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.
$5k to Work incentive payment application (PDF 193.13KB)
LAB1020W - OCT 2020
Help to move to another area in New Zealand to start a new job, if you qualify for a benefit.
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.
Accommodation Supplement Application for current clients (PDF 811.91KB)
For clients already receiving Work and Income benefits or payments, who want to apply for help with accommodation costs.
Adverse Event - Payments to hosts for accommodation (PDF 117.58KB)
For hosts providing temporary accommodation in an adverse event, including a Civil Defence emergency.
Appointment of an Agent (PDF 825.67KB)
To appoint someone to act on your behalf for Ministry of Social Development matters.
Automatic Payments - Australia (PDF 22.45KB)
Complete this form to arrange regular automatic payments to repay your debt if you're living in Australia
Away From Home Allowance application form (PDF 682.19KB)
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.
Budget plan step 1 (PDF 299.58KB)
BUD101 – MAY 2020
Budgeting form to help work out your costs and income.
Budget plan step 2 (PDF 296.81KB)
BUD102 – MAY 2020
Budgeting form to help plan your financial goals.
Budget plan step 3 (PDF 296.85KB)
BUD103 – MAY 2020
Budgeting form to help review your budgeting progress and future financial plans.
Change of Address/Accommodation Costs (PDF 687.54KB)
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.
Change of Bank Account (PDF 187.91KB)
Use this form to change your bank account
Change of Living Situation for Seniors (PDF 216.76KB)
For Seniors clients to declare any changes in their living situation, eg change in relationship status, living with others, or living alone.
Child Disability Allowance Application (PDF 968.77KB)
Apply for this payment if you're caring for a child with a serious health condition.
Child 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.
Child Inclusion Form (PDF 238.03KB)
Tell us if a child has come into your care while you're getting a benefit from us.
Child support costs information form (PDF 657.64KB)
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.
Childcare Assistance - Change of Circumstances (PDF 753.83KB)
Tell us about any changes of circumstances while you're getting childcare payments from us.
Childcare Assistance application form (PDF 1.2MB)
Apply for a Childcare Subsidy (for pre-school childcare) or the OSCAR Subsidy (for before or after school care).
Childcare Subsidy Verification Form (PDF 659.76KB)
To be completed by a childcare supervisor, if you're applying for a Childcare subsidy.
Civil Defence Payments to evacuees application form (PDF 344.7KB)
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.
Civilian 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.
Community Costs Payment Application (PDF 899.51KB)
A weekly payment for people in short-term residential treatment programmes to help meet essential ongoing living costs
Community Services Card application form (PDF 1MB)
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.
Course Participation Assistance application form (PDF 686.15KB)
LAB300 - JUL 2023
Debt 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.
Dental treatment information (PDF 156.69KB)
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.
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.
Disability Allowance application form for current clients (PDF 805.16KB)
For current clients to apply for help with on-going medical costs.
Disability Allowance Medical Alarm Assessment Form (PDF 177.32KB)
Apply for help with on-going costs of a Medical Alarm.
Disability Allowance Review form (PDF 352.59KB)
If you have a Disability Allowance, you can use this form to update your existing costs or add a new one.
Disability Certificate (PDF 197.1KB)
To be completed by a health practitioner if you're applying for Disability Allowance, or to tell us about a new cost.
Disability Certificate - Counselling (PDF 661.29KB)
To be completed by a health practitioner and a counsellor if you're applying for a Disability Allowance for counselling.
Early Learning Payment application form (PDF 1)
Families in a Family Start or Early Start programme can apply for Early Learning Payment.
Employment and earnings - information for applications (PDF 219.66KB)
To be completed by your employer as verification of income, if we've asked you to do this as part of an application.
Employment and earnings - information for reviews (PDF 718.39KB)
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.
Extra Help application form (PDF 1.27MB)
This form includes application for Accommodation Supplement, Disability Allowance and Temporary Additional Support for people not receiving Work and Income assistance
Extraordinary Care Fund Grant Application (PDF 295.97KB)
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).
Failed pre-employment drug test result confirmation form (PDF 57.85KB)
An employer can use this form to record the results of a pre-employment drug-test.
Flexible Childcare Assistance application form (PDF 830.5KB)
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.
Funeral Grant Application (PDF 910.19KB)
Apply for financial help with the costs of a funeral and other associated costs.
Guaranteed 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.
Home Help Payments application form (PDF 587.04KB)
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.
Home 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.
Housing Modification Grant Income and Asset Details (PDF 115.28KB)
Declare your income and assets if you're applying for a Housing Modification Grant.
