housing and Communities (DLUHC) privacy notice?",
"hint_text": "You must show the privacy notice to the tenant or buyer before you can use this service",
"type": "radio",
"answer_options": {
"0": "Yes",
"1": "No"
}
}
}
},
"gdpr_declined": {
"hide_subsection_label": true,
"header": "You cannot use this service",
"hint_text": "",
"description": "We cannot accept data about a tenant or buyer unless they’ve seen the DLUHC privacy notice.
Go to your logs",
"questions": {},
"depends_on": [{ "gdpr_acceptance": "No" }]
},
"organisation_details": {
"header": "Organisation details",
"description": "",
"questions": {
"property_owner_organisation": {
"check_answer_label": "Owning organisation",
"header": "Which organisation owns this property?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "A",
"1": "B"
}
},
"property_manager_organisation": {
"check_answer_label": "Managing organisation",
"header": "Which organisation manages this property?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "A",
"1": "B"
}
}
},
"depends_on": [{ "gdpr_acceptance": "Yes" }]
},
"sale_or_letting": {
"header": "",
"description": "",
"questions": {
"sale_or_letting": {
"check_answer_label": "Letting or sale",
"header": "Is this a letting or sale?",
"hint_text": "",
"type": "radio",
"answer_options": {
"1": "Letting",
"0": "Sale"
}
}
},
"depends_on": [{ "gdpr_acceptance": "Yes" }]
},
"tenant_same_property_renewal": {
"header": "",
"description": "",
"questions": {
"tenant_same_property_renewal": {
"check_answer_label": "Property renewal",
"header": "Is this a renewal to the same tenant in the same property?",
"hint_text": "",
"type": "radio",
"answer_options": {
"1": "Yes",
"0": "No"
}
}
},
"depends_on": [{
"gdpr_acceptance": "Yes",
"sale_or_letting": "Letting"
}]
},
"startdate": {
"header": "",
"description": "",
"questions": {
"startdate": {
"check_answer_label": "Tenancy start date",
"header": "What is the tenancy start date?",
"hint_text": "For example, 27 3 2021",
"type": "date"
}
},
"depends_on": [{
"gdpr_acceptance": "Yes",
"sale_or_letting": "Letting"
}]
},
"about_this_letting": {
"header": "Tell us about this letting",
"description": "",
"questions": {
"rent_type": {
"check_answer_label": "Rent type",
"header": "What is the rent type?",
"hint_text": "",
"type": "radio",
"answer_options": {
"1": "Affordable rent",
"2": "London affordable rent",
"4": "London living rent",
"3": "Rent to buy",
"0": "Social rent",
"5": "Other intermediate rent product"
},
"conditional_for": {
"intermediate_rent_product_name": [
"Other intermediate rent product"
]
}
},
"intermediate_rent_product_name": {
"check_answer_label": "Product name",
"header": "What is intermediate rent product name?",
"type": "text"
},
"needstype": {
"check_answer_label": "Needs type",
"header": "What is the needs type?",
"hint_text": "",
"type": "radio",
"answer_options": {
"1": "General needs",
"0": "Supported housing"
}
}
},
"depends_on": [{
"gdpr_acceptance": "Yes",
"sale_or_letting": "Letting"
}]
},
"tenant_code": {
"header": "",
"description": "",
"questions": {
"tenant_code": {
"check_answer_label": "Tenant code",
"header": "What is the tenant code?",
"hint_text": "This is how you usually refer to this tenancy on your own systems.",
"type": "text",
"width": 10
}
},
"depends_on": [{
"gdpr_acceptance": "Yes",
"sale_or_letting": "Letting"
}]
},
"property_reference": {
"header": "",
"description": "",
"questions": {
"propcode": {
"check_answer_label": "Property reference",
"header": "What is the property reference?",
"hint_text": "This is how you usually refer to this property on your own systems.",
"type": "text",
"width": 10
}
},
"depends_on": [{ "gdpr_acceptance": "Yes" }]
},
"sale_completion_date": {
"header": "",
"description": "",
"questions": {
"sale_completion_date": {
"check_answer_label": "Sale completion date",
"header": "What is the sale completion date?",
"hint_text": "For example, 27 3 2021",
"type": "date"
}
},
"depends_on": [{
"gdpr_acceptance": "Yes",
"sale_or_letting": "Sale"
}]
},
"purchaser_code": {
"header": "",
"description": "",
"questions": {
"purchaser_code": {
"check_answer_label": "Purchaser code",
"header": "What is the purchaser code?",
"hint_text": "",
"type": "text",
"width": 10
}
},
"depends_on": [{
"gdpr_acceptance": "Yes",
"sale_or_letting": "Sale"
}]
}
}
}
}
},
"household": {
"label": "About the household",
"subsections": {
"household_characteristics": {
"label": "Household characteristics",
"depends_on": [{ "about_this_log": "completed" }],
