Customer forms by code

Customer forms listed by code that cover a range of Centrelink, Child Support and Medicare services.

Code Title
MS018 Aboriginal and Torres Strait Islander Medicare enrolment and amendment
SY023 ABSTUDY - Additional information
SY031 ABSTUDY Additional Incidentals Allowance Claim
SY054 ABSTUDY and Assistance for Isolated Children (AIC) - Explanation or formal review of decision
SY053 ABSTUDY Change of circumstances or enquiries
SY032 ABSTUDY Fares Allowance Claim
SY108 ABSTUDY Lawful Custody Allowance claim for reimbursement form - to support SY022
SY034 ABSTUDY Submission for away from base activity funding
SA116 Advice of death
SA486 Aged Care Calculation of your cost of care
SA483 Aged Care Carer or close relative assessment
SA462 Aged Care Claim for financial hardship assistance
AC019 Aged Care Request for a nominee for Department of Veterans' Affairs customers
MS015 Application for a Medicare Entitlement Statement
CS4119 Application for fixed annual rate not to be used
CS4120 Application for Post Separation Income to be Excluded
CS065 Application to add a child to an existing child support assessment
CS1970 Application to change your assessment - special circumstances
MS011 Application to copy or transfer from one Medicare card to another
SU594 Application to provide an Assurance of Support
SU714 Application to provide an Assurance of support for Community Support Program
MS006 Application to receive the Australian Government Rebate on Private Health Insurance as a reduced premium
CS2840 Application to reduce minimum assessment to nil
CS1652 Application to stop deductions from salary or wages
AUS156 Assessment for Carer Payment
SY068 Assistance for Isolated Children (AIC) - Application for Short Term Boarding Allowance
SY042 Assistance for Isolated Children (AIC) - Current Tax Year Assessment
SY069 Assistance for Isolated Children (AIC) - Marginal Distance Confirmation
SY067 Assistance for Isolated Children (AIC) - Organisation details
SY099 Assistance for Isolated Children (AIC) medical statement - Student special needs
SU057 Assurance of Support - Review for Assuree
SU058 Assurance of Support - Review for Assurer
SU631 Assurance of Support Bank Guarantee Release
AV067 August 2016 Kabul kidnapping - Australian Victim of Terrorism Overseas Payment - Health Professional or Allied Health Professional Report
AV066 August 2016 Kabul kidnapping - Australian Victim of Terrorism Overseas Payment - Primary Victim for a person 16 years and over
NH007DF Australian Organ Donor Register
PB299 Australian Thalidomide Survivors Support Program Extraordinary Assistance Fund
PB300 Australian Thalidomide Survivors Support Program Health Care Assistance Fund
MO050 Authorisation to act on an incapacitated person's behalf for Medicare purposes
MO064 Authorising a person or organisation to act on your behalf - COVID-19 Vaccine Claims Scheme
SS313 Authorising a person or organisation to enquire or act on your behalf
AUS221 Authorising a person or organisation to enquire or act on your behalf (outside Australia)
SI039 Authority to release personal information - Personal injury, insurance, superannuation or other matter
MS023 Bali 2005 registration
MS021 Balimed registration
FA008M Bereavement Declaration
MOD F Business details
SS532 Cancel Nominee Arrangement
SS454 Carer Adjustment Payment claim
SA426 Carer Allowance - Medical Report for a child under 16 years
SA489 Carer Allowance adjusted taxable income details
SA381 Carer Allowance Questionnaire - Carer not living with the person for whom care is being provided
SA304(C) Carer Payment - Income and assets details - child or children being cared for - under 16 years
SA304(A) Carer Payment - Income and assets details of the person being cared for - 16 years or over
SA428 Carer Payment - Medical Report for a child under 16 years
SA427 Carer Payment - Medical Report including functional assessment for a child under 16 years
SA431 Carer Payment and Carer Allowance - Medical Report for a child under 16 years
SA010 Carer Payment and Carer Allowance review of care provided - Caring for a person 16 years or over
SA394 Carer Payment and/or Carer Allowance - Care Needs Assessment (for a child under 16 years)
SA332A Carer Payment and/or Carer Allowance Medical Report for a person 16 years or over
AUS172 Certification of location in a country with which Australia has a social security agreement
SY107 Change to attendance information for ABSTUDY students
CS2716 Child over 18 in full time secondary education
