ESA Application Form January 2022

Closes 31 Jan 2022

Before you claim


What is Employment and Support Allowance?

Employment and Support Allowance (ESA) is a social security benefit for people who have an illness or a disability. You may be able to get ESA if you have an illness or disability, and you

• are unemployed, or

• are self‑employed, or

• work for an employer but you cannot get Statutory Sick Pay, or

• have been getting Statutory Sick Pay but it has now stopped

Statutory Sick Pay is money employers pay to employees who are away from work for 4 days or more in a row because of their illness or disability.

Waiting Days

Normally, you will not get any ESA for the first 7 days from when you want to claim. These are called waiting days. Not everyone has to serve waiting days, for example, people who have received ESA at any time in the previous 12 weeks.

Work capability assessments

We may ask you to take part in a work capability assessment. By ‘work capability assessment’ we mean 

• filling in and returning a questionnaire, and

• going to a medical assessment.

We will contact you about this. If you do not fill in the form or take part in an assessment, we may stop your benefit.

Work focused Interviews

We may ask you to go to Work focused Interviews that will help you get back into work. This includes Steps 2 Success referral interviews. We will contact you about these. If you do not take part in these interviews, we may reduce your benefit. 

If you have claimed Employment and Support Allowance before

If you have claimed ESA before and we decided during your last claim that you were capable of doing some type of work, we will ask you to provide evidence to show that

• you have a new illness, disability or health condition,  or

• the effect your illness, disability or health condition now has on your ability to do some work has significantly worsened since we last assessed you.

We will try and contact you within the next 14 days if possible. This will either be by phone or in writing.

New Style and Contribution-based Employment and Support Allowance

New Style ESA works in the same way as Contribution-based ESA. You may get New Style ESA if you have paid or been credited with enough class 1 or class 2 National Insurance contributions in the last two relevant tax years.

ESA may be limited to a maximum of 365 days depending on the outcome of your Work Capability Assessment.

ESA is paid at a basic rate for the first 13 weeks. We will then pay your benefit at a rate based on your Work Capability Assessment. We call the first 13 weeks that we pay your benefit your ‘assessment phase’.

Sometimes you cannot get ESA based on your United Kingdom (UK) National Insurance contributions. But you may be able to get ESA if you have worked outside the UK.

We may reduce your ESA if you get

• other social security benefit

• a personal or occupational pension

• a public service pension.

Your savings will not affect New Style or Contribution‑based ESA.

Children and qualifying young persons

ESA does not include any extra money for children or qualifying young persons. You may be eligible to claim Universal Credit at the same time as New Style or Contribution-based ESA.

We use ‘child’ to mean a person aged under 16 who you are getting Child Benefit for.

We use ‘qualifying young person’ to mean a person aged 16, 17, 18 or 19 who you are getting Child Benefit for.

Medical statements

If you are getting Statutory Sick Pay, please send us your current medical statement with your claim.

‘Medical statements’ are also known as medical certificates, doctor’s statements, sick lines or sick notes.

If you are not entitled to Statutory Sick Pay, you do not normally need to get a medical statement for the first 7 days of your illness or disability. From the 8th day you will need to get a medical statement from your doctor and send it to us.

How we collect and use information about you

The information the Department for Communities (DfC) collects from and about you depends mainly on the reason for your business with us.

We will use information about you for all of the Department’s purposes, which include:

• The payment of social security benefits, grant loans and pensions;

• Child Maintenance;

• Employment and Training;

• Investigation of offences relating to social security;

• Social Security Research and Statistics.

DfC uses information to deal with enquiries and complaints, to provide DfC services, to protect public funds, and to conduct research and produce statistics to monitor and improve our services.

We will obtain information about you as the law allows from other organisations to check the information you give to us, protect public funds, and to improve our services.

DfC also shares information with other organisations as the law allows, for example to protect against crime, and with HM Revenue and Customs.

DfC uses external suppliers to help deliver some services. We also use technology to make decisions and improve our services. We will only ask you for information about your health when this is needed for a benefit or service you are using. We will keep your information secure, and make sure nobody has access to it who shouldn’t.

Please look at the DfC Privacy Notice on to find out more about:

• your information rights;

• how to request a copy of your information;

• DfC’s data controller details and other data protection information;

• how long DfC will keep your data for; and

• more detail about how DfC uses personal information.

Universal Credit

Universal Credit replaces Income Related Employment and Support Allowance. You may be able to claim Universal Credit along with Contribution based Employment and Support Allowance. To find out more or to claim Universal Credit online go to

Make the Call

If you would like to talk about accessing other benefits, supports and services you may be entitled to, you can call Make the Call on 0800 232 1271, text ‘Advice’ to 67300 or email For more information you can visit Make the Call.