Request to Change Payment Collection Method form

Request to Change Payment Collection MethodWhen to use this formYou can complete this form if all of the following apply:• you already have a registered child support case• you want to request a change in your collection method• you are the receiving party of child support.You can complete this form over the phone, call us on 131 272Monday to Friday between 8.30 am and 4.45 pm, local time.Note: Call charges apply – calls from mobile phones may becharged at a higher rate.This form is available online, go to our websitehumanservices.gov.au/childsupportTick where applicable. Please write clearly in BLOCK LETTERS.Home phone ( )Work phone ( )Mobile phoneEmail2 What is your Child Support ReferenceNumber?1 What are your personal details?Title Mr Mrs Miss Ms OtherFamily name(as shown on your Child Support Letters)3 What is your Tax File Number (TFN)?First given nameOther given namesWe use your tax information to calculate your child supportassessment. You are not breaking the law if you do not giveus your Tax File Number. We will obtain this informationfrom the Australian Tax Office if you do not provide it.Date of birth/ /Postal addressPostcode1979.12051 of 4

CHANGING TO DEPARTMENT OF HUMANSERVICES COLLECTNote: If you are requesting that we collect payments on yourbehalf and this is not the first time you have made this request,we may not accept this application.9 In addition to collecting your ongoingpayments, do you want us to collect anyoutstanding private payments?No Go to 11.10 Do you believe you have exceptionalcircumstances which prevented you fromapplying for collection earlier?If the paying parent owes you child support for the last 9months, you may be eligible to recover these payments. Pleaseprovide information if you believe exceptional circumstanceshave prevented you from applying for collection earlier.No Go to 11.YesCircumstancesPlease provide information below.YesPlease complete the table below.We can collect up to 3 months of arrears if payments have notbeen made during this time.Please state the amounts owing to you and the periods theseamounts cover.Amount dueAmount paid$$11 What are the paying parent’s employmentdetails? (if known)Employer nameDate paid / /Period the payment covers from/ / to/ /Employer addressAmount due$Amount paid$Date paid / /Period the payment covers from/ / toAmount due$/ /Employer phone number( )Employer mobile phone numberDo you know any other details that might help us to locate thepaying parent? (e.g. The name of the paying parent’s bank orbusiness income, or the name and contact details of a personwho might know.)Amount paid$Date paid / /Period the payment covers from/ / to/ /1979.12053 of 4

12 Where would you like us to deposit yourchild support payments?Payments must be made to a bank, building society or creditunion account held in your name or jointly with another person.Bank/credit union/building society nameBranch nameBranch number (BSB)Account numberAccount name13 StatementI declare that:• the information provided in this form is complete and correct.I understand that:• giving false or misleading information is a serious offence.Your signatureDate/ /14 NotesPrivate CollectKeeping payment recordsPrivate Collect means that we will continue to calculate yourchild support assessments, while you manage the transferof payments. It is important that you keep a record of allpayments. You may need to supply this information as proof ofpayment if we request it at a later date.Family Tax Benefit and child supportIf the receiving parent receives more than the base rate ofFamily Tax Benefit (FTB), we require the receiving parent tocollect child support at the assessed rate. If the receivingparent does not take reasonable action to collect the fullassessed rate of child support then they will not be paid morethan the base rate of FTB.Private payments do not mean that the paying parent does nothave to pay. We will assume the receiving parent is collectingthe full assessed rate of child support. Remember that thereceiving parent may already be receiving a reduced rate offamily assistance, due to the amount of child support they areentitled to receive. In this situation, if the paying parent doesnot pay the full child support amount, the receiving parent willbe disadvantaged through reduced benefits and reduced childsupport. The receiving parent should contact us on 131 272 todiscuss options.Child Support CollectPayments and enforcementChild Support Collect means that we will attempt to collectpayments on the receiving parent’s behalf. This is anappropriate option for parents who have difficulty collectingpayments privately.Please note that although we will make every attempt tocollect child support, we cannot guarantee payments. In somecircumstances, we do not have enough information to enforcepayments. It is important that the receiving parent providesany details that might help locate the paying parent. Helpfulinformation includes the name of the paying parent’s employerand bank.Additional informationWhere do I send this form?Send the completed form to:Department of Human ServicesGPO Box 9815MELBOURNE VIC 3001orFax: 1300 309 949Where can I find more information?If you need more information, or you would like help to complete this form, please phoneus on 131 272. You can also read more about your options in our fact sheets available onour website humanservices.gov.au/childsupportPrivacy and your personal informationCentrelink, Medicare Australia, Child Support and CRS Australia are services within theAustralian Government Department of Human Services (Human Services).Your personal information is protected by law, including the Privacy Act 1988. Yourinformation is collected for Social Security, Family Assistance, Medicare, Child Supportand CRS purposes. This information may be required by the powers provided within eachservices’ 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 andservices. Your information may also be used within Human Services, where you haveprovided consent or it is required or authorised by law. Human Services may disclose yourinformation to Commonwealth departments, other persons, bodies or agencies ONLY whereyou have provided consent or it is required or authorised by law.You can get more information about privacy by goingto our website humanservices.gov.au/privacy orrequesting a copy of the full privacy policy at one of ourService Centres.What if I have a complaint?Step One:Contact us and speak to your Customer Service Officerwho will try to solve the problem.Step Two:If you are not satisfied with the outcome, ask to speak totheir manager.Step Three:If you are still not satisfied, call our Complaints Serviceon 132 919 and speak to a Complaints Officer.If you feel that we have been unable to successfullyresolve your complaint, you can escalate your concernsby contacting the Commonwealth Ombudsman.How can I report suspected fraud?If you have information about someone who is misusinggovernment services, please phone the AustralianGovernment Services Tip-off Line on131 524.The tip-off line allows you to confidentially report fraudagainst the Department of Human Services.