Parenting Payment – Change of relationship status - Becoming ...

Parenting Payment – Change of relationship status
Becoming partnered
Return this form to one of our Service Centres by / /
Centrelink Reference Number (if known)
When to use this form
Definition of a partner
For more information
If you have a hearing
or speech impairment
Interpreters and
translations
What else you will
need to provide
Filling in this form
This form is used by a Parenting Payment Single payment customer to transfer to a Parenting
Payment Partnered payment.
For the Department of Human Services purposes a person is considered to be your partner
if you and the person are living together, or usually live together, and are:
• married, or
• in a registered relationship (opposite or same-sex), or
• in a de facto relationship (opposite or same-sex).
We consider a person to be in a de facto relationship from the time they commence living
with another person as a member of a couple.
We recognise all couples, opposite-sex and same-sex.
If you need assistance with this form, go to our website
www.humanservices.gov.au/parentingpayment or call us on 136 150 or visit one of our
Service Centres.
To speak to us in languages other than English, call 131 202.
Note: Calls charges apply – calls from mobile phones may be charged at a higher rate.
TTY service Freecall 1800 810 586. A TTY phone is required to use this service.
If you need an interpreter or translation of any documents for Centrelink business,
we will arrange this for you free of charge.
This form tells you which other documents you need to provide.
Depending on your circumstances, you may have to fill in other forms.
• Please use black or blue pen.
• 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.
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Returning the 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 required documents (and this form):
• by post – we will sight and record your documents, which may include copying, and
return 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 within 14 days.
If you cannot return all the forms or documents within 14 days, contact us for extra time.
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1
Are you the principal carer of a child under 6?
No
Yes
2 Your name
Mr
Family name
First given name
You cannot receive Parenting Payment
Please call us on 136 150
Go to next question
Mrs
Miss
Ms
Other
9
10
11
What is your date of marriage or registered relationship?
/ /
Go to 11
When did you and your partner start living together as a member
of a couple?
Do you currently live in the same home as your partner?
No
/ /
Yes Go to 14
Go to next question
3
Second given name
Your date of birth
/ /
12
Why are you not living with your partner?
Partner’s illness
Your illness
Partner in prison
Partner’s employment
Other Give details below
4
Your Centrelink Reference Number (if known)
5
Your contact phone number
( )
13
Period not living with your partner
From / /
6
Your permanent address
To
/ / OR indefinite
14
Your partner’s name
Postcode
Mr Mrs
Family name
Miss
Ms
Other
7
Your postal address (if different to above)
First given name
Postcode
Second given name
8
Please read this before answering the following question.
We recognise both opposite-sex and same-sex relationships.
This includes de facto relationships and relationships registered
under state or territory law.
Select ONE option below that best describes your current
relationship status.
What is your CURRENT relationship status?
Married Go to 9
Registered relationship
(opposite-sex or same-sex relationship
registered under state or territory law)
Go to 9
Partnered
Go to 10
(living together in an opposite-sex or
same-sex relationship, including de facto) CLK0SC279 1303
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15
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)?
No Go to next question
Yes Give details below
1 Other name
21
Has your address and/or accommodation details changed since
you last contacted us?
No Do not answer questions 22 to 26.
Go to 27
Yes What date did your address and/or accommodation
change?
/ / Go to next question
22
Which of the following best describes where you live?
Type of name (e.g. name at birth)
2 Other name
In a home you own or you own jointly with
another person, this can include:
• paying it off (mortgage)
• a caravan, transportable home or boat Go to 27
In a place where you pay board and
lodging
Go to 23
Type of name (e.g. maiden name)
In a place where you pay private rent
(this includes site or mooring fees)
Go to 24
No rent paid Go to 27
If you have more than 2 other names, attach a separate sheet
with details.
Other (e.g. this could be a place where
you do not have a fixed address)
Specify below
16
Your partner’s sex
Male
Go to 24
17
Female
Your partner’s date of birth
/ /
23
Can you separate the amounts you (and/or your partner) pay for
board and/or lodging?
No Total board and lodging charged per day, week,
fortnight, 4 weeks or calendar month
$ per
18
Do you give permission for your partner to discuss your payments
with us?
You can change this authority at any time.
Yes
Amount paid for board (meals) per day, week,
fortnight, 4 weeks or calendar month
No
$
per
19
Yes
Does your partner receive a payment from us?
Amount paid for lodging (accommodation only) per day,
week, fortnight, 4 weeks or calendar month
$ per
Note: If your partner is not a current customer you will need
to provide 3 documents to confirm his/her proof of identity.
For information about identity documents, go to our website
www.humanservices.gov.au or call us on 136 150 or visit one of
our Service Centres.
