Fillable Printable Re-claim or Transfer for Austudy or Youth Allowance - Australia

Re-claim or Transfer for Austudy or Youth Allowance - Australia

SY089.1401

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Re-claim or Transfer for

Austudy or Youth Allowance

• Please use black or blue pens only.

• Print in BLOCK LETTERS.

• Mark boxes like this

with a or .

• Where you see a box like this

Go to 5

skip to the question number shown. You do not

need to answer the questions in between.

This form is for people who are:

• claiming Austudy or Youth Allowance as a student or full-time Australian Apprentice within

14 days of last claiming or receiving a Centrelink payment.

• re-claiming Austudy or Youth Allowance as a student or full-time Australian Apprentice

within 52 weeks of last receiving Austudy or Youth Allowance.

You should have received the booklet

Information you need to know about your claim

for Austudy and Youth Allowance

with this form. In this claim, this booklet will be referred

to as the Information Booklet. If you do not have this booklet, go to our website

www.humanservices.gov.au/forms or call us on 132 490.

Purpose of this form

For more information

Go to our website for Austudy at

www.

humanservices.gov.au/austudy or for Youth Allowance

www.

humanservices.gov.au/youthallowance or call us on

132 490

or visit one of our

Service Centres.

To speak to us in languages other than English, call 131 202.

Note: Call charges apply – calls from mobile phones may be charged at a higher rate.

If you have a hearing

or speech impairment

TTY service Freecall™ 1800 810 586. A TTY phone is required to use this service.

Interpreters and

translations

If you need an interpreter or translation of any documents for our business, we can

arrange this for you free of charge.

What else you will

need to provide

This form tells you which other documents you need to provide to support your claim.

Depending on your circumstances, you may have to fill in other forms.

Filling in this form

Returning your form(s)

Check that you have answered all the questions you need to answer and that you have

signed and dated this form.

If you return the required documents (and your claim form):

• online - you can submit your documents online if you are registered for online services.

To access online services or to find out how to register, go to

www.

humanservices.gov.au/submitdocumentsonline

• by post – we will sight and record your documents, which may include copying,

and return the originals to you by registered post.

• in person – we will sight and record your documents, which may include copying,

and return the originals to you.

Return this form, all additional documents and any other forms you are required to complete

to one of our Service Centres or Online within 14 days, to ensure you are paid from the

earliest date possible.

If you cannot return all the forms or documents within 14 days, contact us for extra time.

If you are lodging documents online, to establish your identity,

we may still require you to attend an office to provide orginial

documents. For more information on how to lodge documents

online, go to

www.humanservices.gov.au/submitdocumentsonline

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Your permanent address

Your postal address (if different to above)

Postcode

Your date of birth

Your name

Other

Family name

First given name

Second given name

MsMissMrsMr

Will you live at a different address while studying?

Postcode

Yes Give the full street address, not a Post Office Box

Go to next question

Home phone number

Is this a silent number?

Mobile phone number

No Yes

Fax number

Work phone number

Alternative phone number

( )

Your contact details

Have you started study or changed study details since last

claiming or receiving a Centrelink payment?

Yes

Go to next question

Go to 16

Are you a full-time Australian Apprentice?

Yes

Give details

Go to next question

Your Centrelink Reference Number (if known)

Start date of Australian Apprenticeship

/ /

Expected end date of Australian Apprenticeship

/ /

Go to 16

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CLK0SY089 1401

Have you attempted Year 12 before?

Are you enrolled on a full-time or part-time basis?

Go to next question

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When?

Yes

Go to next question

Austudy and Youth Allowance is usually only paid for 2

attempts at Year 12.

Part-time

If you are not sure whether you are

enrolled to study full-time, attach details

of your course subjects and we will

assess your study load.

What are your current course details?

If you are going to more than 2 institutions/courses, attach a

separate sheet with details.

