Forms

A

• Accommodation Supplement - Apply online

  If you're not getting any payments from us, or only getting childcare payments, you can apply online for an Accommodation Supplement. Otherwise, call us on 0800 559 009.

• Accommodation Supplement application for current clients [PDF 759 KB]

  S01 - MAR 2026

  For clients already receiving Work and Income benefits or payments, who want to apply for help with accommodation costs.

• Adverse event - Payments to hosts for accommodation [PDF 118 KB]

  CD1 - JUN 2010

  For hosts providing temporary accommodation in an adverse event, including a Civil Defence emergency.

• Appointment of an Agent form [PDF 951 KB]

  V01 - NOV 2025

  To appoint someone to act on your behalf for Ministry of Social Development matters.

• Automatic Payments - Australia [PDF 85 KB]

  Complete this form to arrange regular automatic payments to repay your debt if you're living in Australia.

• Away from Home Allowance application form [PDF 682 KB]

  M36W - DEC 2019

  Apply for the Away from Home Allowance if your child is 16-17 years old, and is living away from home while on a tertiary or training course.

B

• Board and rent information form [PDF 188 KB]

  V36 - MAR 2026

  This form gives us information about your accommodation and any boarders or renters you share your home with, or who just rent space from you.

• Budget plan step 1 - My money [PDF 781 KB]

  BUD101W – MAY 2025

  Budgeting form to help work out your costs and income.

• Budget plan step 2 - My goals [PDF 744 KB]

  BUD102W – MAY 2025

  Budgeting form to help plan your financial goals.

• Budget plan step 3 - Managing your money [PDF 744 KB]

  BUD103W – MAY 2025

  Budgeting form to help review your budgeting progress and future financial plans.

C

• Change of Address/Accommodation Costs form [PDF 695 KB]

  R02 - MAR 2026

  Tell us about a change of address and/or accommodation costs if you're already getting payments from us. Or you can update this online using MyMSD.

• Change of bank account form [PDF 654 KB]

  V03 - FEB 2025

  Use this form to change your bank account.

• Change of Living Situation for seniors [PDF 217 KB]

  R32 - SEP 2019

  For Seniors clients to declare any changes in their living situation, eg change in relationship status, living with others, or living alone.

• Child Disability Allowance application form [PDF 1.1 MB]

  M08 - JAN 2025

  Apply for this payment if you're caring for a child with a serious health condition.

• Child Disability Allowance medical certificate [PDF 198 KB]

  V12CW - JAN 2020

  To be completed by a health practitioner if you're applying for a Child Disability Allowance.

• Child Inclusion form [PDF 238 KB]

  R30 - APR 2020

  Tell us if a child has come into your care while you're getting a benefit from us.

• Child support costs information form [PDF 658 KB]

  R35 – Aug-2023

  If you have new child support costs, or your child support costs have changed or ended, please complete this form so we can review the payments you get from us.

• Childcare Assistance application form [PDF 1.3 MB]

  S02 - MAR 2026

  Apply for a Childcare Subsidy (for pre-school childcare) or the OSCAR Subsidy (for before or after school care).

• Childcare Assistance change of circumstances form [PDF 825 KB]

  R24 - APR 2026

  Tell us about any changes of circumstances while you're getting childcare payments from us.

• Childcare Subsidy verification form [PDF 660 KB]

  S33W - JUN 2024

  To be completed by a childcare supervisor, if you're applying for a Childcare subsidy.

• Civil Defence Payments to evacuees application [PDF 345 KB]

  CD2W - Feb 2023

  Civil Defence Payments are available to meet the immediate needs of people who are resident in an area where a civil defence emergency has been declared and are required to leave their home.

• Civilian Amputee Assistance application [PDF 792 KB]

  SW288W - DEC 2023

  Apply for help with some of the costs of going to an Artificial Limb Centre if you're an amputee or were born without a limb.

