Notes Booklet for Claim for Dad and Partner Pay

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1 tes Booklet for Claim for Dad and Partner Pay Online Services When to use this form When to claim For more information Use our online services You do not need to complete this form if you use our online services. Claiming online is faster and easier. You can access your Centrelink, Medicare and Child Support online services through mygov. mygov is a fast, simple way to access a range of government services online with one username, one password, all from one secure location. To create a mygov account, go to To make a claim online log into and select Centrelink from the services tab, then select Make a claim. If you do not use our online services, processing this form will take longer. You should receive advice about your payments within 28 days of lodging this form and any requested documents. Use this form if you wish to claim Dad and Partner Pay. te: If you are not able to access our online services, or need assistance to register for an online account, call us on You can claim Dad and Partner Pay up to 3 months before the expected birth date or adoption of your child. Go online or call us on or visit one of our service centres. If you need a translation of any documents for our business, we can arrange this for you free of charge. To speak to us in languages other than English, call For information in languages other than English go to our website www. humanservices.gov.au/multicultural te: Call charges apply calls from mobile phones may be charged at a higher rate. If you have a hearing or speech impairment, you can contact the TTY service on Freecall A TTY phone is required to use this service. Please keep these tes (pages 1 to 12) for your information.

2 Contents page About claiming 2 Registering the birth of your child 2 Known adoptions 2 About the Paid Parental Leave scheme 3 What is the Paid Parental Leave scheme? 3 What is Dad and Partner Pay? 3 Who is eligible for Dad and Partner Pay? 3 Proof of birth or proof the child has come into your care 4 Effect on other payments 5 Eligible father or partner 5 Care of the child 5 Work test 6 Australian residence requirements 7 Providing your income details 8 Why your income details are important 8 What is adjusted taxable income? 8 Other services 11 Social Work assistance 11 Other languages 12 About claiming Registering the birth of your child Known adoptions If you are the parent of a newborn child, you must register* the child s birth as required by the Births, Deaths and Marriages Registry in your state or territory. Parents are responsible for registering the birth of their child within 60 days of the child s birth. There is no cost for registering the birth of your baby. To receive Parental Leave Pay, Dad and Partner Pay or the Newborn Supplement component of Family Tax Benefit Part A, you must apply to register the birth of your child. * Birth registration forms are given to parents in hospital. You must complete and forward this form to the relevant Births, Deaths and Marriages Registry in your state or territory. The requirement to register the birth does not apply where the child was stillborn, born outside Australia or has been adopted. Known adoptions are situations where this child has lived continuously with the prospective adoptive parent before the date the process of adoption commenced and the adoption is more in the nature of formalising the parental relationship. In these cases, it would normally be expected that this child would not be regarded as being placed with the adoptive parents as part of the process of adoption. Known adoptions for Dad and Partner Pay purposes include step-child adoptions. tes 2 of 12

3 About the Paid Parental Leave scheme What is the Paid Parental Leave scheme? The Paid Parental Leave scheme provides income tested and work tested payments that enables eligible parents to take time off work to care for a new baby or recently adopted child. Payments provided under this scheme may also be payable when a child is stillborn or dies. There are 2 payments under the Paid Parental Leave scheme: Parental Leave Pay, which is payable for up to 18 weeks to eligible working parents who are the child s primary carer (usually the birth mother or the initial primary carer of an adopted child). Dad and Partner Pay, which is payable for up to 2 weeks to eligible working fathers or partners. Eligible fathers or partners must lodge a separate claim for Dad and Partner Pay. This form may be used to claim Dad and Partner Pay. For more information about Parental Leave Pay, go online www. humanservices.gov.au/parentalleavepay What is Dad and Partner Pay? Dad and Partner Pay is a payment under the Paid Parental Leave scheme to support eligible working fathers or partners (including adopting parents and parents in same-sex relationships) caring for a child born or who came into your care. Dad and Partner Pay is a taxable payment paid at the rate of the National Minimum Wage for a maximum of 2 weeks. Who is eligible for Dad and Partner Pay? To be eligible for Dad and Partner Pay, you must: be caring for a child born or who came into your care. An adopted child must be under 16 years of age when they came into your care be an eligible father or partner (see on page tes 5) have care of the child for each day in the Dad and Partner Pay period have met the Dad and Partner Pay work test (see on page tes 6) meet Australian residence requirements (see on page tes 7 ) have an individual adjusted taxable income of $150,000 or less in the financial year before the start date of the Dad and Partner Pay period or date of claim, whichever is the earlier not be working or taking paid leave (such as employer provided paid paternity leave or annual leave) during the Dad and Partner Pay period. te: You must be eligible on each day of your Dad and Partner Pay period. For a multiple birth or adoption (for example, twins), Dad and Partner Pay is only paid for one child in the same pregnancy or adoption. If you are claiming Dad and Partner Pay for children not from the same pregnancy or adoption (for example, adopted children who came into your care on different dates) you may be eligible for Dad and Partner Pay for more than one child. Adopted children must be under the age of 16 years at the time of entering your care as part of an adoption process. Payments will continue if this child turns 16 years before or part way through the Dad and Partner Pay period, as long as they were under 16 years when they first came into your care. Your Dad and Partner Pay period can start from the day your child is born or adopted, or a later date. The start date is not the date your payment will be received; it is the start of your entitlement period. Your payment of Dad and Partner Pay will occur after your Dad and Partner Continued tes 3 of 12