CS1666 Child support agreement
CS4647 Child Support statutory declaration - a non-parent carer, and the person named in the form is named on the birth certificate for the children
CS4648 Child Support statutory declaration - the persons named in the form are named on the birth certificate for the children
SA432 Child to adult transfer for Carer Payment and/or Carer Allowance
SA296 Claim for a Commonwealth Seniors Health Card
SS050 Claim for a Health Care Card
SY019 Claim for ABSTUDY
SY021 Claim for ABSTUDY Allowances and Part time Award
SY020 Claim for ABSTUDY Pensioner Education Supplement
SY092 Claim for ABSTUDY Remote Areas
SY018 Claim for ABSTUDY Schooling A
SY022 Claim for ABSTUDY Student or Australian Apprentice in lawful custody
SA002 Claim for Age Pension and Pension Bonus
FA048 Claim for an annual lump sum payment of Family Tax Benefit - A payment to help families with the cost of raising children for the 2021-22 financial year
SY040 Claim for Assistance for Isolated Children (AIC)
AUS140 Claim for Australian Pension from an agreement country
SU508 Claim for Crisis Payment - Release from Prison or Psychiatric Confinement
SA466 Claim for Disability Support Pension
SA494 Claim for Disability Support Pension for a Terminal Illness
SC003 Claim for Double Orphan Pension
SA440 Claim for Essential Medical Equipment Payment
SA451 Claim for Essential Medical Equipment Payment - Multiple Claim
SS456 Claim for Ex-Carer Allowance (Child) - Health Care Card
NH005 Claim for External Breast Prostheses Reimbursement Program
SY005 Claim for Fares Allowance - tertiary students only - Austudy, Youth Allowance or Pensioner Education Supplement
SU694 Claim for Farm Household Allowance
MA001 Claim for Mobility Allowance
SA388 Claim for Pension Bonus Bereavement Payment
SY004 Claim for Pensioner Education Supplement
SS415 Claim for persons granted a Refugee, Humanitarian or Protection Visa
SU004 Claim for Special Benefit
SU721 Claim for Special Benefit for a child
SU514 Claim for Special Employment Advance
CS4649 Commonwealth of Australia Statutory Declaration - you are a parent of the children named
MOD C Compensation and damages
SS509 Compensation Application
SS485 Compensation Personal Sickness and Accident Claim
SS484 Compensation Recovery Statement of Financial Circumstances
RA010 Confirmation of Identity - Verification for Aboriginal and Torres Strait Islander people
SU709 Confirmation of Imprisonment and Application for Payment
SS231 Confirming your identity
SA472 Consent to disclose medical information
AC022 Continuing Care Recipient opting into the New Aged Care Arrangements from 1 July 2014
MO062 COVID-19 Vaccine Claims Scheme Application
MO063 COVID-19 Vaccine Claims Scheme medical report
SU619 Crisis Payment - Prison release and anticipated payment receipt
SA379 Customer in Psychiatric Confinement
MS026 Dahab Egypt registration
SA330 Details of income stream product
FA012 Details of your child’s care arrangements
SA473 Disability Support Pension Medical Evidence Checklist
MS035 Disaster Health Care Assistance Scheme claim
SU505 Earnings Worksheet
SU001 Employment Separation Certificate
CS1671 Ending a child support assessment
SA450 Essential Medical Equipment Payment - Equipment User Declaration
CS1670 Estimate of income for use in Child Support Assessment
SS524 Executor/Administrator Request for information
SS351 Explanation or formal review of a decision
SU699 Farm Household Allowance - Farm Financial Assessment
SY106 First or last day of attendance for ABSTUDY Away from home students
SI031 Freedom of Information - access or change document(s)
AUS156A Health Professional Assessment for Carer Payment
SA456 Home Care Package Calculation of your cost of care
SA310 Home Equity Access Scheme partnered application
SA498 Home Equity Access Scheme review
SA496 Home Equity Access Scheme single application
SA497 Home Equity Access Scheme variation
MOD IA Income and Assets
SA369 Income and Assets
CS1668 Income declaration
CS4145 Income Declaration - Income earned outside Australia
SU505(i) Information you need to know about reporting employment and using the Earnings Worksheet
CI015 Information you need to know about your claim for Carer Allowance
CI002 Information you need to know about your claim for Carer Payment and Carer Allowance
CI010 Information you need to know about your claim for concession and health care cards
CS1665 International application for an Australian child support assessment
AUS178 International bank account
CS2899 Joint election to stop a change to your Child Support Assessment being initiated