• Community Costs Payment application [PDF 940 KB]

  S29W - MAR 2026

  A weekly payment for people in short-term residential treatment programmes to help meet essential ongoing living costs

• Community Services Card application [PDF 1.2 MB]

  CSC1 - MAR 2026

  Apply for a Community Services Card to help with the costs of health care (e.g. some health services and prescriptions) for you and your family.

• Course Participation Assistance application [PDF 686 KB]

  LAB300 - JUL 2023

  Course Participation Assistance is to pay for costs you have because you’re attending a short-term employment related course or programme. To get this assistance you must be getting a benefit or be on a stand-down for a benefit and meet some other conditions.

D

• Debt Repayments Authority Form [PDF 654 KB]

  ISS570 - NOV 2025

  Complete this form to repay debt to the Ministry of Social Development if you are not getting payments from us.

• Dental treatment information [PDF 157 KB]

  V15 - NOV 2022

  This form should be completed by a dentist, for a person who needs help to pay for an oral health issue that already has or would immediately begin to deteriorate if left untreated, and already is or is likely to have a detrimental effect on the person's oral and/or physical health.

• Disability Allowance - apply online

  If you're not getting any payments from us, or only getting childcare payments, you can apply online for Disability Allowance. Otherwise, call us on 0800 559 009.

• Disability Allowance application form for current clients [PDF 915 KB]

  S03 - APR 2026

  For current clients to apply for help with on-going medical costs.

• Disability Allowance Medical alarm assessment form [PDF 177 KB]

  S21 - DEC 2022

  Apply for help with on-going costs of a Medical Alarm.

• Disability Allowance medical certificate [PDF 197 KB]

  S22 - APR 2020

  To be completed by a health practitioner if you're applying for Disability Allowance, or to tell us about a new cost.

• Disability Allowance review [PDF 353 KB]

  R13 - May 2020

  If you have a Disability Allowance, you can use this form to update your existing costs or add a new one.

• Disability Allowance Special Food information form [PDF 673 KB]

  S67W - NOV 2025

  You can use this form to work out the extra costs of a special diet or food if you're applying for a Disability Allowance for these costs.

• Disability certificate - counselling [PDF 665 KB]

  S23 - NOV 2024

  To be completed by a health practitioner and a counsellor if you're applying for a Disability Allowance for counselling.

E

• Early Learning Payment application [PDF 1006 KB]

  S32W - JUL 2023

  Families in a Family Start or Early Start programme can apply for Early Learning Payment.

• Employment and earnings information for applications [PDF 220 KB]

  V06 - OCT 2021

  To be completed by your employer as verification of income, if we've asked you to do this as part of an application.

• Employment and earnings information for reviews [PDF 718 KB]

  V26 - JUL 2024

  To be completed by your employer as verification of income if we've asked you to do this as part of a review of your benefit.

• Extra Help application [PDF 1.2 MB]

  M43 - MAR 2026

  This form includes application for Accommodation Supplement, Disability Allowance and Temporary Additional Support for people not receiving Work and Income assistance

• Extraordinary Care Fund Grant application [PDF 296 KB]

  S54W - JAN 2024

  If you are receiving an Orphan's or Unsupported Child's Benefit for a child in your care, you can apply to the Extraordinary Care Fund for a grant of between $100 and $2,000 each financial year (1 July - 30 June).

F

• Failed pre-employment drug test result confirmation form [PDF 58 KB]

  V28W - JUL 2013

  An employer can use this form to record the results of a pre-employment drug-test.

• Flexible Childcare Assistance application form [PDF 831 KB]

  S37W - APR 2024

  Flexible Childcare Assistance helps you with the costs of informal childcare if you can’t access formal childcare programmes while you’re at work or in employment-related study or training. It needs to be for at least three hours a week. It can be paid for up to five children.

• Funeral Grant application [PDF 910 KB]

  S04 - JUL 2023

  Apply for financial help with the costs of a funeral and other associated costs.