No
Your partner must complete and attach a
Parenting Payment (partnered) Partner
details form (SC278). If you do not have this
form, go to our www.website
www.humanservices.gov.au/parentingpayment
Go to 21
24
Go to 25
How much do you (and/or your partner) pay per day, week,
fortnight, 4 weeks or calendar month (e.g. rent, maintenance or
site fees)?
This would be the total you (and/or your partner) pay for the
property minus any subsidy/rebate or contribution from
another person or organisation.
$ per
20
Yes
Go to next question
Your partner’s Centrelink Reference Number (if known)
25
What is the total amount of rent charged for the property per
day, week, fortnight, 4 weeks or calendar month?
$ per
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26 Do you (and your partner) share your accommodation with
other people?
Sharing your accommodation means that you have the right to
use a kitchen, bedroom or bathroom with one or more persons.
This includes ALL family members, people who regularly stay
at your accommodation and people who work away from home
(e.g. truck drivers, miners, flight attendants, fishermen,
members of the armed forces).
No
Yes
1
Sex
Go to next question
Give details below of people who share your
accommodation.
Person’s name
Male
Female
When did they first stay?
2
Sex
/ / $
How often do they pay?
Person’s name
Male
Female
When did they first stay?
3
Sex
/ / $
How often do they pay?
Person’s name
Male
Female
When did they first stay?
4
Sex
/ / $
How often do they pay?
Person’s name
Male
Female
When did they first stay?
/ / $
How often do they pay?
Age
Your relationship to this person
Their share of the rent/lodging
Age
Your relationship to this person
Their share of the rent/lodging
Age
Your relationship to this person
Their share of the rent/lodging
Age
Your relationship to this person
Their share of the rent/lodging
If you share with more than 4 people, attach a separate sheet
with details.
27
28
29
30
31
Do you want to change the account your Parenting Payment is
made to?
No Go to next question
Yes Give details of the account you want your Parenting
Payment made to
The bank, building society or credit union account must be in
your name. A joint account is acceptable.
Name of bank, building
society or credit union
Branch where your
account is held
Branch number (BSB)
Account number
(this may not be
your card number)
Account held in the name(s) of
Has there been any change to your income or assets since
becoming partnered?
No
Yes
Please read this before answering the following questions.
You are not breaking the law if you do not give us your tax
file number, but if you do not provide it, to us, or authorise us
to get it from the Australian Taxation Office, your partner may
not be paid.
In giving us your tax file number in relation to this claim you
authorise us to use your tax file number for other social
security payments and services in future where necessary.
Have you given us your tax file number before?
No
Not sure
Yes
Go to next question
You will need to complete and attach an
Income and Assets form (Mod iA). If you do
not have this form, go to our www.website
www.humanservices.gov.au/parentingpayment
Has there been any change to your partner’s income or assets?
No Go to next question
Yes
Your partner will need to complete and attach
an Income and Assets form (Mod iA). If you
do not have this form, go to our www.website
www.humanservices.gov.au/parentingpayment
Go to next question
Go to next question
Go to 32
Does your partner have a tax file number?
No Please call us on 136 150.
Yes Your partner’s tax file number
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32
33
34
35
36
37
Has the number of children in your care changed since you
became partnered?
No
Yes
INT
Do you already receive Family Tax Benefit for all the children in
your care?
No
Yes Go to next question
Do you share the care of any children with another person (other
than your partner)?
No
Yes
Is your partner the parent or guardian of any children in your
care?
No
Yes
Did you previously get maintenance/child support from your
partner?
No
Yes
INT
INT
INT
Which of the following forms are you providing with this form?
If you are not sure, check the question to see if you should attach
the forms.
Parenting Payment (partnered) Partner details
form (SC278)
(If you answered No at question 19)
Income and Assets form (Mod iA)
(If you answered Yes at questions 28 and 29)
38 IMPORTANT INFORMATION
Privacy and your personal information
Centrelink, Medicare, Child Support and CRS Australia are
services within the Australian Government Department of
Human Services (Human Services).
Your personal information is protected by law, including the
Privacy Act 1988. Your information is collected for Social
Security, Family Assistance, Medicare, Child Support and
CRS purposes. This information may be required by the powers
provided within each service’s legislation or voluntarily given
by you when you apply for services or payments.
Your information will be used for the assessment and
administration of payments and services. Your information may
also be used within Human Services, where you have provided
consent or it is required or authorised by law. Human Services
may disclose your information to Commonwealth Departments,
other persons, bodies or agencies ONLY where you have
provided consent or it is required or authorised by law.
You can get more information about privacy by going to our
website www.humanservices.gov.au/privacy or requesting a copy
of the full privacy policy at one of our Service Centres.
39 Statement
I declare that:
• the information provided in this form is complete and correct.
I understand that:
• giving false or misleading information is a serious offence.
• the Department of Human Services can make relevant
enquiries to ensure I receive my correct entitlement.
Your signature
Date
/ /
Your partner’s signature
Date
/ /
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