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Thread: Listing of ESA standard forms.

  1. #1
    Senior Member nukecad's Avatar
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    Listing of ESA standard forms.

    I thought a listing of all the (current) ESA forms may be useful.

    Some are forms, some are information leaflets, some are letter templates.
    And no doubt some will be obsolete/no longer used.

    I have added download links for fillable forms,

    Where the link says Download it should take you to the official page to download a form that you can fill in and send off.

    Where the link says Example only then that is all it is, and example to look at, if you need that particular form then request an official copy from the DWP/Jobcentre.
    The Example only forms linked here may not be the latest version.


    ESA1 Claim form for a new claim. Download (but you should claim by phone if you can)
    ESA1 (UC) Claim form for 'New Style' Contribution Based ESA in Universal Credit Full-Service (Digital Service) areas. Example only (you should claim by phone)
    ESA2 Circumstances review form.
    ESA3 Claimant application for reassessment because of change of circumstances. Example only
    (Also used to apply for Income Related ESA when Contribution Based runs out, after 52 weeks in WRAG).

    ESA5 Request for pension information.
    ESA6 Request for pension and other income/benefits information.

    JSA/ESA10 Application for hardship payment.Example only

    ESA40 General Information leaflet about ESA. Download

    ESA49 Work Related Activity Plan (letter setting out agreed WR activities).

    ESA50 Capability for Work questionaire. Download
    ESA50A Short version (12 pages) of ESA50, sent when the DM is satisfied from medical evidence that you qualify for WRAG but wants more info. to check for Support Group. Example only

    ESA-N-50 Capability questionaire, claimant overseas. Example only
    ESA-N-54B Guidance notes, for assessor overseas. Example only
    ESA-N-54C Medical Report Form, claimant overseas. Example only

    ESA51 Cover letter from CHDA (Maximus) sent with ESA50 (Why we are sending you this form).

    ESA55 Jacket (folder) in which WCA and medical documents are placed and kept.

    ESA56 Decision Makers points scoresheet. Example only


    ESA65 Disallowance notification if WCA is not passed.
    ESA65B Letter sent to your GP re fit-notes if you are found Fit-for-Work at WCA. Example only

    ESA72 Notification of continuing award after assessment. Example only

    ESA82 Letter advising ESA will not be paid until a decision is made following the WCA. (Repeat Claims after FFW at previous WCA).
    ESA83 Form to report worsening condition after FFW at previous WCA. Example only

    ESA85 WCA report (f2f).
    ESA85a WCA report (no f2f). Example only
    ESA85s Personalised Summary Statement. (Extra notes from the assessor to the Decision Maker)

    ESA86 Form used to record advice on LCWRA only clerical referrals

    ESA113 Form sent to GPs to request information. (also see FRR# below) Download

    ESA120 Letter about WFIs when changed from WRAG to SG. Example only

    ESA124 Written details of how your ESA payment was worked out. Example only

    ESA125 Written details of ESA claim. (Proof of receiving ESA benefit). Example only

    ESAL0001 Letter inviting SG claimant to jobcenter for voluntary WFI. Example only

    ESAHWC1 Invitation letter to 'Health and Work Conversation. Example only

    HC1 Health and Work Conversation questionaire. Example only

    Permitted work forms
    DWPF01 General information leaflet, Permitted work. Example only
    PW1 Permitted work form. (Notify the DWP you are/will be doing PW). Download
    PW8 Letter/form sent to check that you are still doing (the same) work. Example only
    PW9 Letter/form sent to check you are still doing SUPPORTED PW. Example only
    PW12 Letter saying that there is now no 12 month limit for Permitted Work. Example only

    Related application forms.
    HC1 Claim Free Health Costs, prescriptions, etc. (Low Income). Order (comes with a prepaid return envelope) or Download (quicker but no envelope)
    (HC1 is not needed if you are on Income Related ESA, you are already entitled to Free Health Costs).

    HCTB1 Housing Benefit claim form. Download

    IS10 Application for Severe Disability Premium. Example only

    SF500 Budgeting Loan application form. Download

    Other forms related to ESA.
    BF223 Good Cause enquiry form. Sent to ask why you did not attend a WCA appointment. Example only
    DP_Gen Form to give bank details for payment of benefits. Example only
    DS1500 Doctors confirmation of terminal ilness.
    FRR2 Request for specific medical evidence, sent to GP or another healthcare provider involved in the claimants care.
    FRR3 Request for medical evidence, sent to another HealthCare Professional.
    FRR4 Recording and/or paper notes of telephone contact between HCP and GP, or HCP and claimant.
    LT54 Decision Makers Report. Example only (part 3 for ESA decisions)

    Last edited by nukecad; 10-27-2017 at 01:00 PM.
    I'm intelligent enough to know that I don't know everything.
    But I'm good at searching for, and finding, stuff.


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  2. #2
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    You've left out LT54, Decision Makers explanation/report of ESA Decision. Normally requested in conjunction with ESA85/85a or found in ESA Tribunal Evidence 'bundle'.

  3. #3
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    a very usefull thread , i have printed it off for future refference :-)

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    Any idea on the following DWP abbreviations / forms please?

    BDC -
    HOTT - i think its a handover term
    DPA1 - (the note just says "DPA1 held")
    DP - Disability Premium???? (note says "DP marker set")
    ESF F- (note says "ESF family support")
    NQF - regarding framework?
    DJ -
    (DJ) IRP -
    IRP ISS EF -
    CFA -
    SAH -
    SCC -
    LR 3207 -
    IC.O/P - re: a claimed overpayment

    If these help the following are:
    PWLL - permitted work lower limit
    PWHL - permitted work higher limit
    WCA - work capability assessment
    WARS or WRAG - work related activity group or support group

  5. #5
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    Also
    490 - notes says "arrears issued from (date-date) of (amount) VIA '490'."

  6. #6
    Senior Member nukecad's Avatar
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    Hi penthouse,

    Some of those look like internal jobcentre codes.
    We do have a 'sticky' thread for abbreviations already, I've not checKed but you may find them there:
    http://www.youreable.com/forums/show...t=abbreviation

    JA490 is one of their internal procedures for processing recovery of overpayments.
    It is mentioned, along with other "JA" numbers, in this document:
    https://www.whatdotheyknow.com/reque...%20benefit.pdf
    I do't know exactly what it is but assume the 'JA' stands for Jobseekers allowance.
    I'm intelligent enough to know that I don't know everything.
    But I'm good at searching for, and finding, stuff.


    Migration from ESA to Universal Credit- Click here.

  7. #7
    Senior Member nukecad's Avatar
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    29 April 2017.

    Various changes and additions.

    'Clickable' Weblinks added to known downloads and examples.

    Admin have made this thread a 'sticky' (Thanks admin) so it should be easier for people to find in future.
    Last edited by nukecad; 04-29-2017 at 02:44 PM.
    I'm intelligent enough to know that I don't know everything.
    But I'm good at searching for, and finding, stuff.


    Migration from ESA to Universal Credit- Click here.

  8. #8
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    Thanks for posting this thread Nukecad. Very useful

  9. #9
    Senior Member nukecad's Avatar
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    Permitted Work forms updated following removal of '12 month' rule.
    I'm intelligent enough to know that I don't know everything.
    But I'm good at searching for, and finding, stuff.


    Migration from ESA to Universal Credit- Click here.

  10. #10
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    So, I noticed that you said that the ESA56 form is only given when you have no F2F. I did get/ask for the ESA56 when I asked for the LT54, but I had a F2F, so maybe it's generated for all decisions, not just those with no F2F?

    Extremely useful thread though, thank you for posting.

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