4 About the Paid Parental Leave scheme continued Pay period start date and when proof of birth or proof of the child coming into your care has been provided, along with any other requested documents. Your Dad and Partner Pay period must be one continuous period and must be within the first year after your child s birth or date child came into your care as part of the adoption process. To be eligible for Dad and Partner Pay, you must lodge your claim with us: up to 3 months before the expected date of birth or date the child will come into your care, and no later than 52 weeks after the date of birth or the date the child came into your care. Proof of birth or proof the child has come into your care Your claim for Dad and Partner Pay will not be finalised until after the child s actual date of birth or date the child comes into your care. You or your partner will need to lodge proof of the child s birth or proof of the child coming into your care before we can finalise your claim for Dad and Partner Pay. Proof of birth can be one of the following: the Newborn Child Declaration (FA081) (see te below) in the case of child bereavement where the child is stillborn or dies, the Claim for Bereavement Payment form (FA008) including a completed proof of birth page a birth certificate. For example, if your partner is claiming Parental Leave Pay or a family assistance payment and lodges proof of birth for the child for their claim, we will also use this proof of birth for your Dad and Partner Pay claim. If the person who lodges proof of birth is a parent of the child, they will need to register* the child s birth as required by the Births, Deaths and Marriages Registry in your state or territory. There is no cost for registering the birth of the child. te: The Newborn Child Declaration (FA081) will need to be completed by the person claiming Dad and Partner Pay if there is NO Parental Leave Pay or family assistance being claimed in respect of the same child. Proof of the child coming into your care includes, for example, adoption or surrogacy papers. * A birth registration form is given to parents in hospital. It must be completed and forwarded to the relevant Births, Deaths and Marriages Registry in your state or territory. The requirement to register the birth does not apply where the child was stillborn, born outside Australia or has been adopted. tes 4 of 12

5 About the Paid Parental Leave scheme continued Effect on other payments If eligible, your family can receive Dad and Partner Pay and Parental Leave Pay or Newborn Supplement and Newborn Upfront Payment for the same child. For example, you may receive 2 weeks Dad and Partner Pay and your partner may receive 18 weeks Parental Leave Pay. As an individual, you can only receive a maximum of 18 weeks pay under the Paid Parental Leave scheme. If you are eligible for Parental Leave Pay as well as Dad and Partner Pay for the same child, the total you receive for both payments cannot be more than 18 weeks. Dad and Partner Pay is treated as taxable income and counts as income for the Paid Parental Leave scheme and family assistance payments, including: Family Tax Benefit Part A Family Tax Benefit Part B Stillborn Baby Payment Parental Leave Pay any future Dad and Partner Pay, and Child Care Benefit. Dad and Partner Pay will also be included in the adjusted taxable income for child support purposes and the Commonwealth Seniors Health Card. Dad and Partner Pay is also regarded as income for the Low Income Health Care Card. Dad and Partner Pay is not treated as income for Parenting Payment or other income support payments, such as Disability Support Pension or Newstart Allowance. Eligible father or partner To be eligible for Dad and Partner Pay you must be an eligible father or partner. You may be eligible if you are the: biological father of the child partner of the birth mother adoptive parent partner of an adoptive parent, or person caring for a child born of a surrogacy arrangement. In some limited circumstances a person may be eligible if they are the: partner of the biological father, or partner of a new carer where care arrangements have changed (other than a foster care or permanent care arrangement). te: Birth mothers are not eligible for Dad and Partner Pay. Birth mothers may be eligible for Parental Leave Pay or, Newborn Supplement and Newborn Upfront Payment paid with Family Tax Benefit Part A where Parental Leave Pay has not been paid. For more information, go online Care of the child To be eligible for Dad and Partner Pay, you must be caring for the child. More than one person may be caring for the same child on a particular day. You may be the primary carer of the child, or you may be providing care for the child at the same time as another person (for example, the child s birth mother) who is providing primary care for the child. tes 5 of 12

