Listing of ESA standard forms.

[nukecad]

I thought a listing of current ESA forms could be useful.

I have added download links for fillable forms, clicking on Download should take you to the official page to download a form that you can fill in and send off.

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


ESA1 Claim form for a new claim Download (you should claim by phone if you can)
ESA1 (UC) Claim form for 'New Style' Contribution Based ESA in UC Full-Service areas Example (you should claim by phone)
ESA2 Circumstances review form

ESA3 Claimant application for reassessment because of change of circumstances Example
(Also used to apply for Income Related ESA when Contribution Based runs out after 52 weeks in WRAG)
They are also currently using a special version of this form ESA3(IBR) to capture data when correcting the IB>ESA transfer error - they will contact you if this may apply to you.Example

ESA5 Request for pension information
ESA6 Request for pension and other income information

JSA/ESA10JP Application for hardship payment.Example

ESA40 General Information leaflet Download

ESA49 Work Related Activity Plan (sets out agreed WR activities)

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

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

ESA51 Sent with ESA50 (Why we are sending you this form)

ESA55 Jacket (folder) in which WCA documents are kept Example

ESA56 Decision Makers points scoresheet Example


ESA65 Disallowance notification if WCA is not passed
ESA65B Letter sent to your GP re fit-notes if you are found FfW at WCA Example

ESA72 Notification of continuing award after assessment Example

ESA82 Letter advising ESA will not be paid until a decision is made following the WCA
ESA83 Form to report worsening condition after FfW at previous WCA Example

ESA85 WCA report (f2f)
ESA85a WCA report (no f2f) Example
ESA85s Personalised Summary Statement (Extra notes from the assessor to the DM)

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

ESA124 Details of how your ESA payment was worked out Example

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

ESA214 A detailed guide to the WCA Download
THIS INCLUDES A LIST OF ALL THE DESCRIPTORS AND POINTS.

ESAL0001 Letter inviting SG claimant for voluntary WFI Example

ESAHWC1 Invitation letter to 'Health and Work Conversation' Example

HC1 H&W Conversation questionaire. Example

Permitted work forms
DWPF01 General information leaflet, PW Example
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
PW9 Letter/form sent to check you are still doing SUPPORTED PW Example
PW12 Letter saying that there is now no 12 month limit for PW Example

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 IR ESA, you are already entitled to Free Health Costs)

HCTB1 Housing Benefit claim form Download

IS10 Application for Severe Disability Premium Example

SF500 Budgeting Loan application form Download

Other forms related to ESA
BF223 Good Cause enquiry form. Sent if you miss a WCA appointment Example
DP_Gen Form to give bank details for payment of benefits Example
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 (part 3 for ESA decisions)

UC50 Capability for Work questionaire - Universal Credit Download

SSCS1 Appeal application. -This is now done using an online form Online Application

[Jard]

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'.

[paul446]

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

[Penthouse]

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

[Penthouse]

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

[nukecad]

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.

[nukecad]

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.

[Wiggy]

Thanks for posting this thread Nukecad. Very useful

[nukecad]

Permitted Work forms updated following removal of '12 month' rule.

[gone]

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.