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.

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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.

Documents

ESA claim form

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.

Published 1 April 2013
Last updated 27 January 2021 + show all updates
  1. 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. Added Welsh ESA1 form.

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

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

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

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

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

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

  12. Added updated versions - Oct 2013.

  13. First published.