6 About the Paid Parental Leave scheme continued Work test To meet the work test for Dad and Partner Pay you must have: worked for at least 295 days (approximately 10 months) of the 392 days (approximately 13 months) before the start date of your Dad and Partner Pay period, and worked at least 330 hours in that 295 day (approximately 10 month) period (just over 1 day a week) with no more than an 8 week (56 day) gap between 2 working days. A working day is a day on which you worked for at least 1 hour. Paid leave may count towards the work test. te: There are some exceptions if you do not meet the work test due to premature birth. For more information, call us on You do not need to be working full-time to be eligible for Dad and Partner Pay. You may meet the work test even if you: are a part-time, casual or seasonal worker are a contractor or self-employed work in a family business (such as a farm) have multiple employers, or have recently changed jobs. If you work for a family business (such as a farm) you can include your hours of work, even if the business is not generating any income, providing you are undertaking the work for financial gain. You can include periods of work if it is done for financial reward or gain, whether in Australia or outside Australia. Periods of paid leave taken before the birth or adoption can be included as work. The following activities will count as work: employment at an Australian Disability Enterprise operating a business while receiving assistance under the New Enterprise Incentive Scheme farm labour or operating a business while receiving Farm Household Allowance jury service, and defence reservist work. Periods of unpaid leave or voluntary work cannot be included as work. Activities undertaken for Work for the Dole, Green Corps, Drought Force, the National Green Jobs Corps and other income support programs which include a work component will not count as work. Previous periods of Parental Leave Pay and/or Dad and Partner Pay can be included as work for the work test. If you are including a previous period of Parental Leave Pay and/or Dad and Partner Pay in the work test, a weekday counts as 7.6 hours. tes 6 of 12

7 About the Paid Parental Leave scheme continued Australian residence requirements To be eligible for Dad and Partner Pay you must satisfy residence requirements. You must be living in Australia and: be an Australian citizen, or hold a permanent visa, or have arrived on a New Zealand passport, or hold a partner provisional, interdependency or temporary protection visa. te: You cannot be paid Dad and Partner Pay before you meet the above residence requirements. You may be able to claim Dad and Partner Pay during a temporary absence from Australia if you have been absent for less than 56 weeks. In deciding whether you are living in Australia, we may need to look at the nature of your accommodation, the nature and extent of family relationships in Australia, the nature and extent of employment, business or financial ties with Australia, the frequency and duration of travel outside Australia and any other relevant matters. Absences from Australia may affect your Dad and Partner Pay. For example, temporary visa holders may not be eligible for Dad and Partner Pay during any absence from Australia. When Dad and Partner Pay is stopped it generally cannot be resumed on return to Australia. For more information about the conditions for payment outside Australia go online www. humanservices.gov.au/paymentsoverseas tes 7 of 12

8 Providing your income details Why your income details are important What is adjusted taxable income? Your income for Dad and Partner Pay will be based on your actual adjusted taxable income in the financial year before the start date of the Dad and Partner Pay period or date of this claim, whichever is earlier. The Dad and Partner Pay income test is based on your individual income, not family income (it does not include your partner s income). For example, if you are lodging a pre-birth claim for Dad and Partner Pay during the financial year, we need to know your income for the financial year. Please read this information before completing questions 55 and 56. Adjusted taxable income consists of: taxable income reportable fringe benefits reportable superannuation contributions total net investment losses tax free pensions or benefits foreign income tax exempt foreign income LESS child support you have paid. Taxable income Taxable income = gross income less allowable deductions. Taxable income is the amount remaining after you take away all your allowable deductions from your assessable or gross income. Your gross income may include the following: money from employment partnership* and trust distributions Parental Leave Pay many income support payments such as pensions and benefits Dad and Partner Pay capital gains on disposal of assets Disaster Recovery Allowance superannuation withdrawals business eligible termination payment(s) rental income income from banks, credit unions, building societies interest overtime, bonuses, pay rises and maternity payments dividends allowable deductions which should be taken away from your gross income include: deductions for work-related expenses expenses incurred for business purposes gifts and donations to eligible charities and organisations * Partnership means that income from the partnership which is declared to the Australian Taxation Office as partnership income. If you and your partner jointly own a rental property, this is not regarded as being a partnership unless the income from the property is reported to the Australian Taxation Office as partnership income. Each co-owner s share of the income and expenses stated in their individual tax returns must be provided to us when claiming family assistance and updating income estimates. Australian Government pensions and benefits see table on page tes 9 tes 8 of 12