"pages": {
"person_1_age": {
"header": "",
"description": "",
"questions": {
"age1": {
"check_answer_label": "Tenant’s age",
"header": "What is the tenant’s age?",
"hint_text": "",
"type": "numeric",
"min": 0,
"max": 120,
"step": 1,
"width": 2
}
}
},
"sex1": {
"header": "",
"description": "",
"questions": {
"sex1": {
"check_answer_label": "Tenant’s gender",
"header": "Which of these best describes the tenant’s gender identity?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Female",
"1": "Male",
"2": "Non-binary",
"3": "Prefer not to say"
}
}
}
},
"tenant_ethnic_group": {
"header": "",
"description": "",
"questions": {
"ethnic": {
"check_answer_label": "Ethnicity",
"header": "What is the tenant’s ethnic group?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "White: English, Welsh, Scottish, Northern Irish or British",
"1": "White: Irish",
"2": "White: Gypsy or Irish Traveller",
"3": "White: Other",
"4": "Mixed: White and Black Caribbean",
"5": "Mixed: White and Black African",
"6": "Mixed: White and Asian",
"7": "Mixed: Other",
"8": "Asian or Asian British: Indian",
"9": "Asian or Asian British: Pakistani",
"10": "Asian or Asian British: Bangladeshi",
"11": "Asian or Asian British: Chinese",
"12": "Asian or Asian British: Other",
"13": "Black: Caribbean",
"14": "Black: African",
"15": "Black: Other",
"16": "Other Ethnic Group: Arab",
"17": "Other Ethnic Group: Other",
"18": "Prefer not to say"
}
}
}
},
"tenant_nationality": {
"header": "",
"description": "",
"questions": {
"national": {
"check_answer_label": "Nationality",
"header": "What is the tenant’s nationality?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "UK national resident in UK",
"1": "UK national returning from residence overseas",
"2": "Czech Republic",
"3": "Estonia",
"4": "Hungary",
"5": "Latvia",
"6": "Lithuania",
"7": "Poland",
"8": "Slovakia",
"9": "Bulgaria",
"10": "Romania",
"11": "Ireland",
"12": "Slovakia",
"13": "Slovenia",
"14": "Croatia",
"15": "Other EU Economic Area (EEA country)",
"16": "Any other country",
"17": "Prefer not to say"
}
}
}
},
"person_1_economic": {
"header": "",
"description": "",
"questions": {
"ecstat1": {
"check_answer_label": "Work",
"header": "Which of these best describes the tenant’s working situation?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Part-time - Less than 30 hours",
"1": "Full-time - 30 hours or more",
"2": "In government training into work, such as New Deal",
"3": "Jobseeker",
"4": "Retired",
"5": "Not seeking work",
"6": "Full-time student",
"7": "Unable to work because of long term sick or disability",
"8": "Child under 16",
"9": "Other",
"10": "Prefer not to say"
}
}
},
"soft_validations": {
"override_net_income_validation": {
"check_answer_label": "Net income confirmed?",
"type": "validation_override",
"answer_options": {
"override_net_income_validation": "Yes"
}
}
}
},
"household_number_of_other_members": {
"header": "",
"description": "",
"questions": {
"other_hhmemb": {
"check_answer_label": "Number of other household members",
"header": "How many other people are there in the household?",
"hint_text": "The maximum number of others is 7",
"type": "numeric",
"min": 0,
"max": 7,
"step": 1,
"width": 2,
"conditional_for": {
"relat2": ">0",
"age2": ">0",
"sex2": ">0",
"ecstat2": ">0",
"relat3": ">1",
"age3": ">1",
"sex3": ">1",
"ecstat3": ">1",
"relat4": ">2",
"age4": ">2",
"sex4": ">2",
"ecstat4": ">2",
"relat5": ">3",
"age5": ">3",
"sex5": ">3",
"ecstat5": ">3",
"relat6": ">4",
"age6": ">4",
"sex6": ">4",
"ecstat6": ">4",
"relat7": ">5",
"age7": ">5",
"sex7": ">5",
"ecstat7": ">5",
"relat8": ">6",
"age8": ">6",
"sex8": ">6",
"ecstat8": ">6"
}
},
"relat2": {
"check_answer_label": "Person 2’s relationship to lead tenant",
"header": "What’s person 2’s relationship to lead tenant",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Partner",
"1": "Child - includes young adult and grown-up",
"2": "Other",
"3": "Prefer not to say"
}
},
"age2": {
"check_answer_label": "Person 2’s age",
"header": "What’s person 2’s age",
"hint_text": "",
"type": "numeric",
"min": 0,
"max": 150,
"step": 1
},
"sex2": {
"check_answer_label": "Person 2’s gender",
"header": "Which of these best describes person 2’s gender identity?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Female",
"1": "Male",
"2": "Non-binary",
"3": "Prefer not to say"
}
},
"ecstat2": {
"check_answer_label": "Person 2’s Work",
"header": "Which of these best describes person 2’s working situation?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Part-time - Less than 30 hours",
