Fillable Printable Income Declaration - Australia
Fillable Printable Income Declaration - Australia
Income Declaration - Australia
1 of 4
When to use this form
The Australian Government Department of Human Services uses
your adjusted taxable income to calculate your child support
assessment. Adjusted taxable income is the total of your taxable
income, plus other income components such as gross reportable
fringe beneﬁts total, target foreign income, total net investment
losses, some tax free pensions or beneﬁts and reportable
superannuation contributions. This forms allows you to provide an
income declaration if your taxable income has not yet been assessed
by the Australian Taxation Ofﬁce (ATO). It is important to keep your
income details up-to-date to ensure your child support assessment
IMPORTANT: When you lodge your tax return, we may replace your
income declaration with your taxable income and amend your child
support. The best way to ensure your child support is correct is to
lodge your tax return on time every year. If you lodge your tax return
late we may not be able to backdate any changes to your child
This form is available for printing online, go to our website
humanservices.gov.au/forms or call us on 131 272 Monday to
Friday between 8.30 am and 4.45 pm, local time. Note: call charges
apply – calls from mobile phones may be charged at a higher rate.
To complete this form
• Print using BLOCK LETTERS
• Use blue or black pen
• Tick where applicable
• Sign the form
Where do I send this form?
Send the completed form to:
Department of Human Services
GPO Box 9815
MELBOURNE VIC 3001
Fax: 1300 309 949
For more information
For more information, go to our website
humanservices.gov.au/childsupport or call us on 131 272.
Help in other languages
(TIS), 131 450
2 of 4
1 Your Child Support Reference Number
— — —
(as shown on your Child Support Letters)
2 What are your personal details?
Mr Mrs Miss Ms Other
First given name
Other given names
3 Date of birth
4 Postal address
5 Home phone
6 Work phone
7 Mobile phone
9 Which tax years are you supplying income details for?
Financial year (July – June) ie: 2009 – 2010
20 – 20 20 – 20
Please attach a separate sheet if you need to provide
details for more than two ﬁnancial years.
10 Have you lodged tax returns for the above years?
No Are you required to
lodge tax returns for the
No Go to question 11
Yes Please state the years
that you need to lodge and
the date you will lodge
Yes What date did you
lodge the returns?
What name and address were on your returns?
3 of 4
11 What are your income details for the years identiﬁed in
Tax Year 20 – 20
a Gross income (see Notes)
b Allowable deductions (see Notes)
c Net taxable income (a minus b)
d Total net investment losses (see Notes)
e Reportable fringe beneﬁts (see Notes)
f Target foreign income (see Notes)
g Total tax free pensions and beneﬁts
h Reportable superannuation contributions
i Total adjusted taxable income (c + d + e + f + g + h)
IMPORTANT: If you now earn at least 15 per cent less
than the adjusted taxable income provided on this form,
you may be able to supply an estimate of your income.
If your estimate is accepted, we will amend your child
support to reﬂect your new income. Any changes to your
assessment will be effective from the date your estimate
is received. Your assessment will not be backdated.
Privacy and your personal information
Your personal information is protected by law, including the
Privacy Act 1988, and is collected by the Australian
Government Department of Human Services for the
assessment and administration of payments and services.
This information is required to process your application or
Your information may be used by the department or given to
other parties for the purposes of research, investigation or
where you have agreed or it is required or authorised by law.
You can get more information about the way in which the
Department of Human Services will manage your personal
www.humanservices.gov.au/privacy or by requesting a copy
from the department.
I declare that:
• the information provided in this form is complete and
I understand that:
• giving false or misleading information is a serious offence.
4 of 4
What if I have a complaint?
Contact us and speak to your Customer Service Ofﬁcer who
will try to solve the problem.
If you are not satisﬁed with the outcome, ask to speak to
If you are still not satisﬁed, call our Complaints Service on
132 919 and speak to a Complaints Ofﬁcer.
If you feel that we have been unable to successfully
resolve your complaint, you can escalate your concerns by
contacting the Commonwealth Ombudsman.
How can I report suspected fraud?
If you have information about someone who is misusing
government services, please phone the Australian
Government Services Tip-off Line on 131 524.
The tip-off line allows you to conﬁdentially report fraud
against the Department of Human Services.
Gross income must include gross income from wages
before tax, pension/beneﬁts, business income, rental
income, investment income, net capital gains and eligible
terminations payments. Include any other assessable
income that would be included in your tax return.
Allowable tax deductions must be recognised by the ATO
e.g. work related expenses, business expenses, net rental
property losses, net ﬁnancial investment losses.
A total net investment loss is the amount by which the
expenses for your investments, e.g. from rental property,
shares, managed investments and forestry managed
investment schemes, exceed the gross income from those
investments, if this loss was deducted from your income for
Reportable fringe beneﬁts are beneﬁts that are provided to
an employee or an associate, instead of full salary/wage
payment (e.g. salary sacriﬁcing in exchange for a car).
Target foreign income is any foreign income exempt from
tax, less any losses or outgoings incurred in deriving that