9 Providing your income details continued Parental Leave Pay and Dad and Partner Pay are not income support payments, and any Parental Leave Pay and Dad and Partner Pay you receive must be included in your taxable income. ABSTUDY is not an income support payment, however some components, such as Living Allowance, are taxable and should be included in your taxable income. For more information, go online An income support payment is any of the following Australian Government pensions or benefits: Age Pension Austudy Bereavement Allowance Carer Payment Disability Support Pension Disability Support Pension (Blind) Department of Veterans Affairs Service Pension, Income Support Supplement or Defence Force Income Support Allowance Farm Household Allowance Newstart Allowance Parenting Payment Partner Allowance Sickness Allowance Special Benefit Special Needs Pension Widow Allowance Widow B Pension If your tax return is lodged, your taxable income is the income shown on your assessment notice from the Australian Taxation Office. Reportable fringe benefits A reportable fringe benefit provided by your employer is counted as part of your income. The value of any reportable fringe benefit will be recorded on your payment summary for the financial year ending 30 June 2015 and will relate to fringe benefits received between 1 April 2015 and 31 March You can ask your employer to tell you the amount that is expected to be shown on your payment summary. For more information, go online www. humanservices.gov.au/familyincomeestimate Examples of reportable fringe benefits provided by employers Wife Pension Youth Allowance helping you pay your rent or home loan providing a home phone providing a car paying your child(ren) s school fees paying your health insurance premiums paying your child care expenses An employer s contribution to a complying superannuation fund is not a fringe benefit. Reportable superannuation contributions Any reportable superannuation contributions are included as income. Reportable superannuation contributions include: discretionary contributions. Examples of these include: voluntary salary sacrificed contributions, made by you or on your behalf by your employer. These are above those required by law such as an industrial award or the superannuation guarantee, and total superannuation contributions made by you as a self-employed person, for which you can claim a tax deduction. Reportable superannuation contributions do not include compulsory employer contributions. If you have reportable superannuation contributions, you need to ensure this income is declared to us as part of your income estimate. If you do not know if this applies to you, contact your employer, financial adviser or the Australian Taxation Office. tes 9 of 12

10 Providing your income details continued Total net investment losses The value of any net investment losses is added back to your annual income. If you made a loss from rental property income, investment income or both, you need to give details of the total amount of losses. Record losses from investment earnings, not capital losses. For example: Tony expects to make a net loss of $3,000 on his rental property, but expects to have net income of $1,000 from his investments. The total net investment loss he must record is $3,000. Annette expects to make a loss from rental property income of $4,500 and a loss from investment income of $1,200. The total net investment loss she must record is $5,700. How do I work out my total net investment loss? If you made a loss from rental property income, investment income or both, you need to give us the details of the total amount of losses. It is important you only record losses from investment earnings, not capital losses. te: A capital loss is the difference between the purchase price and sale price, where an asset is sold for less than it was purchased for. Investment earnings include taxable and tax exempt interest, dividends and rental income. If you do not know if this applies to you, contact your accountant, financial adviser or the Australian Taxation Office. Tax free pensions or benefits Income from tax free pensions and benefits that you receive, through the Department of Human Services or the Department of Veterans Affairs must be included in your income. Add the amounts of any of the following payments you receive through: Department of Human Services Disability Support Pension paid to a person who is not old enough to receive the Age Pension Carer Payment where both the carer and the person being cared for are not old enough to receive the Age Pension Wife Pension paid where both the customer and the partner if applicable are not old enough to receive the Age Pension. Department of Veterans Affairs Invalidity Service Pension where the recipient is not old enough to receive the Age Pension Disability Pension, War Widow s and War Widower s Pensions Special Rate Disability Pension Partner Service Pension where both the carer, and the veteran being cared for, are under age pension age and the veteran has died and received an Invalidity Service Pension at the time of death Defence Force Income Support Allowance, if it is tax free Income Support Supplement, if it is tax free. Tax free pensions or benefits do not include Family Tax Benefit, Bereavement Payment, Pharmaceutical Allowance, Rent Assistance, Remote Area Allowance or Language, Literacy and Numeracy Supplement. tes 10 of 12

