DWP forms for healthcare professionals
Updated 23 December 2024
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This publication is available at https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals/dwp-forms
This table lists the forms DWP may ask healthcare professionals to complete and whether there is a charge for doing so.
| Form reference number / code | Title of form | Purpose of the form | Benefit it applies to | GP / hospital | Chargeable and rate |
|---|---|---|---|---|---|
| DLA / AA claim form statement | Statement at back of claim form in connection with Disability Living Allowance (DLA) / Attendance Allowance (AA) |
DLA AA |
GP | No | |
| DLA / AA factual report | Factual report in connection with DLA / AA |
DLA AA |
GP | Yes (£33.50) | |
| 113 | UC / ESA 113 (Factual Report) | Factual report in connection with Universal Credit (UC) or Employment and Support Allowance (ESA) |
UC ESA |
GP | No |
| ATW006 | Access to Work ATW006 | To corroborate medical information in support of travel relating to Access to Work | Access to Work | GP | No |
| BI127 | BI127 | Request for photocopies of case notes including x-ray reports in connection with Industrial Injuries Disablement Benefit (IIDB) | Industrial Injuries | Hospital | No – should be supplied within 10 working days |
| BI205 | BI205 | Factual report in connection with IIDB | Industrial Injuries | GP | Yes (£32.00) |
| DS1500 | DS1500 | Factual report in connection with UC, ESA, Personal Independence Payment (PIP), DLA, AA for people who may be terminally ill |
UC ESA PIP DLA AA |
GP | Yes (£17.00) |
| ESA50 (last page) | UC / ESA 50 cancer statement | Section of the ESA50 which if completed, means that the rest of the form does not require completion |
UC ESA |
GP | Yes but rarely charged for |
| FRR2 | FRR2 GP (Factual report) | Factual report in connection with UC / ESA requesting answers to one or more specific questions |
UC ESA |
GP | No |
| FSF7 | Request for information regarding Flexible Support Fund | For clinician to provide information to JCP | Flexible Support Fund | GP and hospital | Fee agreed locally |
| GPFR | PIP GP (Factual report) | Factual report in connection with PIP | PIP | GP | Yes (£33.50) |
| HFR | PIP hospital factual report (HFR) | To request further information about a patient’s medical condition(s) and the impact these have on their daily life | PIP | Hospital | No |
| SoFFR | Fit note | To provide evidence of the advice given by a doctor regarding their fitness for work |
UC ESA |
GP | No |
| SR1 | Doctor’s report for claiming benefits under the 12 months special rules criteria | Factual report in connection with UC and ESA for people who may be terminally ill |
UC ESA |
GP | Yes (£17.00) |