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Work and income | Te Hiranga Tangata
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      Get help with accommodation costs, and advice on any housing issues and public housing tenancies.

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      Find out how we can help if you’re moving house.

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  1. Home
  2. Providers
  3. Forms for providers

Providers

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  • Forms

Forms for providers

Work and Income forms for medical practitioners, childcare providers, advocates and community organisations

Browse: A B C D E G H M O P R S T

A

linksActivity in the Community Sponsor Application (PDF 489.28KB)

EMPL1001W - Apr 2016

linksAppointment of an Agent (PDF 204.64KB)

V01 - DEC 2019

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B

Brochures

Providers can check if they've got the latest version of a Work and Income brochure or order some more.

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C

linksChild Disability Allowance - Medical Certificate (PDF 198.13KB)

V12CW - DEC 2019

linksChildcare / OSCAR provider Registration form (PDF 100.61KB)

S62W - OCT 2016

linksChildcare and OSCAR subsidy application form (PDF 699.75KB)

S02 - DEC 2019

linksChildcare Assistance - Change of Circumstances (PDF 176.43KB)

R24 - AUG 2012

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D

linksDental treatment information (PDF 156.69KB)

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.

linksDesignated Doctor Application (PDF 109.22KB)

HDS009W - JUL 2013

If you are interested in becoming a Work and Income designated doctor, please complete this form and return it to Work and Income's Health and Disability Team in your area.

linksDisability Allowance - Medical Alarm Assessment Form (PDF 177.32KB)

S21 - DEC 2022

linksDisability Certificate (PDF 197.1KB)

S22 - SEP 2011

Registered health practitioner to complete

linksDisability Certificate - Counselling (PDF 118.42KB)

S23 - AUG 2011

Registered health practitioner and counsellor to complete

linksDrug testing registration of interest form (PDF 92.46KB)

LAB402W - OCT 2013

This registration form sets out the information required from drug testing agencies who wish to register their interest in becoming a potential provider of drug tests for Work and Income beneficiaries who are required to pass a drug test.

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E

linksEarly Learning Payment application form (PDF 829.59KB)

S32W - MAR 2021

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G

linksGuaranteed Childcare Assistance Payment Application (PDF 623.38KB)

YS008W - AUG 2012

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H

linksHousing Modification Grant Income and Asset Details (PDF 115.28KB)

M27W - AUG 2009

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M

linksMedical Appeals Board hearing application (PDF 587.78KB)

HDS021W - AUG 2013

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O

linksOnline payment schedule email request form (PDF 66.31KB)

S60W - JUL 2015

If you are a childcare centre or OSCAR provider, you can use this form to add, change or cancel your email address for receiving payment schedules each week.

linksOSCAR Funding application - Part one - Provider information (PDF 255.48KB)

S35W - APR 2023

If you (or your organisation) provide Out of School Care and Recreation (OSCAR) for 5 to 13 year olds before school, after school or as holiday programmes, you may be eligible for OSCAR grant funding from the Ministry of Social Development.

linksOSCAR Funding application - Part two - Programme information (PDF 243.71KB)

S36W - APR 2023

If you (or your organisation) provide Out of School Care and Recreation (OSCAR) for 5 to 13 year olds before school, after school or as holiday programmes, you may be eligible for OSCAR grant funding from the Ministry of Social Development.

linksOSCAR Subsidy Declaration (PDF 138.65KB)

R18 - DEC 2011

The OSCAR Programme Supervisor will need to fill in part of this form.

linksOSCAR Subsidy Verification Form (PDF 123.69KB)

S34W - DEC 2011

This form needs to be completed by the OSCAR programme supervisor. The information you provide will help us to assess if the applicant is eligible for the OSCAR Subsidy.

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P

linksPre-employment drug test claim form for drug testing agencies (PDF 193.36KB)

LAB400W - AUG 2013

This form contains information required by Work and Income for a drug testing agency to claim back the cost of a drug test taken by a Work and Income client.

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R

linksRedirection of Benefit Payment (PDF 213.91KB)

V19 - DEC 2015

linksResidential Care - Deferred Loan Application (PDF 530.08KB)

RSU09W - JUL 2011

linksResidential Support Subsidy - Authorisation Form (PDF 661.8KB)

RSU08W - SEP 2011

linksResidential Support Subsidy Residents Details Notification Form (PDF 191.08KB)

RSU12W - NOV 2011

linksReview of Decision Application (PDF 194.22KB)

R10 - MAR 2013

linksRural Assistance Payment Application (PDF 404.87KB)

RUR01W - JAN 2015

linksRural Assistance Payment continuation form (PDF 175.08KB)

RUR02W - MAR 2015

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S

Supplier registration - online form

Register with us if you're a supplier of goods or services and want to receive payments from MSD, eg, being able to accept Payment Cards.

linksSupplier registration - paper form (PDF 96.03KB)

ISS22W - NOV 2015

Register as a supplier with us using the paper form if you're registering for Youth Service Payment Card, your Merchant ID has letters in it or you have problems using the online form.

linksSupported Living Payment medical certificate for a person being cared for (PDF 133.65KB)

M113-MCW - JUL 2013

Registered health practitioner to complete

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T

linksTransitional housing consent form (PDF 283.21KB)

This form should be completed by a client who needs help with transitional housing. It asks for their consent to share information between us, transitional housing providers and the Ministry of Housing and Urban Development.

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