Using this form
Fill in this form only if you’ve been asked to do a Work Capability Assessment.
You can either print the form and complete using a pen or you can:
- Save a copy of the form
- Open it in Adobe Acrobat Reader version 11 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.
If you would like this questionnaire in braille, large print or audio, please call Universal Credit. You can find the number at the top of any letters we have sent you, or tell us using your online journal if you have one.
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
Residents of Northern Ireland
Don’t use this form if you live in Northern Ireland.