Claim for Special Benefit form (SU004)

Use this form to claim Special Benefit if you’re in financial hardship and you aren’t eligible for any other income support.

Download and complete the Claim for Special Benefit form.

When to use this form

Only use this form if you cannot claim online. If you claim online, you will be able to track the progress of your claim.

When not to use this form

Do not use this form if you are a non-resident parent or guardian claiming for a child who is either of the following:

  • an Australian citizen
  • a permanent resident of Australia.

Instead, use the Claim for Special Benefit for a child form.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 13 May 2023.
QC 19431

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