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Work and income | Te Hiranga Tangata
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  1. Home
  2. Benefits, rates and forms
  3. Forms

Products

  • A-Z benefits
  • Benefit rates
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  • Income and cash asset limits

Forms

A-Z list of our forms. PDF versions of our forms are available here for you to print. If you need help to read a form, please contact us.

Browse: # A B C D E F G H I J N O P R S T U V Y

#

links$5k to Work incentive payment application (PDF 193.13KB)

LAB1020W - OCT 2020

Help to move to another area in New Zealand to start a new job, if you qualify for a benefit.

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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.

linksAccommodation Supplement Application for current clients (PDF 322.95KB)

S01 - JAN 2022

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

linksAdverse Event - Payments to hosts for accommodation (PDF 117.58KB)

CD1 - JUN 2010

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

linksAppointment of an Agent (PDF 204.64KB)

V01 - Dec 2019

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

linksAutomatic Payments - Australia (PDF 22.45KB)

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

linksAway From Home Allowance application form (PDF 682.19KB)

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.

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linksBudget plan step 1 (PDF 299.58KB)

BUD101 – MAY 2020

Budgeting form to help work out your costs and income.

linksBudget plan step 2 (PDF 296.81KB)

BUD102 – MAY 2020

Budgeting form to help plan your financial goals.

linksBudget plan step 3 (PDF 296.85KB)

BUD103 – MAY 2020

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

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linksChange of Address/Accommodation Costs (PDF 218.41KB)

R02 - JUN 2020

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.

linksChange of Bank Account (PDF 187.91KB)

V03 - MAY 2020

Use this form to change your bank account

linksChange of Living Situation for Seniors (PDF 216.76KB)

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.

linksChild Disability Allowance Application (PDF 484.39KB)

M08 - MAY 2022

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

linksChild Disability Allowance Medical Certificate (PDF 198.13KB)

V12CW - JAN 2020

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

linksChild Inclusion Form (PDF 238.03KB)

R30 - APR 2020

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

linksChildcare and OSCAR subsidy application form (PDF 699.75KB)

S02 - NOV 2020

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

linksChildcare Assistance - Change of Circumstances (PDF 176.43KB)

R24 - AUG 2012

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

linksChildcare Subsidy Verification Form (PDF 70.92KB)

S33W - AUG 2009

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

linksCivil Defence Payments to evacuees application form (PDF 344.7KB)

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.

linksCivilian Amputee Assistance application form (PDF 480.4KB)

SW288W - DEC 2019

Apply for help with some of the costs of going to an Artificial Limb Centre.

linksCommunity Costs Payment Application (PDF 453.08KB)

S29W - Dec 2019

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

linksCommunity Services Card application form (PDF 670.3KB)

CSC1 - APR 2020

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

linksCourse Participation Assistance application form (PDF 221.26KB)

LAB300 - DEC 2019

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linksDebt Repayments Authority Form (PDF 71.37KB)

ISS570 - JAN 2011

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

linksDental treatment information (PDF 156.69KB)

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.

linksDisability Allowance application form for current clients (PDF 118.13KB)

S03 - OCT 2020

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

linksDisability Allowance Medical Alarm Assessment Form (PDF 177.32KB)

S21 - DEC 2022

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

linksDisability Certificate (PDF 197.1KB)

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.

linksDisability Certificate - Counselling (PDF 118.42KB)

S23 - AUG 2011

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

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linksEarly Learning Payment application form (PDF 829.59KB)

S32W - NOV 2022

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

linksEmployment and earnings - information for applications (PDF 219.66KB)

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.

linksEmployment and earnings - information for reviews (PDF 224.11KB)

V26 - Oct 2021

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.

linksExtra Help application form (PDF 1.44MB)

M43 - Sep 2022

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

linksExtraordinary Care Fund Grant Application (PDF 373.8KB)

S54W - JUL 2021

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).

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linksFailed pre-employment drug test result confirmation form (PDF 57.85KB)

V28W - JUL 2013

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

linksFuneral Grant Application (PDF 169.43KB)

S04 - JUN 2017

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

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linksGuaranteed Childcare Assistance Payment Application (PDF 623.38KB)

YS008W - DEC 2019

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.

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linksHome Help Payments application form (PDF 587.04KB)

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.

linksHome Help timesheet (PDF 106.18KB)

ISS221W - MAR 2018

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

linksHousing Modification Grant Income and Asset Details (PDF 115.28KB)

M27W - AUG 2009

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

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linksIncluding a partner form (PDF 537.66KB)

R31 - APR 2022

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.

linksIncome and Asset Information (PDF 209.15KB)

R03 - SEP 2021

Declare any income and/or assets.

linksIncreased payment while in hospital form (PDF 66.8KB)

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.

linksInternational Custody Dispute payment application form (PDF 516.24KB)

S30W - DEC 2019

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

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linksJob Support application form (PDF 470.99KB)

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.