11 Providing your income details continued Foreign income Any income from sources outside Australia that you receive for which you do not have to pay Australian tax is counted as foreign income. Foreign income is included in your annual income for Dad and Partner Pay purposes. Newly arrived residents should include foreign income earned in the financial year before arriving in Australia when providing their income for the financial year. You should use the exchange rate applicable to convert foreign income amounts into Australian dollars. Current exchange rates are available by calling us on Tax exempt foreign income Tax exempt foreign income is any income for qualifying service on a particular approved project (under section 23AF of the Income Tax Assessment Act 1936) and/or foreign service (under section 23AG of the Income Tax Assessment Act 1936) for a continuous period of 91 days or more. If you receive this type of income, it will be recorded on your payment summary. If you expect to pay Australian tax on any foreign income, include this amount in your taxable income component. Child support you PAY Child support includes: private child support any amount you pay directly to another person (either as a result of a court order or a private agreement) any child support you pay through Child Support services non-cash child support for example school fees, rent/mortgage payment other amounts which are not part of a property settlement, including spousal maintenance. You should keep proof of the child support you pay as you may be asked to show evidence of your claim. The full amount you pay for child support is subtracted from your annual income. Your income for Dad and Partner Pay will be for the financial year before the start date of the Dad and Partner Pay period or the date of this claim, whichever is earlier. For example, if you are lodging a pre-birth claim for Dad and Partner Pay during the financial year, we need to know the amount of child support you PAY as part of your financial year income. Any child support you PAY must be for your own child support assessment (not your partner s), in the financial year. Other services Social Work assistance We have Social Workers who can help you when you are experiencing a change in your personal and/or family circumstances. Social Workers will listen, give support and help you work out some options. To arrange to talk with a Social Worker, call us on tes 11 of 12

12 Other languages tes 12 of 12

13 Claim for Dad and Partner Pay Online Services When to use this form Filling in this form Returning your form For more information Use our online services You do not need to complete this form if you use our online services. Claiming online is faster. You can access your Centrelink, Medicare and Child Support online services through mygov. mygov is a fast, simple way to access a range of government services online with one username, one password, all from one secure location. To create a mygov account, go to To make a claim online log into and select Centrelink from the services tab, then select 'Make a Claim'. If you do not use our online services, processing this form will take longer. Use this form if you wish to claim Dad and Partner Pay. te: If you are not able to access our online services, or need assistance to register for an online account, call us on Please use black or blue pen. Print in BLOCK LETTERS. Mark boxes like this with a or. Where you see a box like this Go to 5 skip to the question number shown. You do not need to answer the questions in between. Check that all required questions are answered and that the form is signed and dated. You can return this form and any supporting documents: online submit your documents online. For more information about how to access an Online Account or how to lodge documents online, go to www. humanservices.gov.au/submitdocumentsonline by post return your documents by sending them to: Department of Human Services Families Reply Paid 7802 CANBERRA BC ACT 2610 in person if you are unable to submit this form and any supporting documents online or by post, you can provide them in person to one of our service centres. Go online or call us on or visit one of our service centres. If you need a translation of any documents for our business, we can arrange this for you free of charge. To speak to us in languages other than English, call For information in languages other than English go to our website www. humanservices.gov.au/multicultural te: Call charges apply calls from mobile phones may be charged at a higher rate. If you have a hearing or speech impairment, you can contact the TTY service on Freecall A TTY phone is required to use this service.

14 Online Services If you complete your claim online, and you are eligible, your claim can be assessed faster than if you complete this claim form. You do not need to complete this form if you use our online services. 1 Please read this before answering the following question You can claim Dad and Partner Pay up to 3 months before the expected birth date or adoption of your child. Any claim for Dad and Partner Pay will not be finalised until after the child's actual date of birth or date an adopted child comes into your care. Information required to complete this claim form for Dad and Partner Pay: Centrelink Reference Numbers passport number the date you first arrived in Australia if you were not born in Australia details of periods you lived outside Australia bank account details tax file number income details. 4 Do you (and/or your partner) have a Centrelink Reference Number? You Give details below Your Centrelink Reference Number (if known) Your Partner Your partner s Centrelink Reference Number (if known) For information to help you answer questions, refer to the tes Booklet. Are you claiming, or have you claimed, Dad and Partner Pay online? If you complete your claim online and you are eligible, your claim may be assessed faster than if you complete this claim form. te: If you need assistance registering for Online Services, you can call us on to arrange this service. Do not complete this form. Go online www. my.gov.au and select Centrelink from the services tab. 2 Are you the birth mother of the child? Birth mothers are not eligible for Dad and Partner Pay. You may be eligible for Parental Leave Pay or Newborn Supplement and Newborn Upfront Payment. For more information go online,www. humanservices.gov.au/paidparentalleave 3 Is this claim before or after your child s date of birth or date the child came into your care as part of an adoption process? Before After CLK0FA of 13

