Form

Income-related or contribution-based Employment and Support Allowance (ESA) claim form

You can no longer make a new claim for income-related ESA or contribution-based ESA. You may be able to claim Universal Credit or New Style ESA instead.

• From: Department for Work and Pensions
• Published: 1 April 2013
• Last updated: 27 January 2021
  Show all updates

  1. 27 January 2021

     You can no longer make a new claim for income-related ESA or contribution-based ESA. You may be able to claim Universal Credit or New Style ESA instead.

  2. 22 October 2020

     Added Welsh ESA1 form.

  3. 16 October 2020

     Removed October 2018 version of the English and Welsh ESA1 form as it is no longer in use. Welsh translation of the updated form to follow.

  4. 27 August 2020

     Edited ESA claim form you can download, fill in on screen, save and then print. Updates include changes to contact phone numbers, alternate versions and GDPR. Added consent to notify GP of outcome of WCA (medical consent) section.

  5. 27 March 2020

     Updated with new guidance on how to claim income-related or contribution-based Employment and Support Allowance.

  6. 30 November 2018

     Revised ESA1 interactive and print versions (English and Welsh). Corrected a web page URL in the notes.

  7. 28 November 2018

     Added ESA1RR forms - English and Welsh - renewal reclaim versions only to be complete if you got Employment and Support Allowance in the last 12 weeks. Revised ESA1 forms - print and interactive - English and Welsh.

  8. 31 July 2017

     Revised notes for ESA1 interactive form. New contact details for online helpdesk.

  9. 2 March 2017

     Published revised ESA claim form you can print and fill in with a pen – English and Welsh.

  10. 28 February 2017

      Published revised ESA claim form you can download, fill in on screen, save – and then print.

  11. 31 March 2015

      Expanded notes section to inlcude advice for claimants who have claimed ESA before.

  12. 13 January 2014

      Added updated versions - Oct 2013.

  13. 1 April 2013

      First published.

This publication was withdrawn on 27 January 2021

You can no longer make a new claim for income-related Employment and Support Allowance (ESA) or contribution-based ESA. You may be able to claim Universal Credit or New Style ESA instead.

Applies to England, Scotland and Wales

Documents

ESA claim form

Ref: ESA1

PDF, 63.4 KB, 1 page

Details

You can no longer make a new claim for income-related Employment and Support Allowance (ESA) or contribution-based ESA. You may be able to claim Universal Credit or New Style ESA instead.