G

• Guaranteed Childcare Assistance Payment application [PDF 1.1 MB]

  YS008W - JUN 2024

  Apply for help with the cost of childcare for children under 5, if you're a young parent in education, training or work-based learning.

H

• Home Help Payments application [PDF 587 KB]

  M29 - DEC 2019

  If you're a parent or carer we may be able to help you with the cost of home help to complete household tasks or training in parenting skills.

• Home Help timesheet [PDF 106 KB]

  ISS221W - MAR 2018

  You can use this timesheet to record information about the work you have done for a person who has had Home Help approved by the Ministry of Social Development.

• Housing Modification Grant Income and Asset Details [PDF 115 KB]

  M27W - AUG 2009

  Declare your income and assets if you're applying for a Housing Modification Grant.

I

• Including a partner form [PDF 1.1 MB]

  R31 - MAR 2026

  If you receive a benefit from Work and Income and now have a partner, your partner will need to be included in your benefit and may receive payments as well.

• Income and assets form [PDF 759 KB]

  R03 - APR 2026

  Declare any income and/or assets.

• Increased payment while you are in hospital [PDF 67 KB]

  SO6W - JUL 2018

  If you get a benefit or NZ Super and you're in hospital for more than 13 weeks, your payments need to change to our hospital rate. If you still have costs to pay, you need to complete this form so we can work out the right rate to pay you while you're in hospital.

• International Custody Dispute Payment [PDF 864 KB]

  S30W - JUL 2023

  Apply for help with costs if you're a parent involved in an international custody or access dispute over the care of your children.

J

• Jobseeker Support - Apply online

  The quickest way to apply for Jobseeker Support is online. If you can't apply online, call us on 0800 559 009 to talk to us about other ways to apply.

• Jobseeker Support obligations and privacy form [PDF 864 KB]

  M111-OBS - MAR 2026

  Complete this form if you're applying for Jobseeker Support, to show you understand your obligations and what happens to information you give us.

N

• New Zealand payments overseas application [PDF 326 KB]

  WIS7W - OCT 2019

  Apply to get your payment if you'll be living in another country, or travelling for more than 26 weeks. Talk to International Services on 0800 777 227 before you complete this.

• New Zealand Superannuation - Apply online

  The quickest way to apply for NZ Super is online. Or, you can call us for free on 0800 552 002 to talk about other ways you can apply.

• New Zealand Superannuation application [PDF 1.5 MB]

  M12 - FEB 2025

  Apply for New Zealand Superannuation if you're not already getting a main benefit from Work and Income.

• NZ Super or Veteran's Pension application for residents of the Cook Islands, Niue or Tokelau [PDF 988 KB]

  M50W - Apr 2024

  This application is for residents of the Cook Islands, Niue or Tokelau.

• NZ Super or Veteran's Pension current clients application [PDF 944 KB]

  M11 - MAR 2026

  Apply for NZ Super or Veteran's Pension if you're already getting a main benefit from Work and Income.

O

• Orphan's or Unsupported Child's Benefit application form [PDF 1.1 MB]

  M14 - FEB 2025

  Apply for help with the costs of raising someone else's child.

• OSCAR Subsidy Declaration [PDF 139 KB]

  R18 - DEC 2011

  If you're getting an OSCAR subsidy, you need to tell us whether your children will attend an OSCAR programme over the school holidays.

• OSCAR Subsidy Verification Form [PDF 124 KB]

  S34W - DEC 2011

  To be completed by the OSCAR programme supervisor if you're applying for an OSCAR subsidy.

P

• Privacy statement [PDF 258 KB]

  V30W - NOV 2022

  Explains how we collect, use and share your information, treat it with respect and keep it safe to protect your privacy.

R

• Re-application (within 52 weeks) form [PDF 1.1 MB]

  M26 - MAR 2026

  Re-apply for your payment every 52 weeks.

