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Family Spending and Savings Questions 2014

Purpose of this form


This form requests information about family spending and savings from the parent(s)/guardian(s) of a person claiming Youth Allowance or ABSTUDY in 2014. We use this information to calculate the Youth Allowance or ABSTUDY entitlement under the Family Actual Means Test. Note: Your parent(s)/guardian(s) may be eligible for a higher rate of Family Tax Benefit than your rate of Youth Allowance or ABSTUDY. Please contact us for comparative rates and other information so the best payment option can be selected. For the Australian Government Department of Human Services purposes a person is considered to be your partner if you and the person are living together, or usually live together, and are: married, or in a registered relationship (opposite-sex or same-sex), or in a de facto relationship (opposite-sex or same-sex). We consider a person to be in a de facto relationship from the time they commence living with another person as a member of a couple. We recognise all couples, opposite-sex and same-sex. The parent(s)/guardian(s) only need to complete ONE SY003 form for all dependent children claiming Youth Allowance or ABSTUDY. Note: The Family Spending and Savings Question Guide form (Ci005) will need to be read and completed, prior to completing the Family Spending and Savings Questions form (SY003). TTY service Freecall 1800 810 586. A TTY phone is required to use this service. If you need an interpreter or translation of any documents for our business, we can arrange this for you free of charge. Please use black or blue pen. Print in BLOCK LETTERS. with a or . Mark boxes like this Go to 5 skip to the question number shown. Where you see a box like this You do not need to answer the questions in between.

Definition of a partner

Who should fill in this form If you have a hearing or speech impairment Interpreters and translations Filling in this form

Returning your form

Check that you have answered all the questions you need to answer and that you have signed and dated this form. If you return required documents (and this form): online you can submit your documents online if you are registered for Online Services. by post we will sight and record your documents, which may include copying, and return the originals to you by registered post. in person we will sight and record your documents, which may include copying, and return the originals to you. If you do not wish to claim online, please complete this form and return it (with any requested documents) as soon as possible by post to: Department of Human Services, Student Services Reply Paid 7804, CANBERRA BC ACT 2610 Alternatively, you can return this form to one of our Service Centres. Return this form, all additional documents and any other forms you are required to complete to one of our Service Centres or online within 14 days to ensure you are paid from the earliest date possible. If you cannot return all the forms or documents within 14 days, contact us for extra time. For more information on how to access Online Services or how to lodge documents online, go to humanservices.gov.au/sumbitdocumentsonline
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Personal details Youth Allowance/ABSTUDY customer

Youth Allowance or ABSTUDY customers name NOT the parent/guardian. Mr Mrs Miss Ms Other

Family name

First given name

Second given name

Youth Allowance or ABSTUDY customers date of birth / /

Youth Allowance or ABSTUDY customers Centrelink Reference Number (if known)

The rest of the questions in this form are about the parent(s)/guardian(s) Go to next page

CLK0SY003 1303

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Personal details Parent(s)/Guardian(s)

Parent/Guardian 4
Please read this before answering the following question. We recognise both opposite-sex and same-sex relationships. This includes de facto relationships and 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 Registered relationship (opposite-sex or same-sex relationship registered under state or territory law) Partnered (living together in an opposite-sex or same-sex relationship, including de facto) Separated (previously lived with an opposite-sex or samesex partner, including in a marriage, registered or de facto relationship) Divorced 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

Parent/Guardian partner

Go to 6 Go to 6

Go to 6

Go to 5

Go to 6 Go to 6

Go to 6

Date relationship ended / /

Are you a step-parent of the Youth Allowance or ABSTUDY customer? No Yes

Are you a step-parent of the Youth Allowance or ABSTUDY customer? No Yes

Go to 8 Go to next question

Go to 8 Go to next question

Does the Youth Allowance or ABSTUDY customer normally live with you? No You do NOT need to provide more personal details. You need to sign the statement on page 8. Go to 38

Does the Youth Allowance or ABSTUDY customer normally live with you? No You do NOT need to provide more personal details. You need to sign the statement on page 8. Go to 38

Yes

Go to next question

Yes

Go to next question

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Parent/Guardian 8
What is your name? Mr Mrs Miss Ms Other

