Skip to main content
background pattern
Work and income | Te Hiranga Tangata
  • Employers
  • Providers
  • Go to MyMSD login
  • Work homepage

    • Overview

      We can help you get ready to apply and find the right job for you. We can even help you while you're working.

    • Get ready to work

      You can get training, help with CVs and cover letters, and advice for job interviews.

    • Find jobs

      Find out what jobs are available, which job is best for you and how you can plan your career.

    • Working

      Whether you've just started a job or need some help at work, we've got your back.

    • Lost your job

      We'll help you get ready to find a new job and support you while you're between jobs.

    • Start your own business

      Get help to plan and set up a successful business or be a self-employed contractor.

  • Benefits and payments homepage

    • Overview

      Take a look at the range of benefits and payments we have available.

    • Not working

      Redundancy, health condition or disability or another reason you can’t work

    • Living expenses

      Food, school costs, power, accommodation or other living expenses you need help with

    • Relationship changes

      You’ve had a relationship break-up, family breakdown or violent relationship end

    • Health and Disability

      Counselling, prescription and GP costs, medical alarms and other costs we can help with

    • Seniors

      Travelling overseas, how to apply, payment rates and dates, overseas pensions, income and other info for Seniors

    • Caring

      Caring for someone else’s child or someone with a health condition, injury or disability

    • Urgent or unexpected costs

      Dental, glasses, car repairs, fridge, washing machine, funeral or other urgent costs you need help with

    • Children

      Childcare, school uniforms, stationery, having a baby and other costs if you have children

    • Moving to New Zealand

      Payments you can get from us, settling into NZ, overseas pensions and more.

    • Benefits and forms

      A-Z list of benefits, forms, benefit rates

  • On a benefit homepage

    • Overview

      Check out what you need to do when you're getting a benefit or other payment from us.

    • Something's changed

      Address, contact details, overseas travel, childcare, relationship or anything else that’s changed.

    • Income

      Declare income and income deduction tables

    • Childcare

      Change in your childcare situation, continue childcare payments, cohort entry schools and other childcare information

    • Going overseas

      Travelling or moving overseas may affect your payments.

    • Re-apply, review or renew

      Re-apply for a payment, review circumstances, renew medical certificate and more

    • Payments

      Check or stop your payments, payment cards and other information

    • Debt

      Check your debt, repayments and other debt information

    • Rights and responsibilities

      Our commitment to you,  obligations, complaints, benefit fraud and more

  • Housing homepage

    • Overview

      Find out how we can help you with housing.

    • Nowhere to stay

      Get help if you have nowhere to stay right now.

    • Find a house

      Find out where to look for private housing, or apply for public (social) housing.

    • Living in your home

      Get help with accommodation costs, and advice on any housing issues and public housing tenancies.

    • Moving house

      Find out how we can help if you’re moving house.

    • Other languages

      Read some of our housing information in other languages.