• Re-apply online

  There are certain benefits or payments that you may have to re-apply for after a certain period of time. The quickest way to do this is online.

• Redirection of benefit payment form [PDF 793 KB]

  V19 - JUL 2023

  Complete this form if you want part or all of your payments to be paid to another person or organisation.

• Reimbursement of Health Overcharges application [PDF 215 KB]

  C04W - APR 2020

  Apply for a reimbursement if you have a Community Services Card and were charged the full price for health services or prescriptions because you didn't have your card with you.

• Relationship status verification form for Sole Parent Support [PDF 196 KB]

  V24W - DEC 2019

  This form is used to record information from someone nominated by you, about your relationship status when applying for Sole Parent Support.

• Relocate for Work application [PDF 682 KB]

  LAB1020W

  The Relocate for Work Support payment is to help you relocate to another area in New Zealand to take up work.

• Repayment Financial Circumstances Form [PDF 602 KB]

  D003W - May 2012

  If you are unable to afford to pay the standard repayment rate on the amount you owe us, please use this form to provide us with more information about the amount you may be able to repay.

• Repayment Form [PDF 580 KB]

  D002W - OCT 2010

  This form provides you with different options on how you can repay Work and Income.

• Residential Care - Deferred Loan application [PDF 978 KB]

  RSU09W - JUL 2023

  Apply for a Deferred Loan if you cannot repay your Residential Care Loan.

• Residential Support Subsidy - Sole parent's dependent children notification [PDF 169 KB]

  RSU13W - SEP 2022

  Complete this form if you're a sole parent, get a Residential Support Subsidy and continue to financially support your children.

• Residential Support Subsidy application and authorisation forms [PDF 662 KB]

  RSU08W - SEPT 2020

  Apply for Residential Support Subsidy. The Residential Service Provider will also need to complete this form.

• Residential Support Subsidy resident's details notification [PDF 1.4 MB]

  RSU12W - JAN 2024

  Tell us if someone getting a Residential Support Subsidy has had a change in details, like changing address or being admitted to hospital.

• Review of Decision application [PDF 677 KB]

  R10 - FEB 2025

  If the Ministry of Social Development has made a decision you don't agree with you can apply for a review of this decision.

• Rural Assistance Payment continuation form [PDF 644 KB]

  RUR02W - MAY 2024

  Apply for help if you're already getting a Rural Assistance Payment, and need to keep getting this payment a while longer.

• Rural Assistanct Payment application [PDF 855 KB]

  RUR01W - MAY 2024

  Apply for help if you're a farmer or grower who needs temporary financial help after an adverse event, such as severe drought or flood.

S

• Seasonal Work Assistance application form [PDF 345 KB]

  M46W -MAR 2026

  Apply for help if you're doing seasonal work in horticulture but can't work because of bad weather.

• Self-Assessment questionnaire [PDF 204 KB]

  HDS016 - MAY 2020

  Tell us about your work and health background, so we can understand how it impacts your ability to work.

• Self-Assessment questionnaire - Easy Read [PDF 1.9 MB]

  HDS016ER - Oct 2014

  This version is easier for people with learning disabilities or English as a second language.

• Sole Parent Support - Apply online

  The quickest way to apply for Sole Parent Support is online. If you can't apply online, call us on 0800 559 009 to talk to us about other ways to apply.

• Sole Parent Support obligations and privacy form [PDF 732 KB]

  M112-OBS - MAR 2026

  Complete this form if you're applying for Sole Parent Support, to show you understand your obligations and what happens to information you give us

• Special Banking Option forms

  The Special Banking Option enables you to receive overseas and New Zealand benefits or pension payments as one regular payment.

• Support Funds Job Support application form [PDF 511 KB]

  HDS045W – MAR 2023

  Job Support is funding to help people with disabilities or health conditions to get a job or stay in a job, including self-employment. The funding can cover extra things like equipment, workplace modifications, transport, interpreters and other support people.

