Forms by code for individuals

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

Code Title
A2115 Parents(s)/Guardian(s) additional details for Youth Allowance, Special Benefit or ABSTUDY customers
AC019 Aged care request for a nominee for Department of Veterans’ Affairs customers
AC022 Continuing Care Recipient opting into the New Aged Care Arrangements from 1 July 2014
AUS027 Verification of working life residence in Australia
AUS109 Treating Doctor’s Report - outside Australia
AUS140 Claim for Australian Pension from an agreement country
AUS142 Work Capacity - Customer information
AUS156 Assessment for Carer Payment
AUS156A Health Professional Assessment for Carer Payment
AUS172 Certification of location in a country with which Australia has a social security agreement
AUS174 Partner details
AUS178 International bank account
AUS184 Separation details outside Australia
AUS221 Authorising a person or organisation to enquire or act on your behalf (outside Australia)
AUS224 International medical assessment
AV079 October 7, 2023 Hamas terrorist attacks - Australian Victim of Terrorism Overseas Payment - Primary Victim for a person 16 years or older
AV080 October 7, 2023 Hamas terrorist attacks - Australian Victim of Terrorism Overseas Payment - Primary Victim for a child younger than 16 years
AV081 October 7, 2023 Hamas terrorist attacks - Australian Victim of Terrorism Overseas Payment -Secondary Victim for a person 16 years or older
AV082 October 7, 2023 Hamas terrorist attacks - Australian Victim of Terrorism Overseas Payment - Secondary Victim for a child younger than 16 years
AV083 October 7, 2023 Hamas terrorist attacks - Australian Victim of Terrorism Overseas Payment Health Professional or Allied Health Professional Report
AV085 May 2024 Bamyan, Afghanistan shooting - Australian Victim of Terrorism Overseas Payment - Primary Victim for a person 16 years or older
AV086 May 2024 Bamyan, Afghanistan shooting - Australian Victim of Terrorism Overseas Payment - Primary Victim for a child younger than 16 years
AV087 May 2024 Bamyan, Afghanistan shooting - Australian Victim of Terrorism Overseas Payment - Secondary Victim for a person 16 years or older
AV088 May 2024 Bamyan, Afghanistan shooting - Australian Victim of Terrorism Overseas Payment - Secondary Victim for a child younger than 16 years
AV089 May 2024 Bamyan, Afghanistan shooting - Australian Victim of Terrorism Overseas Payment Health Professional or Allied Health Professional Report
BC048m Special Benefit Review
CI002 Information you need to know about your claim for Carer Payment and Carer Allowance
CI006 Information you need to know about your claim for Age Pension and Pension Bonus
CI010 Information you need to know about your claim for concession and health care cards
CI015 Information you need to know about your claim for Carer Allowance
CS065 Application to add a child to an existing child support assessment
CS1650 Non-agency payment details
CS1652 Application to stop deductions from salary or wages
CS1665 International application for an Australian child support assessment
CS1666 Child support agreement
CS1668 Income declaration
CS1669 Notice of withdrawal of application for a child support assessment
CS1670 Estimate of income for use in Child Support Assessment
CS1671 Ending a child support assessment
CS1893 Objecting to a Child Support decision
CS1970 Application to change your assessment - special circumstances
CS1971 Response to application to change your assessment - Special circumstances
CS1979 Request to change payment collection method
CS2716 Child over 18 in full time secondary education
CS2840 Application to reduce minimum assessment to nil
CS2898 We are considering changing your Child Support Assessment
CS2899 Joint election to stop a change to your Child Support Assessment being initiated
CS3042 Representative authority
CS4119 Application for fixed annual rate not to be used
CS4120 Application for Post Separation Income to be Excluded
CS4145 Income Declaration - Income earned outside Australia
CS4243 Responding to an Objection
CS4597 Request for medical information
CS4644 Statement of financial details - reviewing your assessment
CS4645 Statement of financial details for debt repayment
CS4647 Commonwealth of Australia Statutory Declaration - non-parent carer
CS4648 Commonwealth of Australia Statutory Declaration - the persons named in the form are named on the birth certificate for the child(ren)
CS4649 Commonwealth of Australia Statutory Declaration - you are a parent of the children named
FA008M Bereavement Declaration
FA012 Details of your child’s care arrangements
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 2024-25 financial year