  • Go to the Work and Income home page
When autocomplete results are available use up and down arrows to review and enter to select.
  • MyMSD login
  • Online Services
    • Apply online
    • Apply for NZ Super
    • MyMSD
    • Check what you might get
    • Kimi Mahi Mai - Find a Job
    • List a job vacancy
    • Help with online services
  • Work
    • Get ready to work
    • Find jobs
    • Working
    • Lost your job
    • Start your own business
  • Benefits and payments
    • Carers
      • Caring for someone with a health condition, injury or disability
      • Caring for a child with a disability
      • Caring for someone else's child
    • Children
      • Childcare
      • Having a baby
      • School costs
      • Caring for someone else's child
    • Emergencies
      • Civil Defence Payment
      • Rural Assistance Payment
      • Enhanced Taskforce Green
    • Health and disability
      • Vehicle modification
      • Contraception
      • Counselling
      • Dental treatment
      • Glasses
      • House modification
      • Medical alarms
      • Prescriptions and health practitioner costs
      • Residential care
      • Travel costs
    • Living expenses
      • Heating and power bills
      • Managing your money
      • Public transport fares
    • You're not working
      • Redundancy
      • Health condition or disability
      • Fired or left
      • Deported to NZ
      • Released from prison
    • Relationships
      • Break-up
      • Family breakdown
      • Violent relationships
    • Seniors
      • Find out if you can get NZ Super or Veteran's Pension
      • NZ Superannuation
      • Veteran's Pension
      • SuperGold Card
      • Other payments
    • Urgent costs
      • Food
      • Accommodation
      • Power, gas and water bills or heating
      • Dental treatment
      • Glasses
      • Whiteware
      • Medical costs
      • House repairs and maintenance
      • Car repairs
      • Bereavement
      • Fire or theft
    • Moving to NZ
      • Overseas pensions
  • On a benefit
    • Changes and income
      • Income
      • Change housing details
      • Relationships
      • Change bank account
      • Child enters or leaves your care
      • Change contact details
    • Going overseas
      • On a benefit
      • NZ Super or Veteran's Pension
    • Re-apply, review or renew
      • Re-apply for Jobseeker Support
      • Re-apply for Sole Parent Support
      • Re-apply for TAS
      • Renew medical certificate or information
      • Review of circumstances and annual income
    • Obligations
      • Jobseeker Support obligations
      • Supported Living Payment obligations
      • Sole Parent Support obligations
      • When you don’t meet your obligations
    • Payments
      • Check your payments
      • Changes to your payments
      • Money management for youth clients
      • Stop your payments
      • Stop your childcare payments
      • Payment cards
    • Debt
      • Repay debt while on benefit or pension
      • Repay debt if not on benefit or pension
    • Childcare
      • Change in circumstances
      • Reviewing Childcare Subsidy payments
      • Confirm OSCAR payments every term
      • Stop childcare
      • Childcare absences
      • Move to OSCAR
      • Extending childcare
    • Having another child
    • Arrest warrants
    • Your rights and responsibilities
      • Your obligations
      • Have someone act on your behalf
      • Fraud and investigations
      • Our commitment to you
  • Housing
    • Nowhere to stay
      • Emergency housing
      • Escaping family violence
      • Leaving prison
    • Find a house
      • Who can get public housing
      • Apply for public housing
      • Waiting for public housing
      • Accepting a public housing offer
    • Living in your home
      • Housing costs
      • Living in public housing
      • Staying in emergency housing
    • Moving house
      • Bond Grant
      • Accommodation Security Cover Grant
      • Accommodation Costs in Advance Grant
      • Moving Costs Grant
      • Tenancy Costs Cover
      • Transition to Alternative Housing Grant
      • Transfer to another public housing property
    • Other languages
  • Benefits, rates and forms
    • A-Z benefits
    • Benefit rates
    • Forms
    • Income and cash asset limits
  • Providers
    • Housing providers
      • Property owners and landlords
      • Emergency housing suppliers
      • Transitional housing providers
      • Public housing providers
    • Getting payments from us
      • Register as a supplier
      • Ways you can be paid
      • Manage your supplier details
      • Refund money you owe
    • Activity in the Community projects
    • Health and disability practitioners
      • Guides and forms
      • Roles
      • Assisting people into work
      • Medical certificates
      • Health and disability related benefits
      • Designated health practitioners second opinions
      • Medical appeals
    • Childcare assistance
      • Registering your childcare service
      • Become an approved OSCAR provider
      • How we can help you
      • Tell us when things change
      • Payment schedules
      • Contacting us if you're a childcare or OSCAR provider
    • Advocates
    • Employment and training providers
    • Forms
  • About Work and Income
    • Contact us
      • Phone us
      • Our locations
      • International Services
      • Overseas pension agencies
      • Veterans' contacts
      • Deaf, hard of hearing, speech impairment
      • Other languages
      • Service Express
      • Report a suspected fraud
    • Our services
      • Our commitment to you
      • Cheap as data
      • Documents to provide when you apply
      • Appointments
      • About International Services
      • Words we use
      • Become a contracted provider
      • Information for trespassed clients
    • Our privacy notice
      • Collecting your information
      • Using your information
      • Sharing your information
      • Respecting your information
      • Managing your information
    • Feedback and complaints
      • Making a complaint
      • Review of a decision
      • Review of a medical decision
      • Online surveys
    • News
    • Careers at Work and Income
  • About this site
    • Accessibility
    • Privacy, disclaimer and copyright information
    • Online security
  • Employers
    • Recruitment
      • List a vacancy
      • Hire an LSV graduate
      • Hire disabled people or people with health conditions
      • Shortlisting
      • Pre-employment drug testing
      • Make an employment offer
      • Hiring migrant workers
    • Extra support and training
      • Flexi-wage
      • Apprenticeship Boost
      • Mana in Mahi
      • Skills for Industry
      • Support once your employee starts work
      • Mainstream programmes
      • Modifications to your workplace
    • Industry partnerships
    • Redundancy support
    • Emergencies and adverse events
    • Employee debt
  1. Home
  2. Providers
  3. Forms for providers

