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.
Residents of Northern Ireland
Don’t use this form if you live in Northern Ireland. Contact the Employment and Support Allowance Centre.