15 You Your partner (if you have one) 5 Do you need an interpreter when dealing with us? 5 Does your partner need an interpreter when dealing with us? This includes an interpreter for people who have a hearing or speech impairment. This includes an interpreter for people who have a hearing or speech impairment. Go to 7 Go to 7 6 What is your preferred spoken language? 6 What is your partner s preferred spoken language? 7 What is your preferred written language? 7 What is your partner s preferred written language? 8 Your name 8 Your partner s name Mr Mrs Miss Ms Other Mr Mrs Miss Ms Other Family name Family name First given name First given name Second given name Second given name 9 Have you ever used or been known by any other name (e.g. name at birth, maiden name, previous married name, Aboriginal or tribal name, alias, adoptive name, foster name)? 9 Has your partner ever used or been known by any other name (e.g. name at birth, maiden name, previous married name, Aboriginal or tribal name, alias, adoptive name, foster name)? Give details below Give details below Other name Other name Type of name (e.g. name at birth) Type of name (e.g. name at birth) If you have more than 1 other name, attach a separate sheet with details. If your partner has more than 1 other name, attach a separate sheet with details. 10 Your sex 10 Your partner s sex Male Male Female Female 11 Your date of birth 11 Your partner s date of birth 3 of 13

16 You Your partner (if you have one) 12 Please read this before answering the following question We recognise both opposite-sex and same-sex relationships. This includes relationships registered under state or territory law. Select ONE option below that best describes your current relationship status. What is your CURRENT relationship status? Married Date of marriage Registered relationship (opposite-sex or same-sex relationship registered under state or territory laws) Date registered Go to 13 Go to 13 Partnered (living together in an oppositesex or same-sex relationship, including de facto) Date you started living with a partner Go to 13 Separated (previously lived with an opposite-sex or same-sex partner, including in a marriage, registered or de facto relationship) Divorced Date of last separation Go to 14 Date of divorce Go to 14 Widowed (previously partnered with an opposite-sex or same-sex partner, including in a marriage, registered or de facto relationship) Never married or lived with a partner Date of partner s death Go to 14 Go to 14 If none of the above describes your current relationship status, please call us on Do you give permission for your partner to speak with us on your behalf? You can change this authority at any time. 4 of 13

17 You Your partner (if you have one) 14 Do you want to authorise another person or organisation to make enquiries, get Centrelink payments and/or act on your behalf? You will need to complete and attach an Authorising a person or organisation to enquire or act on your behal form (SS313). If you do not have this form or want more information about nominee arrangements, go to our website www. humanservices.gov.au/nominees 15 Your permanent address 15 Your partner s permanent address (if different to your address) Postcode Postcode 16 Your postal address (if different to above) 16 Your partner s postal address (if different to above) Postcode Postcode 17 Please read this before answering the following question Please provide at least one phone number that we can contact you on during business hours and an address if you have one. If you provide an address or mobile phone number, you may receive electronic messages (SMS or ) from us. To read the Terms and Conditions, go to our website www. humanservices.gov.au/em or visit one of our service centres. 17 Your contact details Home phone number ( ) Mobile phone number Is this a silent number? Please read this before answering the following question If your partner provides an address or mobile phone number, they may receive electronic messages (SMS or ) from us. To read the Terms and Conditions, go to our website www. humanservices.gov.au/em or visit one of our service centres. Your partner s contact details (if different) Home phone number ( ) Mobile phone number Is this a silent number? Is this a silent number? Is this a silent number? Work phone number ( ) Work phone number ( ) 5 of 13

18 18 Please read this before answering the following questions Questions 18 and 19 are OPTIONAL and will not affect your payment. If you (and/or your partner) do answer, the information will help us to continue to improve services to Aboriginal and Torres Strait Islander Australians and Australian South Sea Islanders. Australian South Sea Islanders are the descendants of Pacific Islander labourers brought from the Western Pacific in the 19th Century. 21 Have you EVER lived or travelled outside Australia, including short trips and holidays? This question assists us to verify your Australian residence. Give details below Year you last entered Australia Are you (and/or your partner) of Aboriginal or Torres Strait Islander Australian origin? If you (and/or your partner) are of both Aboriginal and Torres Strait Islander Australian origin, please tick both boxes. Passport number Country of issue You Aboriginal Australian 22 Are you an Australian citizen who was born in Australia? Torres Strait Islander Australian Your Partner You will need to provide proof of your Australian residence status (e.g. citizenship papers, passport or other documentation). Aboriginal Australian Torres Strait Islander Australian Go to What is your country of birth? 19 Are you (and/or your partner) of Australian South Sea Islander origin? You Your Partner 24 When did you most recently start living in Australia? 25 What is your country of citizenship? Residence details Australia Date granted 20 Please read this before answering the following question Go to 29 Permanently means you normally live in Australia on a longterm basis. Holidays or short trips outside Australia would not affect this. Other Country of citizenship Are you living in Australia permanently? 26 What type of visa did you arrive on? New Zealand passport (Special Category Visa) Permanent Temporary Unknown (e.g. arrived on parent s passport) Go to 28 Go to Your visa details on arrival Visa sub class Date visa granted 6 of 13

