Employment and Support Allowance: permitted work form

Use this form to tell us if you are working, or want to work, while claiming Employment and Support Allowance (ESA).

If you’re claiming ESA, fill in the permitted work form before you start any paid or unpaid work.

Post it to the address at the top of any ESA letters we have sent you. Please do not take this form into your Jobcentre Plus office.

You could lose your benefit if you do any kind of work that doesn’t meet the conditions. If you can’t send the form before you start work, send it as soon as possible after starting work.

If you need this form in a different format

Contact Jobcentre Plus to ask for:

• a printed copy of the form
• a different format, such as large print, braille or audio CD

https://www.gov.uk/government/publications/employment-and-support-allowance-permitted-work-form