Parent/Guardian partner 8
What is your name? Mr Mrs Miss Ms Other

Family name

Family name

First given name

First given name

Second given name

Second given name

Your date of birth / /

Your date of birth / /

10 Your permanent address

10 Your permanent address

Postcode

Postcode

11 Your postal address (if different to above)

11 Your postal address (if different to above)

Postcode

Postcode

12 Your contact details


Home phone number ( Work phone number ( Alternative phone number ( ) ) )

12 Your contact details


Home phone number ( Work phone number ( Alternative phone number ( ) ) )

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13 Please read this before answering the following question.


You can use this form to provide financial information for the 20122013 and 20132014 financial years. Depending on your circumstances you may have to provide information for one or both of these financial years. Your answer to the following question will determine which financial year(s) you will need to provide information for. Tick the box below that best describes your current situation: I am completing this form between January and August Provide information throughout this form for 20122013 only. Note: If your familys spending and savings has decreased substantially since 20122013, please contact us. Provide information throughout this form for both 20122013 and 20132014. Provide information throughout this form for 20132014 only.

Spending

17 What was the address of the familys principal home?


20122013 Address (if different to question 10)

Postcode Is the home: Owned outright Rented privately Rented from a public housing authority Being purchased and financed by a loan (regardless of when taken out) Owned, leased, rented or being purchased by a family company or other related entity Other Give details below

I am completing this form between September and December as part of a new Youth Allowance or ABSTUDY claim I am completing this form between September and December as part of a Youth Allowance or ABSTUDY review

20132014 Address (if different to question 10)

14 Have you completed the Question Guide form (Ci005)?


No You will need to complete the Question Guide form (Ci005) first and transfer the TOTALS to the relevant questions in this form. Postcode Is the home: Owned outright Rented privately Rented from a public housing authority Being purchased and financed by a loan (regardless of when taken out) Owned, leased, rented or being purchased by a family company or other related entity Other Give details below

Yes

Go to next question

15 Do you receive a pension, benefit or allowance from us or another


government agency (this does NOT include Family Tax Benefit)? No Yes

Go to 17 Go to next question

16 Please read this before answering the following question.


Net investment losses (these occur when your deductions are greater than your income from a rental property or investments (such as shares)). If you are not sure, please provide your personal income tax returns. What was the TOTAL net investment loss for all family members? 20122013 20132014 $ $

18 What was the TOTAL spending on the principal home?


To calculate your TOTAL refer to page 7 of the Question Guide form (Ci005). 20122013 $ 20132014 $

19 What was the TOTAL spending for ALL vehicles and other
transport costs used by the family for private purposes? To calculate your TOTAL refer to page 7 of the Question Guide form (Ci005). 20122013 $
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20132014 $

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20 What was the TOTAL spending on education for all family


members? To calculate your TOTAL refer to page 8 of the Question Guide form (Ci005). 20122013 $ 20132014 $

26 Did any family members make voluntary contributions to


superannuation funds? No Yes

Go to 28
Give details below

1 Name of family member

21 What was the TOTAL general living expenses for all family
members? To calculate your TOTAL refer to page 8 of the Question Guide form (Ci005). 20122013 $ 20132014 $ Sole-trader or partnership? No Yes Superannuation contributions 20122013 20132014 $ $

2 Name of family member 22 What was the TOTAL of other spending for all family members
not counted elsewhere? To calculate your TOTAL refer to page 9 of the Question Guide form (Ci005). 20122013 $ 20132014 $

Sole-trader or partnership?

No

Yes

Superannuation contributions 20122013 20132014 $ $

Savings

3 Name of family member

23 What were the TOTAL bank and other financial institution


savings for all family members? To calculate your TOTAL refer to page 10 of the Question Guide form (Ci005). TOTAL INCREASE of savings for the financial year for all family members 20122013 20132014 $ OR TOTAL DECREASE of savings for the financial year for all family members 20122013 20132014 $ $ Sole-trader or partnership? No Yes Superannuation contributions 20122013 20132014 $

Sole-trader or partnership?