19 28 29 Has your visa changed since you arrived in Australia? Visa sub class Most recent visa details Date visa granted Please read this before answering the following questions We need to know if you have lived in any countries other than Australia in the last 3 years. Lived means where you/your family made your home or spent a long period of time it does not include places you visited. In the last 3 years have you lived outside Australia for any period? Tax details 31 Please read this before answering the following questions You are not breaking the law if you do not give us your tax file number, but if you do not provide it you will not be paid. In giving us your tax file number in relation to this claim you authorise us to use your tax file number for other Paid Parental Leave scheme payments and services in future where necessary. Have you given us your tax file number before? t sure Go to 33 List ALL countries, INCLUDING AUSTRALIA, you have lived in during the last 3 years and the date you started living in each country. Do NOT include short trips or holidays. 32 Do you have a tax file number? Please call us on Your tax file number Country Date from 33 Please read this before answering the following question If you need more space, attach a separate sheet with details. Dad and Partner Pay is a taxable payment. We will withhold PAYG at the rate of 15 per cent unless you nominate a different tax rate, prior to payment commencing. Would you like to nominate a different PAYG tax rate? Account details 30 Where do you want payment of your Dad and Partner Pay made? The bank, building society or credit union account must be in your name. A joint account is acceptable. It cannot be in a child s name unless you are the signatory or trustee. You must choose a rate between 0 and 50 per cent. % Name of bank, building society or credit union Branch where your account is held Branch number (BSB) Account number (this may not be your card number) Account held in the name(s) of 7 of 13

20 Dad and Partner Pay details 34 Please read this before answering the following questions The maximum Dad and Partner Pay period is the 14 days beginning on the day you nominate at this question. If you are not eligible on one of the days during the 14 day Dad and Partner Pay period you will not be eligible for that day and any remaining days of the period. Your Dad and Partner Pay period start date is not the date your payment will be received, it is the start of your entitlement period. Your payment will occur after your Dad and Partner Pay period start date and when proof of birth or proof of the child coming into your care has been provided, along with any other requested documents. 36 Are you adopting this child as part of a known adoption? 37 For more information, see Known adoptions in the tes Booklet. You may not be eligible for Dad and Partner Pay. Has this child already come into your care as part of the adoption process? What date will this child come into your care as part of the adoption process? What date would you like your Dad and Partner Pay period to start? From the date of birth or date the child comes into your care OR From another date If you want to get the full 2 weeks of Dad and Partner Pay you should nominate a start date within the first 50 weeks from the date of birth or date the child comes into your care. 38 What date did this child come into your care as part of the adoption process? Go to 47 Go to 39 Are you claiming for a child who has already been born? What is your child s expected date of birth? Go to What is your relationship to the child you are claiming Dad and Partner Pay for? Biological father Partner of birth mother Go to 38 Go to 38 Adoptive parent Partner of adoptive parent Legal parent Go to 38 Partner of legal parent Go to 38 ne of the above Go to 38 8 of 13

21 Child details 39 Details of child Child s family name Child s first given name 45 Was this child stillborn or has this child died? You (or your partner) will need to lodge proof of the child s birth or proof of the child coming into your care before we can finalise your claim. For example, the Newborn Child Declaration (FA081) provided at the birth of your newborn child can be provided as proof of birth. Go to 47 Child s second given name Date of stillbirth or death 40 Has this child been known by any other names? List the other names We have Social Workers who may be able to assist at this difficult time. Services include assistance with claiming, counselling and support. You can arrange to see a Social Worker by calling us on between 8.00 am and 8.00 pm Monday to Friday to make an appointment. 41 Child s sex Male Female 46 Proof of birth will need to be lodged before we can finalise your claim. For example, the Claim for Bereavement Payment form (FA008) with a completed doctor/midwife declaration made on the back page, or the child's birth certificate. Which hospital can confirm this child s date of stillbirth or death? 42 Child s date of birth Hospital name Hospital address 43 Is this child part of a multiple birth or multiple adoption? 44 Have you registered, or applied to register, the birth of your newborn child with your state or territory registry of births? You cannot receive Dad and Partner Pay until you have done so. Contact phone number ( ) Contact name Postcode t required You may be asked to provide proof of this registration. The requirement to register the birth does not apply where the child was stillborn, born outside Australia or has been adopted. Please contact your state or territory registry of births for more information. 47 To assist you in answering questions please complete the following dates to determine the maximum Dad and Partner Pay period you may be entitled to. Write the date provided at question 34 A Date that is 13 days after the date in Box A B 48 Will you work on or take paid leave for any day between the 2 dates at question 47? Go to 50 9 of 13