• Support Funds Review form [PDF 327 KB]

  HDS047W – APR 2023

  If you're getting Job Support or Training Support Funds, you can use this form to tell us about any changes in your circumstances.

• Support Funds Training Support application form [PDF 561 KB]

  HDS046W – MAR 2023

  Training Support is funding to help people with disabilities or health conditions with extra costs relating to training, so they can get or stay in a job, including self-employment. The funding can cover extra things like equipment, transport, interpreters and other support people.

• Supported Living Payment - Apply onine

  The quickest way to apply for a Supported Living Payment is online. If you can't apply online, call us on 0800 559 009 to talk about other ways to apply.

• Supported Living Payment medical certificate [PDF 685 KB]

  M113-MCW - MAR 2026

  To be completed by a health practitioner if you're applying for a Supported Living Payment as a carer.

• Supported Living Payment obligations and privacy form [PDF 861 KB]

  M113-OBS - MAR 2026

  Complete this form if you're applying for Supported Living Payment to show you understand your obligations and what happens to the information you give us.

T

• Temporary Additional Support - Apply online

  If you're not getting any payments from us, or only getting childcare payments, you can apply online for Temporary Additional Support. Otherwise, call us on 0800 559 009.

• Temporary Additional Support application form for current clients [PDF 799 KB]

  S26 - APR 2026

  Clients already receiving Work and Income help use this form to apply for more help with on-going costs not already covered by other Ministry of Social Development payments.

• Training Incentive Allowance application [PDF 2 MB]

  S12W - JUL 2025

  Apply for help to pay for employment-related training costs.

• Transfer to Veteran's Pension [PDF 414 KB]

  S14W - DEC 2019

  Complete this form if you and/or your partner get NZ Super, have Qualifying Operational Service with the New Zealand Defence Force, and want to transfer to a Veteran's Pension.

• Transition to Work Grant applicant form [PDF 365 KB]

  LAB995W - MAR 2026

  Apply for help with the cost of looking for, or moving into, work.

• Transition to Work Grant employer verification [PDF 532 KB]

  LAB996W - Apr 2016

  To be completed by your employer if you're applying for a Transition to Work Grant for job-related costs.

U

• Unsupported Child's Benefit application form [PDF 1.1 MB]

  M14 - APR 2020

  Apply for help with the costs of raising someone else's child.

V

• Veteran's Pension application [PDF 1.1 MB]

  M19W - APR 2024

  Apply for the Veteran's Pension if you have Qualifying Operational Service with the New Zealand Defence Force and aren't getting NZ Super.

Y

• Young Parent Payment application [PDF 1.4 MB]

  YS011W - APR 2026

  Apply for the Young Parent Payment if you're a young parent aged 16-19 years old.

• Young Parent Payment Partner application [PDF 1.4 MB]

  YS012W - APR 2026

  Complete this form if your partner is applying for a Young Parent Payment.

• Youth Payment application [PDF 1.3 MB]

  YS009W - APR 2026

  Apply for a Youth Payment if you're 16-17, can't live with your parents or guardian, and are not being supported by them or anyone else

• Youth Payment or Young Parent Payment - Parent's income verification form [PDF 679 KB]

  V10W - OCT 2024

  To be completed by your parents or guardians if you're a young person applying for a payment.

• Youth Payment Partner application [PDF 1.3 MB]

  YS010W - JUL 2023

  Complete this form if your partner is applying for a Youth Payment.

• Youth Service Continue or stop payments form [PDF 350 KB]

  YS014W - DEC 2019

  Use this form to stop or continue your Youth Payment or Young Parent Payment.

• Youth Service payment card balance transfer application [PDF 502 KB]

  YS019W - JAN 2015

  Apply for a balance transfer if you want to use your Youth Service Payment Card to buy from somewhere that doesn't accept the card.