ESA50 / UC50 Questionnaire


Those applying for Employment and Support Allowance (ESA) or Universal Credit (UC) may be sent a capability for work questionnaire, also known as an ESA50 or UC50 form. It’s really important that you complete the form as fully as possible, answering all of the questions. It is vital that you return the form by the date on the letter you are sent. We will use the information you provide on the form to decide if you need to come in for a face-to-face assessment or not.

You may also download the ESA50(link is external) or UC50 (link is external)form to your computer. If you use the online form, fill it out, print it, sign it and then send it to us.

If you need help filling in the form, you can now speak to a dedicated advisor on our helpline by calling 0800 288 8777. Select option 1 for the English language service, then option 2 for our advisory team. For the Welsh language service, please call our Customer Enquiry line and press option 2.

You may be asked for details of the professionals or carers who know the most about your health conditions, illnesses and disabilities. These might be a:

  • Consultant or Specialist Doctor
  • Psychiatrist
  • Specialist Nurse, such as a Community Psychiatric Nurse
  • Physiotherapist
  • Occupational Therapist
  • Social Worker
  • Support worker or personal assistant
  • Carer

We also need to see any medical evidence or other information you might already have, such as reports, care or treatment plans about you from GPs, hospital doctors, specialist nurses, community psychiatric nurses, occupational therapists, physiotherapists, social workers, support workers, learning disability support team, counsellors or carers.

Things the Health Assessment Advisory Service would like to see, if you already have them include:

  • Your current prescription list
  • Your statement of special educational needs
  • Epilepsy seizure diary
  • Your certificate of visual impairment
  • Hospital Passports. This is a written record kept by people with learning disabilities to provide hospital staff with important information about them and their health when they are admitted to hospital.
  • Education Health Plans.
  • A diary of your symptoms if your disability, illness or health condition varies from day to day.
  • Long-stay hospital information including date of admission, length of stay and the hospital name and address.
  • Medical test results including:
    > Scans
    > Audiology
    > The results of x-rays, but not the x-rays themselves.


Things the Health Assessment Advisory Service don’t need to see include general information about your medical conditions that are not about you personally such as:

  • Photographs
  • Letters about other benefits
  • Fact sheets about your medication
  • Internet printouts
  • Statement of Fitness for Work, otherwise known as fit notes
  • Medical certificates
  • Doctor’s statements or sick notes
  • Appointment letters

Remember – only send us copies of medical or other information if you already have them. Don’t ask or pay for new information or send us original documents. Please write your National Insurance number on each piece of information you send to us.

If you haven’t yet received an ESA50 or UC50 form, it might be easier for you if you start to gather some of your medical information in advance. This form allows us to decide if you will need a face-to-face assessment.

As soon as you have completed the form, you need to sign and date it, and return it in the envelope we provided. It is really important for you to return the form before its due date.

The Department for Work and Pensions may not be able to continue to pay you benefits if we don’t receive this form in time.

If you cannot return the form in time, let us know as soon as possible. There is also a box that allows you to explain why your form was late. If you have any concerns at all about the form, it’s important that you contact us as soon as you can or ask a representative to contact us.