"1": "Full-time - 30 hours or more",
"2": "In government training into work, such as New Deal",
"3": "Jobseeker",
"4": "Retired",
"5": "Not seeking work",
"6": "Full-time student",
"7": "Unable to work because of long term sick or disability",
"8": "Child under 16",
"9": "Other",
"10": "Prefer not to say"
}
},
"relat3": {
"check_answer_label": "Person 3’s relationship to lead tenant",
"header": "What’s person 3’s relationship to lead tenant",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Partner",
"1": "Child - includes young adult and grown-up",
"2": "Other",
"3": "Prefer not to say"
}
},
"age3": {
"check_answer_label": "Person 3’s age",
"header": "What’s person 3’s age",
"hint_text": "",
"type": "numeric",
"min": 0,
"max": 150,
"step": 1
},
"sex3": {
"check_answer_label": "Person 3’s gender",
"header": "Which of these best describes person 3’s gender identity?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Female",
"1": "Male",
"2": "Non-binary",
"3": "Prefer not to say"
}
},
"ecstat3": {
"check_answer_label": "Person 3’s Work",
"header": "Which of these best describes person 3’s working situation?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Part-time - Less than 30 hours",
"1": "Full-time - 30 hours or more",
"2": "In government training into work, such as New Deal",
"3": "Jobseeker",
"4": "Retired",
"5": "Not seeking work",
"6": "Full-time student",
"7": "Unable to work because of long term sick or disability",
"8": "Child under 16",
"9": "Other",
"10": "Prefer not to say"
}
},
"relat4": {
"check_answer_label": "Person 4’s relationship to lead tenant",
"header": "What’s person 4’s relationship to lead tenant",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Partner",
"1": "Child - includes young adult and grown-up",
"2": "Other",
"3": "Prefer not to say"
}
},
"age4": {
"check_answer_label": "Person 4’s age",
"header": "What’s person 4’s age",
"hint_text": "",
"type": "numeric",
"min": 0,
"max": 150,
"step": 1
},
"sex4": {
"check_answer_label": "Person 4’s gender",
"header": "Which of these best describes person 4’s gender identity?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Female",
"1": "Male",
"2": "Non-binary",
"3": "Prefer not to say"
}
},
"ecstat4": {
"check_answer_label": "Person 4’s Work",
"header": "Which of these best describes person 4’s working situation?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Part-time - Less than 30 hours",
"1": "Full-time - 30 hours or more",
"2": "In government training into work, such as New Deal",
"3": "Jobseeker",
"4": "Retired",
"5": "Not seeking work",
"6": "Full-time student",
"7": "Unable to work because of long term sick or disability",
"8": "Child under 16",
"9": "Other",
"10": "Prefer not to say"
}
},
"relat5": {
"check_answer_label": "Person 5’s relationship to lead tenant",
"header": "What’s person 5’s relationship to lead tenant",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Partner",
"1": "Child - includes young adult and grown-up",
"2": "Other",
"3": "Prefer not to say"
}
},
"age5": {
"check_answer_label": "Person 5’s age",
"header": "What’s person 5’s age",
"hint_text": "",
"type": "numeric",
"min": 0,
"max": 150,
"step": 1
},
"sex5": {
"check_answer_label": "Person 5’s gender",
"header": "Which of these best describes person 5’s gender identity?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Female",
"1": "Male",
"2": "Non-binary",
"3": "Prefer not to say"
}
},
"ecstat5": {
"check_answer_label": "Person 5’s Work",
"header": "Which of these best describes person 5’s working situation?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Part-time - Less than 30 hours",
"1": "Full-time - 30 hours or more",
"2": "In government training into work, such as New Deal",
"3": "Jobseeker",
"4": "Retired",
"5": "Not seeking work",
"6": "Full-time student",
"7": "Unable to work because of long term sick or disability",
"8": "Child under 16",
"9": "Other",
"10": "Prefer not to say"
}
},
"relat6": {
"check_answer_label": "Person 6’s relationship to lead tenant",
"header": "What’s person 6’s relationship to lead tenant",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Partner",
"1": "Child - includes young adult and grown-up",
"2": "Other",
"3": "Prefer not to say"
}
},
"age6": {
"check_answer_label": "Person 6’s age",
"header": "What’s person 6’s age",
"hint_text": "",
"type": "numeric",
"min": 0,
"max": 150,
"step": 1
},
"sex6": {
"check_answer_label": "Person 6’s gender",