WARNING: Your device is running Android version 7 or below. From September, you may experience issues accessing our website. We recommend using the Firefox browser.

Providers

  • Housing providers
  • Getting payments from us
  • Activity in the Community projects
  • Health and disability practitioners
  • Childcare assistance
  • Advocates
  • Employment and training providers
  • Forms

Forms for providers

Work and Income forms for medical practitioners, childcare providers, advocates and community organisations

Browse: A B C D E G H L M O P R S

A

linksActivity in the Community Sponsor Application (PDF 489.28KB)

EMPL1001W - Apr 2016

linksAppointment of an Agent (PDF 826.51KB)

V01 - JUL 2024

top

B

Brochures

Providers can check if they've got the latest version of a Work and Income brochure or order some more.

top

C

linksChild Disability Allowance - Medical Certificate (PDF 198.13KB)

V12CW - JAN 2020

linksChildcare / OSCAR provider Registration form (PDF 100.61KB)

S62W - OCT 2016

linksChildcare and OSCAR subsidy application form (PDF 1.2MB)

S02 - DEC 2024

linksChildcare Assistance - Change of Circumstances (PDF 753.95KB)

R24 - MAR 2025

top

D

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.

linksDesignated Doctor Application (PDF 109.22KB)

HDS009W - JUL 2013

If you are interested in becoming a Work and Income designated doctor, please complete this form and return it to Work and Income's Health and Disability Team in your area.

linksDisability Allowance - Medical Alarm Assessment Form (PDF 177.32KB)

S21 - DEC 2022

linksDisability Certificate (PDF 197.1KB)

S22 - APR 2020

Registered health practitioner to complete

linksDisability Certificate - Counselling (PDF 665.39KB)

S23 - NOV 2024

Registered health practitioner and counsellor to complete

linksDrug testing registration of interest form (PDF 92.46KB)

LAB402W - OCT 2013

This registration form sets out the information required from drug testing agencies who wish to register their interest in becoming a potential provider of drug tests for Work and Income beneficiaries who are required to pass a drug test.

top

E

linksEarly Learning Payment application form (PDF 1)

S32W - JUL 2023

linksEmergency housing supplier standards opt in form (PDF 658.36KB)

SHA333W – Dec 2023

If you’re an emergency housing supplier and want to opt-in to the Supplier Standards, you’ll need to complete this form.

top

G

linksGuaranteed Childcare Assistance Payment Application (PDF 1.09MB)

YS008W - JUN 2024

If you’re under 20 and in full-time education, training or work-based learning, you may be able to get Guaranteed Childcare Assistance Payment (GCAP) to help with the cost of pre-school childcare.

top

H

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

M27W - AUG 2009

top

L

linksLimited Service Volunteer Medical Certificate (PDF 684.73KB)

LSV0002MCW - DEC 2023

top

M

linksMedical Appeals Board hearing application (PDF 587.78KB)

HDS021W - AUG 2013

top

O

linksOnline payment schedule email request form (PDF 66.31KB)

S60W - JUL 2015

If you are a childcare centre or OSCAR provider, you can use this form to add, change or cancel your email address for receiving payment schedules each week.

linksOSCAR Funding application - Part one - Provider information (PDF 190.81KB)

S35W - JAN 2025

If you (or your organisation) provide Out of School Care and Recreation (OSCAR) for 5 to 13 year olds before school, after school or as holiday programmes, you may be eligible for OSCAR grant funding from the Ministry of Social Development.

linksOSCAR Funding application - Part two - Programme information (PDF 208.89KB)