No

Yes

Superannuation contributions 20122013 20132014 $ $

4 Name of family member

24 Did any family members have other savings?


No Yes

Go to 26 Go to next question

27 What was the TOTAL of voluntary contributions to 25 What was the TOTAL of other savings for all family members
not counted elsewhere? To calculate your TOTAL refer to page 12 of the Question Guide form (Ci005). 20122013 $ 20132014 $ superannuation funds for all family members? 20122013 20132014 $ $

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Deductions

36 Did any family members receive Defence Reserve payments in


the financial year? No Yes

28 Was any of the familys spending or savings funded by loans


taken out in the financial year? No Yes

Go to next question
Give details below Note: Provide the full Defence Reserve payment for each family member. We will deduct up to $6,000 for each family member who received Defence Reserve payments.

Go to 30 Go to next question

29 What was the TOTAL of the familys spending or savings funded


by loans taken out in the financial year? To calculate your TOTAL refer to page 13 of the Question Guide form (Ci005). 20122013 $ 20132014 $

1 Name of family member who received payments

Amount received 20122013 $

20132014 $

30 Was any of the familys spending or savings funded by the sale


of assets in the financial year? No Yes

Go to 32 Go to next question

2 Name of family member who received payments

31 What was the TOTAL of the familys spending or savings funded


by the sale of assets in the financial year? To calculate your TOTAL refer to page 14 of the Question Guide form (Ci005). 20122013 $ 20132014 $ Amount received 20122013 $ 20132014 $

3 Name of family member who received payments

32 Was any of the familys spending or savings funded by nontaxable compensation payments received in the financial year? No Yes

Go to 34 Go to next question

Amount received 20122013 $

20132014 $

33 What was the TOTAL of the familys spending or savings funded


by non-taxable compensation payments received in the financial year? To calculate your TOTAL refer to page 15 of the Question Guide form (Ci005). 20122013 $ 20132014 $

4 Name of family member who received payments

Amount received 20122013 $

20132014 $

34 Did any family members receive non-taxable Department of


Veterans Affairs payments in the financial year? No Yes

Go to 36 Go to next question

35 What was the TOTAL of the familys spending or savings funded


by non-taxable Department of Veterans Affairs payments in the financial year? To calculate your TOTAL refer to page 15 of the Question Guide form (Ci005). 20122013 $
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20132014 $

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37 Please read this before answering the following question.


Important: Up to $6,000 of income earned by dependent children from employment may be deducted by us. All amounts must be earned income from employment and declared/declarable to the Australian Tax Office. DO NOT INCLUDE SOCIAL SECURITY PAYMENTS. Do you have any dependent children who are aged 16 21 years and have earned income from employment in the financial year? No Yes

38 Are you supplying this information for more than one dependent
child in your family? No Yes

Go to next question
Give details below

1 Name of dependent child

Go to next question
Give details below

2 Name of dependent child

1 Name of dependent child 3 Name of dependent child


Dependent childs date of birth Amount earned 20122013 $ / 20132014 $ /

4 Name of dependent child

2 Name of dependent child


If you have more than 3 dependent children, attach a separate sheet with details. Dependent childs date of birth Amount earned 20122013 $ / 20132014 $ /

39

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.
www.

3 Name of dependent child

Dependent childs date of birth Amount earned 20122013 $

/ 20132014 $

4 Name of dependent child

Dependent childs date of birth Amount earned 20122013 $

/ 20132014 $

If you have more than 4 dependent children who earned income, attach a separate sheet with details.

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Parent(s)/Guardian(s) statement

40 Parent(s)/Guardian(s) statement
Note: Payments will not commence unless all the relevant signatures are supplied. I declare that: the information provided in this form is complete and correct. if requested, I am willing to provide documents, full taxation returns, full financial statements, receipts etc., where available, to support any claim made in this form. I have received the Question Guide form (Ci005). I understand that: giving false or misleading information is a serious offence. responsibility for calculating the familys spending and savings information provided in this form cannot be passed to a third party such as an accountant. the Department of Human Services can make relevant enquiries to ensure the claimant receives the correct entitlement. Signature of Parent/Guardian

Date / /

Signature of Parent/Guardian's Partner

Date / /

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