Capability for work questionnaire

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.

Fill in this form if you’re asked to do a Work Capability Assessment because you’ve claimed benefits or National Insurance credits on the basis of your capability for work.

This form asks about your physical and mental health. You need to answer all questions.

If you have any questions about the form, please contact the office that asked you to fill it in.

You need to save this form and open it in Adobe Acrobat Reader version XI or later, otherwise it won’t work.

Residents of Northern Ireland

This form should not be used by residents of Northern Ireland who should contact the Employment and Support Allowance Centre.