Forms

LAB1020W - OCT 2020

Help to move to another area in New Zealand to start a new job, if you qualify for a benefit.

S01 - JAN 2022

For clients already receiving Work and Income benefits or payments, who want to apply for help with accommodation costs.

CD1 - JUN 2010

For hosts providing temporary accommodation in an adverse event, including a Civil Defence emergency.

V01 - Dec 2019

To appoint someone to act on your behalf for Ministry of Social Development matters.

Complete this form to arrange regular automatic payments to repay your debt if you're living in Australia

M36W - DEC 2019

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.

BUD101 – MAY 2020

Budgeting form to help work out your costs and income.

BUD102 – MAY 2020

Budgeting form to help plan your financial goals.

BUD103 – MAY 2020

Budgeting form to help review your budgeting progress and future financial plans.

R02 - JUN 2020

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.

V03 - MAY 2020

Use this form to change your bank account

R32 - SEP 2019

For Seniors clients to declare any changes in their living situation, eg change in relationship status, living with others, or living alone.

M08 - MAY 2022

Apply for this payment if you're caring for a child with a serious health condition.

V12CW - JAN 2020

To be completed by a health practitioner if you're applying for a Child Disability Allowance.

R30 - APR 2020

Tell us if a child has come into your care while you're getting a benefit from us.

S02 - NOV 2020

Apply for a Childcare subsidy (for pre-school childcare) or the OSCAR subsidy (for before or after school care).

R24 - AUG 2012

Tell us about any changes of circumstances while you're getting childcare payments from us.

S33W - AUG 2009

To be completed by a childcare supervisor, if you're applying for a Childcare subsidy.

CD2W - Feb 2023

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.

SW288W - DEC 2019

Apply for help with some of the costs of going to an Artificial Limb Centre.

S29W - Dec 2019

A weekly payment for people in short-term residential treatment programmes to help meet essential ongoing living costs

CSC1 - APR 2020

Apply for a Community Services Card to help with the costs of health care (eg. some health services and prescriptions) for you and your family.

LAB300 - DEC 2019

ISS570 - JAN 2011

Complete this form to repay debt to the Ministry of Social Development if you are not getting payments from us.

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.

S03 - OCT 2020

For current clients to apply for help with on-going medical costs.

S21 - DEC 2022

Apply for help with on-going costs of a Medical Alarm.

S22 - APR 2020

To be completed by a health practitioner if you're applying for Disability Allowance, or to tell us about a new cost.

S23 - AUG 2011

To be completed by a health practitioner and a counsellor if you're applying for a Disability Allowance for counselling.

S32W - NOV 2022

Families in a Family Start or Early Start programme can apply for Early Learning Payment.

V06 - OCT 2021

To be completed by your employer as verification of income, if we've asked you to do this as part of an application.

V26 - Oct 2021

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.

M43 - Sep 2022

This form includes application for Accommodation Supplement, Disability Allowance and Temporary Additional Support for people not receiving Work and Income assistance

S54W - JUL 2021

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).

V28W - JUL 2013

An employer can use this form to record the results of a pre-employment drug-test.

S04 - JUN 2017

Apply for financial help with the costs of a funeral and other associated costs.

YS008W - DEC 2019

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.

M29 - DEC 2019

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.

ISS221W - MAR 2018

You can use this timesheet to record imformation about the work you have done for a person who has had Home Help approved by the Ministry of Social Development.

M27W - AUG 2009

Declare your income and assets if you're applying for a Housing Modification Grant.

R31 - APR 2022

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.

R03 - SEP 2021

Declare any income and/or assets.

SO6W - JUL 2018

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.

S30W - DEC 2019

Apply for help with costs if you're a parent involved in an international custody or access dispute over the care of your children.

M111-Obs - NOV 2021

Complete this form if you're applying for Jobseeker Support, to show you understand your obligations and what happens to information you give us.

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.

M12 - NOV 2020

Apply for New Zealand Superannuation if you're not already getting a main benefit from Work and Income.

M11 - NOV 2020

Apply for NZ Super if you're already getting a main benefit from Work and Income.

M14 - JUL 2021

Apply for help with the costs of raising someone else's child.

R18 - DEC 2011

If you're getting an OSCAR subsidy, you need to tell us whether your children will attend an OSCAR programme over the school holidays.

S34W - DEC 2011

To be completed by the OSCAR programme supervisor if you're applying for an OSCAR subsidy.

V30W - NOV 2022

Explains how we collect, use and share your information, treat it with respect and keep it safe to protect your privacy.

M26 - JUN 2022

Re-apply for your payment every 52 weeks.

V19 - MAY 2019

Complete this form if you want part or all of your payments to be paid to another person or organisation.

C04W - APR 2020

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.

V24W - DEC 2019

This form is used to record information from someone nominated by you, about your relationship status when applying for Sole Parent Support.

S63W – NOV 2019

Use this form if you need help to pay your overdue rent so you can stay in your home.

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.

D002W - OCT 2010

This form provides you with different options on how you can repay Work and Income.

RSU09W - DEC 2019

Apply for a Deferred Loan if you cannot repay your Residential Care Loan.

RSU13W - SEP 2022

Complete this form if you're a sole parent, get a Residential Support Subsidy and continue to financially support your children.

RSU08W - SEPT 2020

Apply for Residential Support Subsidy. The Residential Service Provider will also need to complete this form.

RSU12W - JAN 2020

Tell us if someone getting a Residential Support Subsidy has had a change in details, like changing address or being admitted to hospital.

R10 - DEC 2022

If the Ministry of Social Development has made a decision you don't agree with you can apply for a review of this decision.

RUR01W - DEC 2019

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.

RUR02W - DEC 2019

Apply for help if you're already getting a Rural Assistance Payment, and need to keep getting this payment a while longer.

M46W - OCT 2021

Apply for help if you're doing seasonal work in horticulture but can't work because of bad weather.

HDS016 - MAY 2020

Tell us about your work and health background, so we can understand how it impacts your ability to work.

HDS016ER - Oct 2014

This version is easier for people with learning disabilities or English as a second language.

M112-Obs - NOV 2021

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.

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.

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.

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.

M113-Obs - NOV 2021

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.

M113-MCW - DEC 2019

To be completed by a health practitioner if you're applying for a Supported Living Payment as a carer.

S26 - FEB 2021

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.

S12W - JUL 2021

Apply for help to pay for employment-related training costs. 

S14W - DEC 2019

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.

LAB995W - AUG 2021

Apply for help with the cost of looking for, or moving into, work.

LAB996W - Apr 2016

To be completed by your employer if you're applying for a Transition to Work Grant for job-related costs.

M14 - APR 2020

Apply for help with the costs of raising someone else's child.

M19W - JUL 2020

Apply for the Veteran's Pension if you have Qualifying Operational Service with the New Zealand Defence Force and aren't getting NZ Super.

YS011W - AUG 2020

Apply for the Young Parent Payment if you're a young parent aged 16-19 years old.

YS012W - AUG 2020

Complete this form if your partner is applying for a Young Parent Payment.

YS009W - JAN 2020

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.

V10W - DEC 2019

To be completed by your parents or guardians if you're a young person applying for a payment.

YS010W - FEB 2020

Complete this form if your partner is applying for a Youth Payment.

YS014W - OCT 2016

To stop your Youth Service payments if you no longer need it or qualify for it.

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.