Education institution/course

Official start date Official end date

/ / / /

Name of school/Australian Technical College/College/TAFE or

University and campus

Your student identification number

Exact course title

(e.g. Certificate III in Business (Legal Studies), Bachelor of Arts)

Course code

Year/stage of course

(e.g. Year 11, 1st year, B.Sc.)

Full course period

From To

/ / / /

When will you be attending the course this year?

How many hours per week do you attend formal course

work or lectures? (Do not include time spent in private study

or completing assignments.)

hrs

Education institution/course

Official start date Official end date

/ / / /

Name of school/Australian Technical College/College/TAFE or

University and campus

Your student identification number

Exact course title

(e.g. Certificate III in Business (Legal Studies), Bachelor of Arts)

Course code

Year/stage of course

(e.g. Year 11, 1st year, B.Sc.)

Full course period

From To

/ / / /

When will you be attending the course this year?

How many hours per week do you attend formal course

work or lectures? (Do not include time spent in private study

or completing assignments.)

hrs

Go to next question

Full-time

Not sure

Will you be (or are you now) studying Year 12, or equivalent?

Yes

Go to next question

Go to 14

First attempt—Year Second attempt—Year

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Have you completed a tertiary (post secondary) course

(e.g. university, TAFE)?

Give details below

Yes

Go to next question

Name of Institution/Campus

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate II in Tourism, Bachelor of Arts)

Years (e.g. 2005–2007)

If you have completed more than 5 courses, attach a separate

sheet with details.

Have you started a tertiary course but not completed it?

Include:

• any previous years of study in your current course or in

other courses

• both full-time and part-time study.

Years (e.g. 2006)

Full-time Part-time

Study period 1 was:

Give details of courses attempted.

You must list every year of study.

Yes

Go to next question

Year/stage (e.g. 1st year)

Name of institution

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate III in Business, Legal Studies, Bachelor of Arts)

Full-time Part-time

Study period 2 was:

Name of Institution/Campus

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate II in Tourism, Bachelor of Arts)

Years (e.g. 2005–2007)

Name of Institution/Campus

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate II in Tourism, Bachelor of Arts)

Years (e.g. 2005–2007)

Name of Institution/Campus

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate II in Tourism, Bachelor of Arts)

Years (e.g. 2005–2007)

Name of Institution/Campus

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate II in Tourism, Bachelor of Arts)

Years (e.g. 2005–2007)

If part-time, attach details of subjects

attempted.

Unsuccessful study. If you failed due to

circumstances beyond your control, attach

a statement giving reasons.

Years (e.g. 2006)

Full-time Part-time

Study period 1 was:

Year/stage (e.g. 1st year)

Name of institution

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate III in Business, Legal Studies, Bachelor of Arts)

Full-time Part-time

Study period 2 was:

Years (e.g. 2006)

Full-time Part-time

Study period 1 was:

Year/stage (e.g. 1st year)

Name of institution

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate III in Business, Legal Studies, Bachelor of Arts)

Full-time Part-time

Study period 2 was:

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Are you claiming Youth Allowance?

Yes

Go to 19

Go to next question

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If you have started more than 7 courses, attach a separate

sheet with details.

Years (e.g. 2006)

Full-time Part-time

Study period 1 was:

Year/stage (e.g. 1st year)

Name of institution

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate III in Business, Legal Studies, Bachelor of Arts)

Full-time Part-time

Study period 2 was:

Years (e.g. 2006)

Full-time Part-time

Study period 1 was:

Year/stage (e.g. 1st year)

Name of institution

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate III in Business, Legal Studies, Bachelor of Arts)

Full-time Part-time

Study period 2 was:

Years (e.g. 2006)

Full-time Part-time

Study period 1 was:

Year/stage (e.g. 1st year)

Name of institution

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate III in Business, Legal Studies, Bachelor of Arts)

Full-time Part-time

Study period 2 was:

Continued

Years (e.g. 2006)

Full-time Part-time

Study period 1 was:

Year/stage (e.g. 1st year)

Name of institution

(e.g. Gold Coast Institute of TAFE, Melbourne University)

Name of course

(e.g. Certificate III in Business, Legal Studies, Bachelor of Arts)

Full-time Part-time

Study period 2 was:

Please read this before answering the following question.

