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  1. #1
    Senior Member nukecad's Avatar
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    Jun 2014
    West Cumbria (Lake District)

    Listing of ESA standard forms.

    Clicking on Download takes you to the official download to fill in.
    Clicking on Example gives an example.

    ESA1 Claim 'Old Style' ESA Download (you should claim by phone)
    Only use if you are barred from claiming UC

    NSESAF1 Claim 'New Style' CB-ESA Download

    JSA NC1 Claim NI Credits Only Example

    ESA2 Circumstances review Example

    ESA3 Apply for reassessment due to C of C Example

    ESA5 Req for pension info Example

    ESA6 Req for pension/income info Example

    ESA10 Apply for hardship payment Example

    ESA40 General Info leaflet Download

    ESA49 Work Related Activity Plan Example

    ESA50 Capability for Work questionaire Download
    ESA50A Short version, check for SG Example

    ESA-N-50 ESA50 claimant overseas Example
    ESA-N-54B Guidance assessor overseas Example
    ESA-N-54C Med Report claimant overseas Example

    ESA51 Info sent with ESA50 Example

    ESA53 Reminder for ESA50 Example

    ESA55/WCA55 Jacket for WCA docs Example

    ESA56 DMs points scoresheet Example

    ESA60 DM rejection of assessment - request for rework Example

    ESA65 Disallowance notification (FFW) Example
    ESA65B Letter to GP re fit-notes Example

    ESA72 Notification of award after WCA Example
    ESA72SC Notification of SG & 'Severe Condition' Example

    ESA82 Letter - ESA will not be paid until decision made following WCA Example

    ESA83 Form - Report worsening condition after previous FFW Example

    ESA85 WCA report (f2f)
    ESA85a WCA report (no f2f) Example
    ESA85s Summary Statement

    ESA86 Used to record advice on LCWRA clerical referrals

    ESA113 Request info from GP (also FRR# below) Download

    ESA120 WFIs when moved from WRAG to SG Example

    ESA124 How your ESA payment is worked out Example

    ESA125 Proof of receiving ESA benefit Example

    ESA214 Detailed guide to the WCA Download

    ESA280 Why you are not entitled to ESA Example

    ESAL0001 Invite SG claimant to voluntary WFI Example

    ESAHWC1 Invite to 'Health & Work Conversation' Example

    HWC1 H&W Conversation questionaire Example
    Same but with the Work Coach notes included: Example

    CRMR1 Request Mandatory Reconsideration Download

    Permitted work
    DWPF01 General info PW Example
    PW1 Permitted work form Download
    DLPW1 letter confirming work is PW Example
    DLPW2 proposed work is not PW Example
    PW8 check if you are still doing PW Example
    PW9 check you are still doing SUPPORTED PW Example

    Related forms.
    HC1 Claim Free Health Costs, (Low Income) Order (prepaid return envelope) or Download (no envelope)

    HCTB1 Housing Benefit claim form Download

    IS10 Application for SDP Usable Example

    SF500 Budgeting Loan application Download

    Other forms related to ESA
    BF223 Good Cause form. Sent if you miss WCA Example
    DP_Gen Form to give bank details Example
    DS1500 Confirmation of terminal illness
    FRR2 Request for specific ME, sent to GP Example
    FRR3 Request for ME, sent to another HCP
    FRR4 Notes of phone contact between HCP & GP, or HCP & claimant
    LT54 Decision Makers Report Example (part 3 for ESA decisions)

    UC50 Capability for Work questionaire - UC Download

    DS700 Carers Allowance claim form Download

    SSCS1 Appeal application -Now done online
    Last edited by nukecad; 02-02-21 at 13:44. Reason: DLPW2 added
    I don't know everything. - But I'm good at searching for, and finding, stuff.

    Migration from ESA to Universal Credit- Click here for information.

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