22 49 Between the 2 dates at question 47, what is the first date you will work or take paid leave? 50 Will you have care of your child for every day between the 2 dates at question 47? For more information, see Care of Child in the tes Booklet. Go to Between the 2 dates at question 47, what is the first date you will not have care of your child? Income details 52 Please read this before answering the following questions Your eligibility for Dad and Partner Pay will be based on your income for the financial year before: the date of this claim, or your nominated Dad and Partner Pay period start date. The earliest of these dates will determine the correct financial year. What date would you like your Dad and Partner Pay period to start? This is the date provided at question What date are you lodging this claim? 54 Using the earliest date at either question 52 or 53, what is the previous financial year to this date? For example, if you lodge this claim within the financial year and your Dad and Partner Pay period start date is on or after 1 July 2015, we need to know your actual adjusted taxable income for financial year. However, if you are lodging a claim in the financial year with a Dad and Partner Pay period start date on or before the 30 June 2015, we need to know your actual adjusted taxable income for financial year. FY / 10 of 13

23 55 Use the following table to calculate your adjusted taxable income for the financial year indicated at question 54. te: If you did not receive income from any of the following sources, please write $0 in the appropriate boxes. For more information, see Providing your income details in the tes Booklet. You A Taxable income from salary and wages $ B Taxable income from lump sum payment(s) $ C Taxable income from business or self-employment Profit $ or Loss $ D Taxable income from investments Profit $ or Loss $ E Taxable income from real estate Profit $ or Loss $ F Taxable income from government pensions, benefits or payments $ G Other taxable income AUD Total taxable income (total of A to G) = $ 56 Provide details of how much you received from any of the following sources in the financial year indicated at question 54. te: If you do not receive income from any of the following sources, please write $0 in the appropriate boxes. For more information, see Providing your income details in the tes Booklet. A B Reportable fringe benefits Reportable superannuation contributions You Estimated amount $ Estimated amount $ C D E F G Total net investment losses If you entered a net loss for your taxable income from investments and/or real estate at questions 55(D) or (E), you should copy the amount of the loss here Tax free pensions and benefits Foreign income Tax exempt foreign income Child support PAID Estimated amount $ Estimated amount $ Estimated amount AUD Estimated amount AUD Estimated amount $ 11 of 13

24 Work test details 57 Please read this before answering the following questions To be eligible for Dad and Partner Pay, you must meet the work test. To do this you must have: worked for at least 295 days (approximately 10 months) of the 392 days (approximately 13 months) period prior to the start date of your Dad and Partner Pay, and worked at least 330 hours in that 295 day (approximately 10 month) period (just over 1 day a week) with no more than an 8 week (56 day) gap between 2 working days. te: There are some exceptions if you do not meet the work test due to the child s premature birth. To assist you with questions 58 61, please complete the following dates to determine the relevant 392 day (approximately 13 month) period for the work test. Write the date provided at question 34 A Date which is 13 months prior to the date in Box A B 61 How many hours have you worked, or will work, within a 295 day (approximately 10 month) period between the 2 dates at question 57? If you have worked, or will work, between 330 and 500 hours, you will need to provide evidence of your work between the 2 dates at question Have you worked, or will you work, at least 8 hours every week between the 2 dates at question 57? This includes paid leave from your employer. Go to Has there been a continuous gap, where you did not work, for longer than 8 weeks between 2 working days within the 2 dates you provided at question 57? You will need to provide evidence of your work (e.g. payslips or declaration from an accountant) between the 2 dates at question Have you worked, or will you work, for at least 500 hours within a 295 day (approximately 10 month) period between the 2 dates at question 57? Go to of 13

25 Document checklist 62 Please read this before answering the following questions At certain questions on this form, you may have been asked to attach documents. In the following list, tick the box next to each document you are providing. Please provide original documents. Which of the following forms, documents and other attachments are you providing with this form? Someone to deal with us on your behalf Authorising a person or organisation to enquire or act on your behal form (SS313) (at question 14) You Your child Australian residence Citizenship papers, passport or other documents (at question 22) Child details see question 45 Proof of birth or proof the child has come into care has already been given to Human Services Proof of birth or adoption (e.g. birth certificate, a Newborn Child Declaration (FA081) or Claim for Bereavement Payment form (FA008) or adoption papers) Work test Evidence of your work between relevant dates (at question 59 or 61) 63 IMPORTANT INFORMATION Privacy and your personal information Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the department or given to other parties for the purposes of research, investigation or where you have agreed or it is required or authorised by law. You can get more information about the way in which the Department of Human Services will manage your personal information, including our privacy policy at or by requesting a copy from the department. Statement 64 Statement I declare that: the information provided in this form is complete and correct. I understand that: giving false or misleading information is a serious offence. the Australian Government Department of Human Services can make relevant enquiries to make sure I receive my correct entitlement. Your signature Date 13 of 13

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