Yes

Go to next question

Commonwealth Scholarships include:

• Commonwealth Education Costs Scholarship (CECS)

• Commonwealth Accommodation Scholarship (CAS), or

• Indigenous Access Scholarship (IAS).

Give details below

Type of payment

(e.g. Commonwealth Accommodation Scholarship)

If you get more than 2 payments, attach a separate sheet with

details.

Amount paid

When was it paid, or will be paid

/ /

Attach documents which give details.

Type of payment

(e.g. Commonwealth Accommodation Scholarship)

Amount paid

When was it paid, or will be paid

/ /

Do you receive (or expect to receive) a Commonwealth

Scholarship from a higher education institution?

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Have you moved away from home to study, work in an

Australian Apprenticeship or to improve work opportunities?

Yes

Go to B

Give details below

See the Information Booklet for more information about

moving away from home.

Since you last claimed or received a Centrelink payment:

Have you become independent for Youth Allowance purposes?

Yes

Go to C

Give details below

See the Information Booklet for more information about

independence.

Have you started or stopped living with your

parent(s)/guardian(s)?

Yes

Go to D

Give details below

Do you have sister(s) or brother(s) whose circumstances have

changed (e.g. started or stopped study, changed course,

started or stopped work)?

Yes

Go to E

Give details below

Have your rent details changed?

Yes

Go to next question

We will send you a

Rent Certificate

form (SU523)

to complete after you return this form.

Have you had any other changes in your circumstances?

Yes

Go to next question

Give details below

Since you last claimed or received a Centrelink payment,

have any of the following changes occurred?

Has a dependent child or student entered or left your care?

Yes

Go to next question

Give details below

Have your income and/or assets changed?

Yes

Go to next question

Give details below

Have you had an illness, injury or disability which limits your

capacity to work or study?

Yes

Go to next question

Give details below

Have your parent(s)/guardian(s) income or assets changed?

This will apply if you were being paid Youth Allowance based

on your parent(s)/guardian(s) income and you are reapplying

for payment in a new year.

Yes

Go to next question

Your parent(s)/guardian(s) will need to

complete and attach a

Parent(s)/Guardian(s)

details

form (Mod JY). If you do not have this

form, go to our website

www.humanservices.gov.au/forms or call us

on 132 490.

Please read this before answering the following question.

This question has 5 parts to it. Please complete parts A to E.

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You became partnered

Tick ALL that apply

Continued

Your partner will need to

complete and attach a

Partner Details

form

(Mod P).

Go to next question

You became separated

You will need to complete

and attach a

Separation

Details

form (Mod S).

You purchased or

acquired Real Estate

(other than your own

home)

You will need to complete

and attach a

Real Estate

Details

form (Mod R).

You claimed or

became entitled to

claim compensation

or damages from

any accident or injury

You will need to complete

and attach a

Compensation

and Damages Details

form

(Mod C).

You were or became

self-employed, a sub-

contractor or involved

in a partnership

You will need to complete

and attach a

Business

Details

form (Mod F).

You received or expect

to receive any leave

entitlement payments

from an employer

you worked for

You will need to attach a

letter from the employer or

Employment

Separation Certificate

form (SU001).

You have done any

seasonal, contract

or intermittent work

You will need to complete

and attach a

Seasonal,

Contract and Intermittent

Work Details

form

(SU496a).

None of the above

changes occurred

If you are required to complete and attach additional forms

(as below), and you do not have these forms, go to our website

www.humanservices.gov.au/forms or call us on 132 490.

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Name of bank, building

society or credit union

Branch where your

account is held

Account number

(this may not be your

card number)

Account held in the name(s) of

Where do you want your payment made?