HW051 Review of a Medicare Decision
MA001 Claim for Mobility Allowance
MA002 Medical Report - Mobility Allowance
MA003m Review of Mobility Allowance
MO021 Medicare Compensation Recovery Third party authority
MO023 Medicare Compensation Recovery Section 23A statement
MO024 Medicare Compensation Recovery Bank account details collection
MO026 Medicare Compensation Recovery Notice of past benefits request
MO029 Reporting suspected fraud
MO050 Authorisation to act on an incapacitated person's behalf for Medicare purposes
MO063 COVID-19 Vaccine Claims Scheme medical report
MO064 Authorising a person or organisation to act on your behalf - COVID-19 Vaccine Claims Scheme
MO066 COVID-19 Vaccine Claims Scheme – Third Party Payment Statement
MOD AR Assurance of Support
MOD C Compensation and damages
MOD DP Partner details - if you live in Australia
MOD F Business details
MOD IA Income and assets
MOD JY Parent or Guardian details - for the BASE tax year and CURRENT tax year for dependent Youth Allowance or ABSTUDY customers
MOD O Residence in Australia and other countries
MOD P Partner details - if you live in Australia
MOD PC Private Company
MOD PT Private Trust
MOD R Real estate details
MOD S Separation details
MOD SDT Special Disability Trust
MOD ST Study details
MOD Y Unreasonable to live at home
MS001 Medicare Two-way claim
MS003 Request an Individual Healthcare Identifier
MS004 Medicare enrolment
MS005 Request or merge a pseudonym Individual Healthcare Identifier record
MS011 Application to copy or transfer from one Medicare card to another
MS014 Medicare Claim
MS015 Application for a Medicare Entitlement Statement
MS016 Medicare Safety Net Registration and Amendment for Couples and Families
MS018 Aboriginal and Torres Strait Islander Medicare enrolment and amendment
MS021 Bali 2002 registration
MS023 Bali 2005 registration
MS026 Dahab Egypt registration
MS027 London 2005 registration
MS029 Tsunami 2004 registration
MS031 Request for Medicare claims information
MS035 Disaster Health Care Assistance Scheme claim
MS042 Disaster Health Care Assistance Scheme motor vehicle or accommodation out-of-pocket travel application
MS044 Request for information about Medicare card details accessed
NH005 Claim for External Breast Prostheses Reimbursement Program
NH007DF Australian Organ Donor Register
PB018 PBS Safety Net replacement or supplementary card application
PB132 Patient claim for refund Pharmaceutical Benefits Scheme (PBS)
PB240 PBS/RPBS Safety Net prescription record form and application for a Safety Net card
PB299 Australian Thalidomide Survivors Support Program Extraordinary Assistance Fund
PB300 Australian Thalidomide Survivors Support Program Health Care Assistance Fund
RA010 Confirmation of Identity - Verification for Aboriginal and Torres Strait Islander people
RS017 Random Sample Surveys Partner details
SA002 Claim for Age Pension and Pension Bonus
SA010 Carer Payment and Carer Allowance review of care provided - Caring for a person 16 years or over
SA013 Request for ophthalmologist/optometrist report
SA116 Advice of death
SA296 Claim for a Commonwealth Seniors Health Card
SA296A Re-claim for a Commonwealth Seniors Health Card
SA304(A) Carer Payment - Income and assets details of the person being cared for - 16 years or over
SA304(C) Carer Payment - Income and assets details - child or children being cared for - under 16 years
SA310 Home Equity Access Scheme partnered application
SA330 Details of income stream product
SA332A Carer Payment and/or Carer Allowance Medical Report for a person 16 years or over
SA369 Income and assets
SA379 Customer in Psychiatric Confinement
SA381 Carer Allowance Questionnaire - Carer not living with the person for whom care is being provided
SA388 Claim for Pension Bonus Bereavement Payment
SA394 Carer Payment and/or Carer Allowance - Care Needs Assessment (for a child under 16 years)
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
SA417 Review of Carer Payment and Carer Allowance Care Needs Assessment (for a child under 16 years)
SA426 Carer Allowance - Medical Report for a child under 16 years
SA427 Carer Payment - Medical Report including functional assessment for a child under 16 years
SA428 Carer Payment - Medical Report for a child under 16 years
SA431 Carer Payment and Carer Allowance - Medical Report for a child under 16 years
SA432 Child to adult transfer for Carer Payment and/or Carer Allowance
SA440 Claim for Essential Medical Equipment Payment
SA449 Medical Practitioners - Essential Medical Equipment Payment (EMEP) - Medical confirmation
SA450 Essential Medical Equipment Payment - Equipment User Declaration
