Application for Advance Payment
When to use this form
Use this form if you are claiming an Advance Payment of your social security payment. An Advance Payment
can help you pay larger expenses or bills which you do not have enough money for.
You can also apply for an Advance Payment online or over the phone. Go to humanservices.gov.au or call
us on 136 240 to register for self service and apply for an Advance Payment.
www.
What is an Advance
Payment?
An Advance Payment is a lump sum amount paid from part of your future payments.
• The Advance Payment has to be repaid.
• The Advance Payment can be paid in 2 instalments.
• The Advance Payment is limited by maximum and minimum amounts. The amount will depend on the type
and rate of payment you receive from us.
• The number of Advance Payments you can receive over a 12 month period is limited and depends on
the type of payment you are receiving. Over a 12 month period, customers who receive a pension can
be paid several Advance Payments, while customers receiving Parenting Payment, Newstart Allowance,
Farm Household Allowance, Youth Allowance, Austudy or ABSTUDY are limited to one Advance Payment.
Who can apply for an
Advance Payment?
You may be eligible for an Advance Payment if you are receiving one of these payments:
How much are the
repayments?
• If you receive an Advance Payment, the money is repaid through fortnightly deductions from your pension
or allowance.
• The deductions will start from your first payment after you receive the Advance and will continue for a
total of 13 fortnights (about 6 months).
• To work out how much your repayments will be, just divide the amount of your Advance Payment by 13.
Here are some examples:
• ABSTUDY
• Parenting Payment (Partnered)
• Age Pension
• Parenting Payment (Single)
• Austudy Payment
• Widow Allowance
• Carer Payment
• Widow B Pension
• Disability Support Pension
• Wife Pension
• Farm Household Allowance
• Youth Allowance
• Newstart Allowance
AND
• have been receiving a Centrelink payment or a service pension for at least 3 months
(Note: This may be waived in certain circumstances for full time students receiving ABSTUDY, Austudy
or Youth Allowance who have study related expenses)
• you do not owe the Commonwealth money (this does not include a Family Tax Benefit Advance Payment)
• you meet the criteria to qualify for an Advance Payment
• you are able to show you can repay the Advance Payment and still have enough money for your day to
day expenses.
Amount of
Advance Payment
Amount to be deducted each
fortnight for 13 fortnights
$250
$350
$400
$450
$500
$650
$750
$850
$1,000
$19.30
$27.00
$30.80
$34.70
$38.50
$50.00
$57.70
$65.40
$77.00
You can have the Advance Payment paid off faster by asking for larger deductions, however, this will only
be approved if you can show you still have enough money for your day to day expenses.
SS352.1603
Notes—1 of 2
Filling in this form
• Please use black or blue pen.
• Print in BLOCK LETTERS.
• Mark boxes like this
with a or .
Returning your form
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 humanservices.gov.au/submitdocumentsonline
• by post.
• 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.
www.
For more information
Go to humanservices.gov.au or visit one of our service centres or call us on:
ABSTUDY
1800 132 317
Austudy
132 490
Disability and Carers
132 717
Employment Services
132 850
Families
136 150
Farmer Assistance Hotline
132 316
Seniors
132 300
Youth and Students
132 490
www.
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 131 202.
Note: 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™ 1800 810 586.
A TTY phone is required to use this service.
Please keep these Notes (pages 1 to 2) for your information.
SS352.1603
Notes—2 of 2
Application for Advance Payment
1
Your permanent address
You cannot receive an Advance Payment (unless
exempt for ABSTUDY/Austudy/Youth Allowance).
Please call us on the appropriate number listed
on page 2 of the Notes.
No
Yes
2
6
Have you been receiving a Centrelink payment, other than Family
Tax Benefit, for 3 months or more?
Postcode
Type of Centrelink payment you are receiving
7
Your postal address (if different to above)
Postcode
Do you have a debt with the Department of Human Services or
another Australian Government department?
8
This does NOT include a Family Tax Benefit Advance Payment.
(
Go to next question
No
Yes
Your contact phone number
You cannot receive an Advance Payment.
Please call us on the appropriate number listed
on page 2 of the Notes.
9
)
To work out if you can afford to repay the Advance Payment:
A Estimate your total fortnightly income
Include all earned income and Centrelink payments.
3
Your Centrelink Reference Number (if known)
$
B Estimate your total fortnightly expenses
4
Include food, rent, travel, contributions to power, phone,
Centrelink repayments and all ongoing expenses and
payments.
Your name
Mr
Mrs
Miss
Ms
Other
$
Family name
C Deduct your total fortnightly expenses from your total
fortnightly income.
This will leave you with a fortnightly excess of (A – B = C)
First given name
$
Second given name
5
Note: If you need help to work out your income and
expenses, you can obtain a copy of the Fortnightly
Savings Planner form (FIS029) by going to
humanservices.gov.au/forms or by calling 132 300.
Your date of birth
/
www.
/
CLK0SS352 1603
SS352.1603
1 of 2
10 Please read this before answering the following question.
12
The Advance Payment is limited by maximum and minimum
amounts – the amount you can be paid will depend on the type
and rate of payment that you receive. We will discuss this with
you when you return this form.
Repayments will start from the first payment after the first
instalment of the Advance Payment. The last repayment may
be for a different amount.
Your payment will return to normal after the last repayment.
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
humanservices.gov.au/privacy or by requesting a copy from
the department.
How much money do you want advanced?
$
www.
11 Do you want your Advance Payment in 2 instalments?
Note: The second instalment must be paid within 6 months
from the first instalment.
However, Farm Household Allowance customers cannot
receive an advance payment in 2 instalments.
No
Go to next question
Yes
How much do you want in the first instalment?
13 Statement
I declare that:
• the information I have 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 the correct
entitlement.
• the Advance Payment will reduce my future fortnightly
Centrelink payments until the Advance Payment is repaid.
• the Advance Payment will be repaid over 6 months (unless I
request a lesser period).
• the rate of repayment can be reduced only when I would
suffer severe financial hardship because of a change in my
circumstances which are unforeseen and exceptional.
• if I stop receiving my Centrelink payment, the remaining
amount of the Advance Payment I still owe, will become a
debt which I will have to repay as soon as possible.
$
When do you want the second instalment paid?
/
/
Your signature
Date
/
SS352.1603
2 of 2
/