Branch number (BSB)

The bank, building society or credit union account must be in

your name. A joint account is acceptable.

Do NOT include an account used exclusively for funding from

the National Disability Insurance Scheme.

Note: If you are under 18 years of age and dependent on your

parent(s), you need to nominate your parent’s account.

Amount

(must be in whole dollars)

Enter the amount OR percentage of tax you want taken

out per fortnight

$ .00 per fortnight

% per fortnight

What is the balance of your (and your partner’s) bank accounts?

You may be asked to provide evidence of bank account

balances.

Do you want a Health Care Card?

Yes

Go to next question

We will automatically assess your eligibility for a

Health Care Card in 8 weeks time or earlier. If you

cannot wait for a Health Card to be sent to you

automatically, the form

Claim for a Health Care

Card

form (SS050) is available, by going to our

website

www.humanservices.gov.au/forms or calling us

on 1800 132 317 (ABSTUDY) or 132 490 (Youth

Allowance or Austudy).

Please read this before answering the following question.

If you are not sure how much tax to have taken out of your

payment, contact the Australian Taxation Office.

Yes

Go to next question

Percentage (%)

of taxable payment

Your accounts Partner’s accounts

Attach proof of account balances

(e.g. ATM slip, statements, passbooks).

My account

Give your parent’s account details

below

My parent’s account

Give your account details below

Do you want tax taken out of your payment?

In the last 12 months, have you received or do you expect to

receive any leave entitlements or redundancy payments from

an employer?

Include:

• annual leave

• maternity leave

• long service leave or sick leave you received when you

stopped work

• entitlements that you cashed in before you stopped work

• money in a long service leave fund or scheme that you have

not cashed in.

Go to next question

Yes

You will need to attach documents which

confirm your leave entitlement payment (e.g.

Employment Separation Certificate

form

(SU001) or a letter from your employer). If you

do not have this form,

go to our

website

www.humanservices.gov.au/forms

or call us on 132 490.

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Details of course subjects if you are unsure

if course is full-time or part-time

(If you answered Not sure at question 11)

Which of the following forms, documents and other attachments

are you providing with this form?

If you are not sure, check the question to see if you should attach

the documents.

Where you are asked to supply documents, please attach

original documents.

Your signature

Date

Statement

I declare that:

• the information provided in this form is complete and correct.

• I will notify the Australian Government Department of Human

Services of any change(s) to this information within 14 days

of the change(s) occurring.

I understand that:

• giving false or misleading information is a serious offence.

• the Australian Government Department of Human Services

can make relevant enquiries to ensure I receive my correct

entitlement.

• I will take all reasonable steps to further my education and/or

employment and, if required, I am willing to enter into an

Activity Agreement.

• payments cannot start until the statements are signed and all

information is provided.

/ /

See page 1 for instructions on returning this form.

Details of subjects attempted on part-time basis

(If required at question 15)

Statement giving reasons for unsuccessful study

(If required at question 15)

Parent(s)/Guardian(s) Details

form (Mod JY)

(If you answered Yes at question 18)

Partner Details

form (Mod P)

(If required at question 20)

Separation Details

form (Mod S)

(If required at question 20)

Real Estate Details

form (Mod R)

(If required at question 20)

Compensation and Damages Details

form (Mod C)

(If required at question 20)

Business Details

form (Mod F)

(If required at question 20)

Employment Separation Certificate

form (SU001)

(If you answered Yes at question 21)

Seasonal, Contract and

Intermittent Work Details

form (SU496a)

(If required at question 20)

Details of Commonwealth Scholorship from a University

(If you answered Yes at question 16)

Documents showing balances for bank, building society and

credit union accounts

(If required at question 23)

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 by law.

You can get more information about the way in which

the Department of Human Services will manage your

personal information, including privacy policy at

www.humanservices.gov.au/privacy or by requesting a copy

from the department.

IMPORTANT INFORMATION

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