Fillable Printable Preliminary claim for Newstart Allowance/Youth Allowance/ Parenting Payment - Australia
Fillable Printable Preliminary claim for Newstart Allowance/Youth Allowance/ Parenting Payment - Australia
Preliminary claim for Newstart Allowance/Youth Allowance/ Parenting Payment - Australia
Family name
First given name
Second given name
Other
1
SU550.1507
Preliminary claim for
Newstart Allowance/Youth Allowance/
Parenting Payment
The signed claim form must be lodged within 14 days of the first contact, EVEN IF you do not have all the paperwork and other documents.
What is your preferred spoken language?
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Your Centrelink Reference Number (if known)
2
Do you need an interpreter when dealing with us?
This includes an interpreter for people who have a hearing or
speech impairment.
To speak to us in languages other than English, call 131 202.
No
Yes
Go to next question
3
What is your preferred written language?
4
Your name
5
Mr Mrs Ms Miss
Your date of birth
8
Your sex
7
Male
Female
Your permanent address
9
Your postal address (if different to above)
10
Postcode
Postcode
12
Do you have a partner?
Go to 16
No
Yes
Go to next question
Partner (married, registered partner or de facto of the
opposite-sex or same-sex)
Go to next question
Other name
Give details below
1
Have you ever used or been known by any other name
(e.g. name at birth, maiden name, previous married name,
Aboriginal or tribal name, alias, adoptive name, foster name)?
6
No
Yes
Type of name (e.g. name at birth)
Other name
2
Type of name (e.g. maiden name)
If you have more than 2 other names, attach a separate
sheet with details.
CLK0SU550 1507
11
Home phone number
Mobile phone number
Email
@
Fax number
Work phone number
Alternative phone number
( )
( )
( )
( )
Your contact details
SU550.1507
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Family name
First given name
Second given name
Other
Your partner’s name
13
Mr Mrs Ms Miss
Your partner’s date of birth
15
I am claiming Newstart Allowance
I declare that:
• I am willing to enter into a Job Plan with the Australian
Government Department of Human Services or my Employment
Services Provider if required
• the information provided in this form is complete and correct
• I will notify the Australian Government Department of Human
Services of any changes to this information within 14 days
of the change(s) occurring.
I understand that:
• I must declare the gross amount of any earnings
• I may need to provide further information if requested
• if required I agree to link with an Employment Services Provider
at the New Claim Interview
• giving false or misleading information is a serious offence
• the Australian Government Department of Human Services
can make relevant enquiries to ensure I receive the correct
entitlement.
• a Job Plan means an Employment Pathway Plan under the
Social Security Act 1991
.
I am claiming Youth Allowance
I am temporarily unfit for work and when my medical
coverage ceases, I will take all reasonable steps to obtain
paid work.
I am unemployed and willing to take all reasonable steps to
obtain suitable paid work, or
I intend to study as a full-time or concessional workload
student this year, or
I am claiming Parenting Payment
17
Statement
Please read and complete the following declaration.
Important Notes on Change of Circumstances next page
Your signature
Date
Go to next question
Other name
Give details below
1
Has your partner ever used or been known by any other name
(e.g. name at birth, maiden name, previous married name,
Aboriginal or tribal name, alias, adoptive name, foster name)?
14
No
Yes
Type of name (e.g. name at birth)
Other name
2
Type of name (e.g. maiden name)
If your partner has more than 2 other names, attach a
separate sheet with details.
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
claim.
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 information, including our privacy policy at
www.humanservices.gov.au/privacy or by requesting a copy
from the department.
IMPORTANT INFORMATION
16
You go outside Australia
• Leave Australia temporarily or permanently.
Change of address or bank account
• Change your address or close the account your payments are
sent to, you should advise us immediately. If mail is returned
to us unclaimed, your payments may be stopped.
Your accommodation
• Receive rent assistance and stop paying, or start to pay rent
to a state, territory or Commonwealth Housing Authority.
• Receive rent assistance and you move in with your parent(s)
or guardian(s).
• Commence living in a home owned or rented by your parent(s)
or guardian(s).
• Move into or out of long term care such as a nursing home
or hostel.
Maintenance
• Receive maintenance for yourself or your child(ren) (whether
periodic, lump sum or capital transfer) including any regular
support or assistance similar to maintenance (such as payments
made to another person on your behalf for mortgage, rent,
site fees), or the amount of maintenance changes etc.
• You are living apart from a partner for whom you receive extra
allowance and you stop paying them maintenance or you pay
them a reduced amount of maintenance.
Your relationship
• You marry; are in or commence a registered or de facto
relationship (either opposite-sex or same-sex) or reconcile
with a former partner.
• you separate from your partner.
• your partner dies.
• An immediate family member dies.
Your children
• You become or cease to be a principal carer of a child under
16 years of age.
• Have a child under 16 years of age and the child leaves home,
is granted a pension, benefit or allowance or leaves Australia.
• Have a student aged 16 – 24 years of age and the student
becomes less dependent on you (e.g. the student’s personal
income increases or the dependent child leaves home), or
• Are granted a pension, benefit or allowance, stops being a
full-time student, starts work, leaves Australia or applies for
and gets an educational allowance from an Australian
department.
• Have a child or student and he or she dies.
• Have any dependent child(ren)/student(s) charged with an
offence and are in custody on remand, in a psychiatric
institution or in prison.
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What you must tell us
The rate of your Newstart Allowance/Youth Allowance/Parenting
Payment may need to be adjusted if there are changes in your
circumstances. If you do not tell us about changes, you could
have a debt. If you have a debt, you may have to pay all or
some of the money back. If you do not tell us about income
you have earned, or if you provide false or misleading information
about your income, you may also have to pay a recovery fee.
After you claim Newstart Allowance, Youth Allowance or
Parenting Payment, you must tell us within 14 days if any of
the following happens.
If you have a partner (including de facto partner), you must also
tell us if any of the following happens to your partner.
Income, investments and business
• Get a new investment or change existing investment(s) or the
investment(s) matures (investments include insurance, bonds,
friendly society investments, public unit trusts, shares, credit
unions or other financial institutions).
• Make a withdrawal from a deferred annuity, approved deposit
fund or superannuation fund investment.
• Receive or cease to receive a pension, benefit or allowance
(other than Family Payment) by the Australian Government
Department of Human Services, or any payment from the
Department of Veterans’ Affairs, or the Department of Education,
or the Department of Employment, or a similar type of payment
from a source outside of Australia.
• Receive or cease to receive a payment under the New
Enterprise Incentive Scheme (NEIS).
• Receive a lump sum payment, redundancy payment or leave
payment.
• Receive any income, distribution or assets from a private trust
or private company or gift any amounts into a private trust or
company.
• Commence a business whether as a sole trader, self-employed,
partnership or within a private trust or private company.
• Loan any money or assets to a private trust or private company.
• Commence employment – even if you have not received any
income from that employment.
Assets
• Have assets that increase above or decrease below the
allowable levels (if you have not been told of your allowable
levels contact one of our Service Centres).
Work or training
• Start, restart or stop paid work or any other form of profession,
trade, business or self-employment.
• Change the number of hours you work.
• Start or stop doing unpaid voluntary work.
• Are sick or injured and cannot look for work or go on a training
course.
• Leave a training course before it ends, or are absent for any
period.
• Apply for or vary your enrolment at school, college or university
or other technical institution.
• Stop being a full-time student or a concessional workload
student.