"header": "Which of these best describes person 6’s gender identity?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Female",
"1": "Male",
"2": "Non-binary",
"3": "Prefer not to say"
}
},
"ecstat6": {
"check_answer_label": "Person 6’s Work",
"header": "Which of these best describes person 6’s working situation?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Part-time - Less than 30 hours",
"1": "Full-time - 30 hours or more",
"2": "In government training into work, such as New Deal",
"3": "Jobseeker",
"4": "Retired",
"5": "Not seeking work",
"6": "Full-time student",
"7": "Unable to work because of long term sick or disability",
"8": "Child under 16",
"9": "Other",
"10": "Prefer not to say"
}
},
"relat7": {
"check_answer_label": "Person 7’s relationship to lead tenant",
"header": "What’s person 7’s relationship to lead tenant",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Partner",
"1": "Child - includes young adult and grown-up",
"2": "Other",
"3": "Prefer not to say"
}
},
"age7": {
"check_answer_label": "Person 7’s age",
"header": "What’s person 7’s age",
"hint_text": "",
"type": "numeric",
"min": 0,
"max": 150,
"step": 1
},
"sex7": {
"check_answer_label": "Person 7’s gender",
"header": "Which of these best describes person 7’s gender identity?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Female",
"1": "Male",
"2": "Non-binary",
"3": "Prefer not to say"
}
},
"ecstat7": {
"check_answer_label": "Person 7’s Work",
"header": "Which of these best describes person 7’s working situation?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Part-time - Less than 30 hours",
"1": "Full-time - 30 hours or more",
"2": "In government training into work, such as New Deal",
"3": "Jobseeker",
"4": "Retired",
"5": "Not seeking work",
"6": "Full-time student",
"7": "Unable to work because of long term sick or disability",
"8": "Child under 16",
"9": "Other",
"10": "Prefer not to say"
}
},
"relat8": {
"check_answer_label": "Person 8’s relationship to lead tenant",
"header": "What’s person 8’s relationship to lead tenant",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Partner",
"1": "Child - includes young adult and grown-up",
"2": "Other",
"3": "Prefer not to say"
}
},
"age8": {
"check_answer_label": "Person 8’s age",
"header": "What’s person 8’s age",
"hint_text": "",
"type": "numeric",
"min": 0,
"max": 150,
"step": 1
},
"sex8": {
"check_answer_label": "Person 8’s gender",
"header": "Which of these best describes person 8’s gender identity?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Female",
"1": "Male",
"2": "Non-binary",
"3": "Prefer not to say"
}
},
"ecstat8": {
"check_answer_label": "Person 8’s Work",
"header": "Which of these best describes person 8’s working situation?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Part-time - Less than 30 hours",
"1": "Full-time - 30 hours or more",
"2": "In government training into work, such as New Deal",
"3": "Jobseeker",
"4": "Retired",
"5": "Not seeking work",
"6": "Full-time student",
"7": "Unable to work because of long term sick or disability",
"8": "Child under 16",
"9": "Other",
"10": "Prefer not to say"
}
}
}
}
}
},
"household_situation": {
"label": "Household situation",
"depends_on": [{ "about_this_log": "completed" }],
"pages": {
"previous_housing_situation": {
"header": "",
"description": "",
"questions": {
"prevten": {
"header": "What was the tenant’s housing situation immediately before this letting?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Owner occupation (private)",
"1": "Owner occupation (low cost home ownership)",
"2": "Private sector tenancy",
"3": "Tied housing or rented with job",
"4": "Supported housing",
"5": "Sheltered accommodation",
"6": "Residential care home",
"7": "Living with friends or family",
"8": "Refuge",
"9": "Hospital",
"10": "Prison or approved probation hostel",
"11": "Direct access hostel",
"12": "Bed and breakfast",
"13": "Mobile home or caravan",
"14": "Any other temporary accommodation",
"15": "Home Office Asylum Support",
"16": "Children’s home or foster care",
"17": "Rough sleeping",
"18": "Other",
"19": "Fixed term Local Authority General Needs tenancy",
"20": "Lifetime Local Authority General Needs tenancy",
"21": "Fixed term PRP General Needs tenancy",
"22": "Lifetime PRP General Needs tenancy"
}
}
}
},
"homelessness": {
"header": "",
"description": "",
"questions": {
"homeless": {
