Only fill in this capability for work questionnaire (ESA50) if you’re asked to do so – this is not a claim form.
Find out how to claim Employment and Support Allowance
Using this form
Fill in this form only if you’ve been asked to do a Work Capability Assessment.
- Save a copy of the form.
- Open it in Adobe Acrobat Reader version XI or later.
- Fill it in on screen.
- Print it and sign it.
The form explains where to send it. If you have any questions, please contact the office that asked you to fill it in.
This form is also available in Welsh, braille, large print, audio cassette or CD. If you want any of these, please call Jobcentre Plus on 0345 608 8545 and tell us which you need.
If you are having technical difficulties
Please contact the DWP online helpdesk if you are having difficulty:
- downloading the form
- navigating around the form
- printing the form
DWP online helpdesk
Telephone 0345 604 3349
Monday to Friday 8am to 6pm
Closed weekends and all public and bank holidays
Residents of Northern Ireland
Don’t use this form if you live in Northern Ireland. Contact the Employment and Support Allowance Centre.
Published: 4 April 2013
Updated: 24 July 2017
- Updated the DWP online helpdesk contact details.
- Published updated English version of the ESA50 form.
- Published updated English and Welsh versions of the ESA50 form.
- published updated version of the ESA50 form.
- First published.