SA451 Claim for Essential Medical Equipment Payment - Multiple Claim
SA456 Home Care Package - Calculation of your cost of home care
SA457 Residential Aged Care Calculation of your cost of care
SA462 Aged Care Claim for financial hardship assistance
SA466 Claim for Disability Support Pension
SA472 Consent to disclose medical information
SA473 Disability Support Pension Medical Evidence Checklist
SA483 Aged Care Carer or close relative assessment
SA485 Residential Aged Care Property details for Services Australia and DVA customers
SA486 Aged Care Calculation of your cost of care
SA489 Carer Allowance adjusted taxable income details
SA494 Claim for Disability Support Pension for a Terminal Illness
SA496 Home Equity Access Scheme single application
SA497 Home Equity Access Scheme variation
SA498 Home Equity Access Scheme review
SC003 Claim for Double Orphan Pension
SI031 Freedom of Information - Request to access or change documents
SI039 Authority to release personal information - Personal injury, insurance, superannuation or other matter
SS050 Claim for a Health Care Card
SS245 Financial information
SS270 Start or end group payment arrangement
SS284 Relationship details
SS293 Relationship details - Separated under one roof
SS313 Authorising a person or organisation to enquire or act on your behalf
SS351 Explanation or formal review of a decision
SS415 Claim for persons granted a refugee or humanitarian visa
SS454 Carer Adjustment Payment claim
SS456 Claim for Ex-Carer Allowance (Child) - Health Care Card
SS459 Notification of refugee arrival
SS484 Compensation Recovery Statement of Financial Circumstances
SS485 Compensation Personal Sickness and Accident Claim
SS509 Compensation Application
SS524 Executor/Administrator Request for information
SS532 Cancel Nominee Arrangement
SU001 Employment Separation Certificate
SU004 Claim for Special Benefit
SU057 Assurance of Support - Review for Assuree
SU058 Assurance of Support - Review for Assurer
SU066 Tax Deduction Authority
SU462 Verification of voluntary work
SU496 Seasonal, Contract and Intermittent Work Details
SU505 Earnings Worksheet
SU505(i) Information you need to know about reporting employment and using the Earnings Worksheet
SU508 Claim for Crisis Payment - Release from Prison or Psychiatric Confinement
SU514 Claim for Special Employment Advance
SU580 Profit and Loss Statement
SU594 Application to provide an Assurance of Support
SU619 Crisis Payment - Prison release and anticipated payment receipt
SU631 Assurance of Support Bank Guarantee Release
SU674 Prison Pre-release Claim
SU684 Verification of medical conditions
SU694 Claim for Farm Household Allowance
SU695 Request for restoration of Disability Support Pension or Age Pension Claim for Crisis Payment and Anticipated Payment
SU698 Status Resolution Support Services Payment - authorising a person or organisation to enquire on your behalf
SU700 Status Resolution Support Services Payment Partner details
SU709 Confirmation of imprisonment and application for payment
SU714 Application to provide an Assurance of support for Community Support Program
SU721 Claim for Special Benefit for a child
SY004 Claim for Pensioner Education Supplement
SY005 Claim for Fares Allowance - tertiary students only - Austudy, Youth Allowance or Pensioner Education Supplement
SY015 Unreasonable to live at home statement by young person
SY016 Unreasonable to live at home statement by parents or guardians
SY017 Unreasonable to live at home statement by independent third party
SY018 Claim for ABSTUDY Schooling A
SY019 Claim for ABSTUDY
SY020 Claim for ABSTUDY Pensioner Education Supplement
SY021 Claim for ABSTUDY Allowances and Part time Award
SY022 Claim for ABSTUDY Student or Australian Apprentice in lawful custody
SY023 ABSTUDY - Additional information
SY031 ABSTUDY Additional Incidentals Allowance Claim
SY032 ABSTUDY Fares Allowance Claim
SY040 Claim for Assistance for Isolated Children (AIC)
SY042 Assistance for Isolated Children (AIC) - Current Tax Year Assessment
SY053 ABSTUDY Change of circumstances or enquiries
SY054 ABSTUDY and Assistance for Isolated Children (AIC) - Explanation or formal review of decision
SY068 Assistance for Isolated Children (AIC) - Application for Short Term Boarding Allowance
SY069 Assistance for Isolated Children (AIC) - Marginal Distance Confirmation
SY092 Claim for ABSTUDY Remote Areas
SY099 Assistance for Isolated Children (AIC) medical statement - Student special needs
SY101 Verification of Campus
SY108 ABSTUDY Lawful Custody Allowance claim for reimbursement form - to support SY022
SY115 ABSTUDY request for private board providers details
Page last updated: 6 November 2024.
QC 84