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.

linksJobseeker Support obligations and privacy form (PDF 377.49KB)

M111-Obs - NOV 2021

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

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linksNew Zealand Payment Overseas application (PDF 325.54KB)

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.

linksNew Zealand Superannuation application form (PDF 672.05KB)

M12 - NOV 2020

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

linksNew Zealand Superannuation application form for current clients (PDF 599.46KB)

M11 - NOV 2020

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

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O

linksOrphan's or Unsupported Child's Benefit application form (PDF 626.94KB)

M14 - JUL 2021

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

linksOSCAR Subsidy Declaration (PDF 138.65KB)

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.

linksOSCAR Subsidy Verification Form (PDF 123.69KB)

S34W - DEC 2011

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

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linksPrivacy Statement (PDF 258.27KB)

V30W - NOV 2022

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

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R

linksRe-application (within 52 weeks) form (PDF 618.04KB)

M26 - JUN 2022

Re-apply for your payment every 52 weeks.

Re-apply (within 52 weeks) online

The quickest way to re-apply for your payment is online.

linksRedirection of Benefit Payment (PDF 213.91KB)

V19 - MAY 2019

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

linksReimbursement of Health Overcharges application form (PDF 214.94KB)

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.

linksRelationship status verification form for Sole Parent Support (PDF 195.5KB)

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.

linksRent arrears assistance application form (PDF 466.9KB)

S63W – NOV 2019

Use this form if you need help to pay your overdue rent so you can stay in your home.

linksRepayment Financial Circumstances Form (PDF 602.02KB)

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.

linksRepayment Form (PDF 579.78KB)

D002W - OCT 2010

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

linksResidential Care - Deferred Loan Application (PDF 530.08KB)

RSU09W - DEC 2019

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

linksResidential Support Subsidy - Sole Parent's Dependent Children Notification (PDF 168.64KB)

RSU13W - SEP 2022

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

linksResidential Support Subsidy authorisation form (PDF 661.8KB)

RSU08W - SEPT 2020

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

linksResidential Support Subsidy Residents Details Notification Form (PDF 191.08KB)

RSU12W - JAN 2020

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

linksReview of Decision Application (PDF 194.22KB)

R10 - DEC 2022

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

linksRural Assistance Payment application form (PDF 404.87KB)

RUR01W - DEC 2019

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.

linksRural Assistance Payment continuation form (PDF 175.08KB)

RUR02W - DEC 2019

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

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S

linksSeasonal Work Assistance form (PDF 611.76KB)

M46W - OCT 2021

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

linksSelf-Assessment questionnaire (PDF 204.24KB)

HDS016 - MAY 2020

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

linksSelf-Assessment questionnaire - Easy-Read version (PDF 1.93MB)

HDS016ER - Oct 2014

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

Sole Parent Support application

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.

linksSole Parent Support obligations and privacy form (PDF 260.83KB)

M112-Obs - NOV 2021

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.

linksSupported Living Payment - Obligations and Privacy Form (PDF 409.74KB)

M113-Obs - NOV 2021

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.

Supported Living Payment Application

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.

linksSupported Living Payment medical certificate for a person being cared for (PDF 349.6KB)

M113-MCW - DEC 2019

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

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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.

linksTemporary Additional Support application form for current clients (PDF 211.91KB)

S26 - FEB 2021

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.

linksTraining Incentive Allowance Application (PDF 223.8KB)

S12W - JUL 2021

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

linksTraining Support application form (PDF 535.14KB)

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.

linksTransfer to Veteran's Pension application form (PDF 414.23KB)

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.

linksTransition to Work Grant (PDF 400.24KB)

LAB995W - AUG 2021

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

linksTransition to Work Grant Employer Verification (PDF 661.4KB)

LAB996W - Apr 2016

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

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U

linksUnsupported Child's Benefit or Orphan's application form (PDF 626.94KB)

M14 - APR 2020

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

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V

linksVeteran's Pension application form (PDF 798.81KB)

M19W - JUL 2020

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

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Y

linksYoung Parent Payment Application (PDF 849.1KB)

YS011W - AUG 2020

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

linksYoung Parent Payment Partner's Application (PDF 755.74KB)

YS012W - AUG 2020

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

linksYouth Payment Application (PDF 832.3KB)

YS009W - JAN 2020

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.

linksYouth Payment or Young Parent Payment - Parent's Income verification Form (PDF 381.27KB)

V10W - DEC 2019

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

linksYouth Payment Partner's Application (PDF 702KB)

YS010W - FEB 2020

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

linksYouth Service Continue or stop payments form (PDF 349.97KB)

YS014W - OCT 2016

To stop your Youth Service payments if you no longer need it or qualify for it.

linksYouth Service payment card balance transfer application (PDF 502.46KB)

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.

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