Including a partner form (PDF 905.76KB)
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.
Income and Asset Information (PDF 691.07KB)
Declare any income and/or assets.
Increased payment while in hospital form (PDF 66.8KB)
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.
International Custody Dispute payment application form (PDF 864.25KB)
Apply for help with costs if you're a parent involved in an international custody or access dispute over the care of your children.
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.
Jobseeker 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.
New 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.
New Zealand Super or Veteran's Pension application form for current clients (PDF 942.21KB)
Apply for NZ Super or Veteran's Pension if you're already getting a main benefit from Work and Income.
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.
New Zealand Superannuation application form (PDF 1.47MB)
Apply for New Zealand Superannuation if you're not already getting a main benefit from Work and Income.
NZ Super or Veteran's Pension application for residents of the Cook Islands, Niue or Tokelau (PDF 988.29KB)
This application is for residents of the Cook Islands, Niue or Tokelau.
Orphan's or Unsupported Child's Benefit application form (PDF 626.94KB)
Apply for help with the costs of raising someone else's child.
OSCAR Subsidy Declaration (PDF 138.65KB)
If you're getting an OSCAR subsidy, you need to tell us whether your children will attend an OSCAR programme over the school holidays.
OSCAR Subsidy Verification Form (PDF 123.69KB)
To be completed by the OSCAR programme supervisor if you're applying for an OSCAR subsidy.
Privacy Statement (PDF 258.27KB)
Explains how we collect, use and share your information, treat it with respect and keep it safe to protect your privacy.
Re-application (within 52 weeks) form (PDF 1.07MB)
Re-apply for your payment every 52 weeks.
The quickest way to re-apply for your payment is online.
Redirection of Benefit Payment (PDF 792.57KB)
Complete this form if you want part or all of your payments to be paid to another person or organisation.
Reimbursement of Health Overcharges application form (PDF 214.94KB)
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.
Relationship status verification form for Sole Parent Support (PDF 195.5KB)
This form is used to record information from someone nominated by you, about your relationship status when applying for Sole Parent Support.
Repayment 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.
Repayment Form (PDF 579.78KB)
D002W - OCT 2010
This form provides you with different options on how you can repay Work and Income.
Residential Care - Deferred Loan Application (PDF 978.19KB)
RSU09W - JUL 2023
Apply for a Deferred Loan if you cannot repay your Residential Care Loan.
Residential 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.
Residential 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.
Residential 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.
Review of Decision Application (PDF 194.22KB)
If the Ministry of Social Development has made a decision you don't agree with you can apply for a review of this decision.
Rural 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.
Rural 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.
Seasonal Work Assistance form (PDF 816.14KB)
Apply for help if you're doing seasonal work in horticulture but can't work because of bad weather.
Self-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.
Self-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.
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.
Sole 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.
The Special Banking Option enables you to receive overseas and New Zealand benefits or pension payments as one regular payment.
Support 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.
Support 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.
Support 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.
Supported 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.
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.
Supported 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.
Temporary Accommodation Assistance application (PDF 977.49KB)
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.
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.
Temporary Additional Support application form for current clients (PDF 767.27KB)
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.
Training Incentive Allowance Application (PDF 223.8KB)
Apply for help to pay for employment-related training costs.
Transfer to Veteran's Pension application form (PDF 414.23KB)
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.
Transition to Work Grant (PDF 849.42KB)
LAB995W - JUL 2023
Apply for help with the cost of looking for, or moving into, work.
Transition to Work Grant Employer Verification (PDF 661.4KB)
LAB996W - Apr 2016
To be completed by your employer if you're applying for a Transition to Work Grant for job-related costs.
Unsupported Child's Benefit or Orphan's application form (PDF 626.94KB)
Apply for help with the costs of raising someone else's child.
Veteran's Pension application form (PDF 1.06MB)
Apply for the Veteran's Pension if you have Qualifying Operational Service with the New Zealand Defence Force and aren't getting NZ Super.
Young 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.
Young Parent Payment Partner's Application (PDF 1.33MB)
YS012W - JUL 2023
Complete this form if your partner is applying for a Young Parent Payment.
Youth 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.
Youth Payment or Young Parent Payment - Parent's Income verification Form (PDF 715.14KB)
To be completed by your parents or guardians if you're a young person applying for a payment.
Youth Payment Partner's Application (PDF 1.29MB)
YS010W - JUL 2023
Complete this form if your partner is applying for a Youth Payment.
Youth Service Continue or stop payments form (PDF 349.97KB)
YS014W - OCT 2016
To stop your Youth Service payments if you no longer need it or qualify for it.
Youth 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.