"header": "Did the tenant experience homelessness immediately before this letting?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Yes - assessed as homeless by a local authority and owed a homelessness duty. Including if threatened with homelessness within 56 days",
"1": "Yes - other homelessness",
"2": "No"
}
}
}
},
"reason_for_leaving_last_settled_home": {
"header": "Leaving their last settled home",
"description": "",
"questions": {
"reason": {
"header": "What is the tenant’s main reason for leaving?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Permanently decanted from another property owned by this landlord",
"1": "Left home country as a refugee",
"2": "Loss of tied accommodation",
"3": "Domestic abuse",
"4": "(Non violent) relationship breakdown with partner",
"5": "Asked to leave by family or friends",
"6": "Racial harassment",
"7": "Other problems with neighbours",
"8": "Property unsuitable because of overcrowding",
"9": "End of assured shorthold tenancy - no fault",
"10": "End of assured shorthold tenancy - tenant’s fault",
"11": "End of fixed term tenancy - no fault",
"12": "End of fixed term tenancy - tenant’s fault",
"13": "Repossession",
"14": "Under occupation - offered incentive to downsize",
"15": "Under occupation - no incentive",
"16": "Property unsuitable because of ill health / disability",
"17": "Property unsuitable because of poor condition",
"18": "Couldn’t afford fees attached to renewing the tenancy",
"19": "Couldn’t afford increase in rent",
"20": "Couldn’t afford rent or mortgage - welfare reforms",
"21": "Couldn’t afford rent or mortgage - employment",
"22": "Couldn’t afford rent or mortgage - other",
"23": "To move nearer to family / friends / school",
"24": "To move nearer to work",
"25": "To move to accomodation with support",
"26": "To move to independent accomodation",
"27": "Hate crime",
"28": "Death of household member in last settled accomodation",
"29": "Discharged from prison",
"30": "Discharged from long stay hospital or similar institution",
"31": "Other",
"divider": true,
"32": "Don’t know",
"33": "Prefer not to say"
},
"conditional_for": {
"other_reason_for_leaving_last_settled_home": ["Other"]
}
},
"other_reason_for_leaving_last_settled_home": {
"header": "Please state the reason for leaving last settled home",
"hint_text": "",
"type": "text"
},
"underoccupation_benefitcap": {
"header": "Was the reason for leaving because of the benefit cap or removal of the spare room subsidy?",
"hint_text": "",
"type": "radio",
"answer_options": {
"0": "Yes - benefit cap",
"1": "Yes - removal of the spare room subsidy",
"2": "Yes - both the benefit cap and the removal of the spare room subsidy",
"3": "No",
"divider": true,
"4": "Don’t know",
"5": "Prefer not to say"
}
}
}
}
}
},
"household_needs": {
"label": "Household needs",
"depends_on": [{ "about_this_log": "completed" }],
"pages": {
"armed_forces": {
"header": "Experience of the UK Armed Forces",
"description": "",
"questions": {
"armedforces": {
"header": "Is anyone in the household...",
"hint_text": "This excludes national service",
"type": "radio",
"check_answer_label": "Armed Forces",
"answer_options": {
"0": "A current or former regular in the UK Armed Forces (excluding National Service)",
"1": "A current or former reserve in the UK Armed Forces (excluding National Service)",
"2": "A spouse / civil partner of a UK Armed Forces member who has separated or been bereaved within the last 2 years",
"3": "No",
"4": "Tenant prefers not to say"
}
}
}
},
"armed_forces_member": {
"header": "Experience of the UK Armed Forces",
"description": "",
"depends_on": [{ "armedforces": "A current or former regular in the UK Armed Forces (excluding National Service)" }],
"questions": {
"leftreg": {
"header": "Are they still serving?",
"hint_text": "",
"type": "radio",
"check_answer_label": "When did they leave the Armed Forces?",
"answer_options": {
"0": "Yes",
"1": "No - they left up to 5 years ago",
"2": "No - they left more than 5 years ago",
"divider": true,
"3": "Prefer not to say"
}
},
"reservist": {
"header": "Were they seriously injured or ill as a result of their service?",
"hint_text": "",
"type": "radio",
"check_answer_label": "Has anyone in the household been seriously injured or ill as a result of their service in the armed forces?",
"answer_options": {
"0": "Yes",
"1": "No",
"divider": true,
"2": "Prefer not to say"
}
}
}
},
"medical_conditions": {
"header": "",
"description": "",
"questions": {
"illness": {
"header": "Does anyone in the household have any of the following that they expect to last for 12 months or more: