Completing a UC50 or ESA50 

If you are applying for Universal Credit (UC) or Employment and Support Allowance (ESA) you may be sent a capability for work questionnaire, also known as an UC50 or ESA50.
 

It is important that the form is completed as fully as possible, answering all of the questions. It is also important that the form is returned by the date shown on the latter that has been sent with the form. The information on the form is used to decide whether a face to face assessment is needed or not.
 

Both forms can be downloaded on the following links:

• UC50 - download here 
• or ESA50 - download here 

 

If you use the online form, fill it out, print it, sign it and then send it to the Health Assessment Advisory Service.

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

• Consultant or Specialist Doctor
• Psychiatrist
• Specialist Nurse e.g. a Community Psychiatric Nurse
• Physiotherapist
• Occupational Therapist
• Social Worker
• Support Worker
• Carer

You may also need to provide any medical evidence or other information you might already have, such as reports, or care or treatment plans.  The Health Assessment Advisory Service also like to see (if you have them):

• Your current prescription list
• Your statement of special educational needs
• Epilepsy seizure diary
• Your certificate of visual impairment
• Hospital passports
• Educational 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, results of x-rays

Remember to only send copies of medical or other information if you already have them.  Don't ask or pay for new information or send original documents.  Your National Insurance number should be written on each piece of information that you send.

If you are unable to return the form in time, let the Health Assessment Advisory Service know as soon as possible. There is also a box that allows you to explain why the form was late.

If you need help completing these forms please contact us on 01440 712950 or email info@reachhaverhill.org.uk