MS027 London Assist registration
SA395 Medical Certificate for Carer Payment (for a child under 16 years of age) - Extension and Reclaim of Episodic Care/Extension of Short Term Care
SA449 Medical Practitioners - Essential Medical Equipment Payment - Medical confirmation
MA002 Medical Report - Mobility Allowance
MS014 Medicare Claim
MO024 Medicare Compensation Recovery Bank account details collection
MO026 Medicare Compensation Recovery Notice of past benefits request
MO023 Medicare Compensation Recovery Section 23A statement
MO021 Medicare Compensation Recovery Third party authority
MS004 Medicare enrolment
MS016 Medicare Safety Net Registration and Amendment for Couples and Families
MS001 Medicare Two-way claim
CS1650 Non-agency payment details
CS1669 Notice of withdrawal of application for a child support assessment
SS459 Notification of refugee arrival
AV074 November 2019 London attack - Australian Victim of Terrorism Overseas Payment - Health Professional or Allied Health Professional Report
AV071 November 2019 London attack - Australian Victim of Terrorism Overseas Payment - Primary Victim for a child under 16 years
AV070 November 2019 London attack - Australian Victim of Terrorism Overseas Payment - Primary Victim for a person 16 years and over
CS1893 Objecting to a Child Support decision
MOD JY Parent or Guardian details - for the BASE tax year and CURRENT tax year for dependent Youth Allowance or ABSTUDY customers
A2115 Parents(s)/Guardian(s) additional details for Youth Allowance, Special Benefit or ABSTUDY customers
MOD DP Partner details - if you live in Australia
MOD P Partner details - if you live in Australia
AUS174 Partner details - if you live overseas
PB132 Patient claim for refund Pharmaceutical Benefits Scheme (PBS)
PB018 PBS Safety Net replacement or supplementary card application
PB240 PBS/RPBS Safety Net prescription record form and application for a Safety Net card
SU674 Prison Pre-release Claim
MOD PC Private Company
MOD PT Private Trust
SU580 Profit and Loss Statement
AUS061ES Proof of Life Certificate
RS017 Random Sample Surveys Partner details
SA296A Re-claim for a Commonwealth Seniors Health Card
MOD R Real estate details
SS284 Relationship details
SS293 Relationship details - Separated under one roof
MO029 Reporting suspected fraud
CS3042 Representative authority
MS003 Request an Individual Healthcare Identifier
MS010 Request for a Medicare benefit tax statement
MS044 Request for information about Medicare card details accessed
CS4597 Request for medical information
MS031 Request for Medicare claims information
SA013 Request for Ophthalmologist or Optometrist Report
MS040 Request for Pharmaceutical Benefits Scheme claims information
SU695 Request for restoration of Disability Support Pension or Age Pension Claim for Crisis Payment and Anticipated Payment
MS005 Request or merge a pseudonym Individual Healthcare Identifier record
CS1979 Request to change payment collection method
MOD O Residence in Australia and other countries
SA457 Residential Aged Care Calculation of your cost of care
SA485 Residential Aged Care Property details for Centrelink and DVA customers
CS4243 Responding to an Objection
CS1971 Response to application to change your assessment - Special circumstances
HW051 Review of a Medicare Decision
MA003m Review of Mobility Allowance
SU496 Seasonal, Contract and Intermittent Work Details
SS270 Send my payment to an institution - Group Payment
MOD S Separation details
BC048m Special Benefit Review
MOD SDT Special Disability Trust
CS4644 Statement of financial details - reviewing your assessment
CS4645 Statement of financial details for debt repayment
SU698 Status Resolution Support Services Payment - authorising a person or organisation to enquire on your behalf
MOD ST Study details
SU066 Tax Deduction Authority
AUS109 Treating Doctor’s Report - outside Australia
MS029 Tsunami 2004 registration
MOD Y Unreasonable to live at home
SY017 Unreasonable to live at home statement by independent third party
SY016 Unreasonable to live at home statement by parents or guardians
SY015 Unreasonable to live at home statement by young person
SY101 Verification of Campus
SU684 Verification of medical conditions
AUS027 Verification of working life residence in Australia
SU462 Voluntary Work Verification of Voluntary Work
CS2898 We are considering changing your Child Support Assessment
AUS142 Work Capacity - Customer information
Page last updated: 10 December 2021.
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