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  1. Home
  2. Benefits, rates and forms
  3. Forms

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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

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.

linksAccommodation Supplement Application for current clients (PDF 811.91KB)

S01 - FEB 2024

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 826.51KB)

V01 - DEC 2024

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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B

linksBudget plan step 1 (PDF 784.24KB)

BUD101W – MAY 2025

Budgeting form to help work out your costs and income.

linksBudget plan step 2 (PDF 747.16KB)

BUD102W – MAY 2025

Budgeting form to help plan your financial goals.

linksBudget plan step 3 (PDF 747.44KB)

BUD103W – MAY 2025

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

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C

linksChange of Address/Accommodation Costs (PDF 687.54KB)

R02 - JUL 2024

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 654.07KB)

V03 - FEB 2025

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 1.06MB)

M08 - JAN 2025

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.

linksChild support costs information form (PDF 657.64KB)

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.

linksChildcare Assistance - Change of Circumstances (PDF 753.95KB)

R24 - MAR 2025

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

linksChildcare Assistance application form (PDF 1.2MB)

S02 - DEC 2024

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

linksChildcare Subsidy Verification Form (PDF 659.76KB)

S33W - JUN 2024

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 792.01KB)

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.

linksCommunity Costs Payment Application (PDF 852.88KB)

S29W - DEC 2024

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

linksCommunity Services Card application form (PDF 1MB)

CSC1 - FEB 2025

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.

linksCourse Participation Assistance application form (PDF 686.15KB)

LAB300 - JUL 2023

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D

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 805.47KB)

S03 - DEC 2024

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 Allowance Review form (PDF 352.59KB)

R13 - May 2020

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

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 665.39KB)

S23 - NOV 2024

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

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E

linksEarly Learning Payment application form (PDF 1)

S32W - JUL 2023

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 718.39KB)

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.

linksExtra Help application form (PDF 1.27MB)

M43 - DEC 2024

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 295.97KB)

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).

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F

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.

linksFlexible Childcare Assistance application form (PDF 830.5KB)

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.

linksFuneral Grant Application (PDF 910.19KB)

S04 - JUL 2023

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

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G

linksGuaranteed Childcare Assistance Payment Application (PDF 1.09MB)

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.

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H

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 information 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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I

linksIncluding a partner form (PDF 906.19KB)

R31 - DEC 2024

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 691.07KB)

R03 - JUL 2024

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 864.25KB)

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.

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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.

linksJobseeker Support obligations and privacy form (PDF 863.71KB)

M111-OBS - JUL 2023

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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N

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.

linksNew Zealand Super or Veteran's Pension application form for current clients (PDF 942.21KB)

M11 - APR 2024

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

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 1.47MB)

M12 - FEB 2025

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

linksNZ Super or Veteran's Pension application for residents of the Cook Islands, Niue or Tokelau (PDF 988.29KB)

M50W - Apr 2024

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

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O

linksOrphan's or Unsupported Child's Benefit application form (PDF 1.06MB)

M14 - FEB 2025

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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P

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 1.07MB)

M26 - JUL 2023

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 792.57KB)

V19 - JUL 2023

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.

linksRelocate for Work Support (PDF 682.04KB)

LAB1020W

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

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 978.19KB)

RSU09W - JUL 2023

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 1.41MB)

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.

linksReview of Decision application (PDF 677.41KB)

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.

linksRural Assistance Payment application form (PDF 855.46KB)

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.

linksRural Assistance Payment continuation form (PDF 643.8KB)

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.

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S

linksSeasonal Work Assistance form (PDF 816.14KB)

M46W - JUL 2023

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 731.41KB)

M112-OBS - JUL 2023

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.

linksSupport Funds Job Support application form (PDF 510.75KB)

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.

linksSupport Funds Review Form (PDF 327.35KB)

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.

linksSupport Funds Training Support application form (PDF 561.16KB)

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.

linksSupported Living Payment - Obligations and Privacy Form (PDF 865.04KB)

M113-OBS - JUL 2023

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 684.77KB)

M113-MCW - JUL 2023

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

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T

linksTemporary Accommodation Assistance application (PDF 977.49KB)

S56W - APR 2024

If you're a homeowner and your home was affected by specified North Island Weather Events in 2023, you may be able to receive Temporary Accommodation Assistance.

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 768.02KB)

S26 - DEC 2024

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 1.96MB)

S12W - APR 2025

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

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 849.42KB)

LAB995W - JUL 2023

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

linksTransition to Work Grant Employer Verification (PDF 532.23KB)

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 1.06MB)

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 1.06MB)

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.

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Y

linksYoung Parent Payment Application (PDF 1.33MB)

YS011W - Aug 2023

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

linksYoung Parent Payment Partner's Application (PDF 1.33MB)

YS012W - JUL 2023

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

linksYouth Payment Application (PDF 1.17MB)

YS009W - JUL 2023

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 679.26KB)

V10W - OCT 2024

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

linksYouth Payment Partner's Application (PDF 1.29MB)

YS010W - JUL 2023

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

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

YS014W - DEC 2019

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

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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