S36W - JAN 2025

If you (or your organisation) provide Out of School Care and Recreation (OSCAR) for 5 to 13 year olds before school, after school or as holiday programmes, you may be eligible for OSCAR grant funding from the Ministry of Social Development.

linksOSCAR Subsidy Declaration (PDF 138.65KB)

R18 - DEC 2011

The OSCAR Programme Supervisor will need to fill in part of this form.

linksOSCAR Subsidy Verification Form (PDF 123.69KB)

S34W - DEC 2011

This form needs to be completed by the OSCAR programme supervisor. The information you provide will help us to assess if the applicant is eligible for the OSCAR Subsidy.

top

P

linksPre-employment drug test claim form for drug testing agencies (PDF 660.98KB)

LAB400W - MAY 2024

This form collects information required by Work and Income so a drug testing agency can claim back the cost of a drug test taken by a Work and Income client.

top

R

linksRedirection of Benefit Payment (PDF 792.57KB)

V19 - JUL 2023

A redirection of benefit payment is where part or all of your benefit is paid to another person or organisation by us. Requests for a redirection will only be approved in special circumstances and for good reason.

linksResidential Care - Deferred Loan Application (PDF 978.19KB)

RSU09W - JUL 2023

When a residential care loan becomes repayable, a deferred loan can be offered to people in certain circumstances.

Residential Care notification form

Residential care providers should complete this form when one of our clients is in long-term care and there's been a change in their situation.

linksResidential Support Subsidy - Authorisation Form (PDF 661.8KB)

RSU08W - SEP 2020

Residential Support Subsidy is a payment that helps with the cost of residential support for a person with a physical, sensory, intellectual, psychiatric disability (including drug and alcohol rehabilitation) or disabling chronic health condition who needs residential care as a result.

linksResidential Support Subsidy Residents Details Notification Form (PDF 1.41MB)

RSU12W - JAN 2024

linksRetailer, supplier, payee - change of details (PDF 679.21KB)

ISS26W - SEP 2023

If you receive money from the Ministry of Social Development that relates to a client and you need to update your details with us, you’ll need to complete this form.

linksReview of Decision Application (PDF 677.41KB)

R10 - DEC 2022

If we've made a decision you don't agree with you can use this form to ask for a formal Review of Decision.

linksRural Assistance Payment Application (PDF 855.46KB)

RUR01W - MAY 2024

The Rural Assistance Payment is a Special Needs Grant for farmers or growers who need temporary assistance following a specific adverse event.

linksRural Assistance Payment continuation form (PDF 643.8KB)

RUR02W - MAY 2024

The Rural Assistance Payment is a Special Needs Grant for farmers or growers who need temporary assistance following a specific adverse event. Complete this form if you need to continue receiving this assistance.

top

S

linksSecurity deposit claim form (PDF 195.75KB)

SHA321W - DEC 2021

Housing providers or suppliers need to complete this form if they wish to claim against an occupant's security deposit.

Supplier registration - online form

Register with us if you're a supplier of goods or services and want to receive payments from MSD, e.g. being able to accept Payment Cards.

linksSupplier registration - paper form (PDF 676.15KB)

ISS22W - SEP 2023

Register as a supplier with us using the paper form if you're registering for Youth Service Payment Card, your Merchant ID has letters in it or you have problems using the online form.

linksSupported Living Payment medical certificate for a person being cared for (PDF 684.77KB)

M113-MCW - JUL 2023

For financial assistance to be given to a carer, Work and Income requires a medical certificate for the person being cared for to assure us that they require full-time care and attention. This form is to be completed by a registered health practitioner.

top

How we can help

  • Benefits and payments
  • Work
  • On a benefit
  • Housing

Online services

  • Check what you might get
  • Find work
  • Apply online
  • MyMSD
  • How to stay safe online

About

  • About Work and Income
  • About this site
  • Accessibility
  • Privacy, disclaimer and copyright

Contact us

  • Phone numbers
  • Find a service centre
  • Facebook
  • Twitter
  • Feedback
  • Help in other languages
Go to Ministry of Social Development's website Te Kāwanatanga o Aotearoa / New Zealand Government Shielded Site