Youth Allowance or ABSTUDY
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- Alisha Moore
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1 Youth Allowance or ABSTUDY Unreasonable to live at home Statement by Independent Third Party Return this form to one of our Service Centres by at the following address Name of young person claiming Unreasonable to live at home Purpose of this form For more information Filling in this form Returning your form The young person named above has applied as an independent person under the 'Unreasonable to live at home' guidelines. In order for the Department of Human Services to make an assessment this form needs to be completed by an independent third party. An independent third party is someone who has contact with the young person and is aware of the family situation (e.g. counsellor, social worker, doctor, teacher or an adult relative). They should not be a friend or partner of the young person only. The young person has applied to be considered independent claiming it is unreasonable for them to live at home. To meet these guidelines it must be unreasonable for the young person to live at home because: of extreme family breakdown (other than normal parent/adolescent conflict), or of serious risk to their physical or mental health if they continue to live at home, or their parent(s) cannot provide a suitable home as they do not have stable accommodation. The information you provide on this form will help us decide if the young person qualifies for the independent rate. If you need help to fill in this form or you need more information about the questions, please call us on To speak to us in languages other than English, call te: Call charges apply calls from mobile phones may be charged at a higher rate. 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 you have answered all the questions you need to answer and that you have signed and dated this form. Return this form and all additional documents to one of our Service Centres or Online by the date shown above. To access online services or to find out how to register, go to 1 of 5
2 1 YOUR DETAILS INDEPENDENT THIRD PARTY Your name Independent Third Party Mr Mrs Miss Ms Other Family name First given name 8 Parent means a natural or adoptive parent, or a person who is legally responsible for the young person. If the young person's parents are separated we need to know details about each of them (if known). Is the young person currently living at home with their parent(s)? Do not answer questions 9 to 31. Go to 32 Second given name 9 When did the young person leave their parent(s) home? 2 Your organisation (if applicable) 10 Has the young person left their parent(s) home previously? 3 Your position (e.g. social worker, teacher) Date the young person left home (or estimate of date left) Date the young person returned home to live (or estimate of date returned) 4 Your permanent address If the young person has left home on more than 4 occasions, attach a separate sheet with details. 5 Your contact details Home phone number Mobile phone number ( ) Is this a silent number? YOUNG PERSON DETAILS PERSON CLAIMING UNREASONABLE TO LIVE AT HOME 11 Is anyone other than the young person s parent(s) responsible for looking after them (e.g. a guardian)? Guardian means any other person whom the young person is substantially dependent on. Person s name 6 Young person s name Family name Their address First given name 7 Second given name Young person s date of birth Contact phone number ( ) How long have they looked after the young person? (e.g. number of days/months/years) CLK0SY of 5
3 12 Details of the person, with whom the young person last lived. Name Relationship to the young person: Both parents Mother Father Guardian Other 17 Questions 17 to 19 relate to the last person the young person lived with. Why did the young person leave home? Give details of any problems or particular incidents that led the young person to leave home. 13 What is your relationship with the young person and their family? Describe briefly the length of your relationship and what contact have you had with them, etc. 18 How long have these problems been going on? 19 How do you think the young person is affected by the problems that led them to leave home? 14 Have you had any contact with the young person's parent(s) to discuss the family situation? 15 Go to 16 Have you tried to contact the young person's parent(s) to discuss the family situation? Go to Are you aware of any way that the young person or their parent(s) have tried to sort out their differences (e.g. counselling, mediation or attempts by the young person to improve their relationship)? 1 What has been tried 16 Describe below, any contact you have had with either of the young person's parents, to discuss the family situation. Name of person or organisation contacted Has this helped improve the relationship between the young person and their parent(s)? 2 What has been tried Name of person or organisation contacted Has this helped improve the relationship between the young person and their parent(s)? 3 of 5
4 21 Is the young person allowed to return home to live? Go to Do you think it is unreasonable for the young person to live at home? 22 Why isn t the young person allowed to return home to live? 25 Do the young person s parents live together? Go to 24 Go to Will any conditions apply if the young person returns home to live? 26 Other parent means the parent they were not living with. Has the young person had any contact with their other parent in the past 2 years? Go to 30 t sure 27 Has the young person ever lived with their other parent? 28 Is the young person able to live with their other parent? 4 of 5
5 29 Describe the relationship between the young person and their other parent i.e. how do they get along, what sort of contact do they have. 31 Is there any other information you can provide that will help us decide if it is unreasonable for the young person to live at home? Attach any other documents/reports etc. that you wish to provide. 30 Are the young person s parent(s) or anyone else providing money or other support to the young person (e.g. providing food, paying bills, subsidising rent, paying school fees, providing regular money)? t sure Include: type of support provided how often support is provided who is providing the support. If you need more space, attach a separate sheet with details. 32 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 www. humanservices.gov.au/privacy or by requesting a copy from the department. YOUR STATEMENT INDEPENDENT THIRD PARTY 33 Statement I declare that: the information I have provided in this form is complete and correct. I understand that: the Australian Government Department of Human Services can make relevant enquiries to ensure the young person receives the correct entitlement. Your signature Date 5 of 5
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