101
Application for child support assessment

CSA 1665-07.2006

This form can be submitted online.

IMPORTANT Did you know that you can collect child support payments yourself? You can make your own private arrangements to collect the payments from the paying parent, or you can ask the Child Support Agency (CSA) to collect the payments for you. Phone 131 272 to discuss your options.

NOTE: this form can be completed over the phone by calling CSA on 131 272.

When can you use this form?
You can use this form to apply for an assessment of how much child support you should be paid.
Before you fill it in, please make sure you are eligible by checking the 'Who is eligible to apply?' section on the back page of this form.

You can also use this form if you want to add another child to your child support assessment, or if your previous assessment has ended and you want to reapply.

When can you not use this form?
Please do not use this form if:

you already have a child support assessment and want CSA to collect payments (use AFC form)
you already have a child support assessment and your personal details have changed (use CMD form)
there have been changes which affect the amount of child support payable (use CMD form); or
you want to register a child support agreement (use form 102).

Did you know, AFC and CMD forms can be processed more quickly over the phone?
Call CSA on 131 272.

Need help to complete this form?

Telephone CSA on 131 272 (local call charge excluding mobile and public phones).
visit your nearest Centrelink office.

Your privacy
The information requested by CSA is needed for child support purposes and is required by child support law. We don't pass your personal information on to the other parent, except where this is required by law or necessary to make a decision that would affect the other parent.

Some information may be passed to Centrelink, the Australian Taxation Office or to a law enforcement agency. CSA may provide your contact details to people contracted by us to deliver services to separated parents, or carry out research to help improve our services. You are not obliged to participate in any programs or research.

Our guidelines on privacy are in accordance with the Information Privacy Principles of the Privacy Act 1988. For more information about the Privacy Act and privacy generally, see the Privacy Commissioner's website at www.privacy.gov.au. For more information about our collection, use and disclosure of information, see The Guide in the legal section of CSA's website.

We will not let the paying parent know your address or phone number.

About you - the person applying for a child support assessment

1. Your name

Title	Mr Mrs Miss Ms
Surname
Given names

2. Your previous name—if you have changed your name

Title	Mr Mrs Miss Ms
Surname
Given names

The name you want CSA to use in letters to you and the paying parent?
Current name Previous name

3. Your postal address


State	Postcode

4. Your home address

(if different to your postal address)
State	Postcode

5. Your telephone numbers

Home	Is this a silent number? Yes No
Work	Mobile
Email address
Best time to contact you?

6. Date of birth (dd/mm/yyyy)

You do not have to answer Question 7, but if you do it will help us to improve our service to you

7. Are you of Aboriginal origin?	Yes No
Are you of Torres Strait Islander origin?	Yes No
In which country were you born?
Is there a language other than English you would prefer to use when dealing with CSA?	Yes No
If Yes, which language?

8. Do you have a Centrelink customer reference number? Yes No Currently applying
If yes, your centrelink reference number

9. Have you applied for a child support assessment before? Yes No
If yes, your CSA reference number Your CSA reference number can be found at the top of CSA letters to you

10. Do you have a court order or court registered agreement for payment of child support? Yes No
If yes, is CSA collecting for you? Yes No

If you answered 'yes', please contact CSA to discuss how this may affect your application. If you are unable to contact CSA, please provide a copy of the Court Order or Agreement.

11. Do you have a parenting plan or court order concerning the care of the children for whom you are applying
for a child support assessment? Yes No

If you answered 'yes', please provide a copy with your application.

12. Do you have a Tax File Number? Your Tax File Number will appear on an Income Tax Notice of Assessment issued by the Australian Taxation Office. Tax File Numbers may also be used as Child Support Agency reference numbers.

Yes No Currently applying
If yes, your Tax File Number Note: It is not an offence if you choose not to quote your Tax File Number. CSA will obtain this information directly from the Australian Taxation Office if you do not provide it.

13. (a) Are you a parent of the child/ren that you want child support for? Yes No If yes, go to 14

(b) Are you living with a parent of the child/ren and are jointly caring for that child/ren?
Yes No If Yes, you should not apply for child support. The parent of the child should apply

(c) Will you apply for child support from both parents of the child/ren?
Yes No Please complete question 15. Note: you will need to apply against each parent separately.

14. (a) What was your taxable income for the last financial year? $

(b) Did you have any rental property losses for the last financial year?
Yes No $

(c) Did you have any tax exempt foreign employment income for the last financial year?
Yes No $

(d) Did you have any reportable fringe benefits for the last financial year?
Yes No $

(e) Total child support income (total of a, b, c and d)
$
Note: A financial year is 1 July to 30 June

About the paying parent - the parent from whom you are claiming child support payments

15. Full name

Title	Mr Mrs Miss Ms
Surname
Given names

16. Previous name - if name has changed

Title	Mr Mrs Miss Ms
Surname
Given names

17. Postal address—if you know it


State	Postcode

18. Home address—if you know it and it is different from the postal address


State	Postcode

Is this an overseas address? Yes No If yes, date the paying parent left Australia (dd/mm/yyyy)
(Not applicable if payer never lived in Australia)

19. Telephone numbers

Home		Email
Work		Mobile

20. Date of birth (dd/mm/yyyy)

It is difficult for CSA to collect child support payments if the paying parent cannot be found.

If you could not answer questions 17, 18 and 19, please give any other information which you think might help find this person — for example, employment details, or name, address and phone number of a friend or relative the paying parent might be living with.

About the child/ren you are applying for child support for

21. Please give details about the child/ren you want child support for

Child 1

A Surname
B Given name
C Other given name
D Date of birth
E Sex of child:	Male Female
F State/territory where birth is registered
G Are you a parent (either natural or by legal adoption) of this child?	Yes - go to I No
If no, date that you took on daily care of this child
H Do you care for this child under a child welfare law?	Yes No
If yes, what is your relationship to this child? (e.g. Aunt)
I Have you always had daily care of the child?	Yes No
If no, the most recent date on which you took on daily care of this child
J Will you share the care of this child more or less equally with the paying parent over the next 12 month period?	Yes No

K How much time do you estimate this child will stay with the paying parent over the next 12 month period?
Note: The amount of child support you may receive will depend on the period of time the child stays with the paying parent.

0-109 nights Go to L
110-145 nights The payer has substantial contact (now go to the next child or question 22)
146-219 nights The payer has shared care (now go to the next child or question 22)
220-255 nights The payer has major care (now go to the next child or question 22)
256-365 nights The payer has sole care. You should not apply for this child. (now go to the next child or question 22)

L Do you and the paying parent agree that the paying parent has substantial contact with the child?
Note: you can agree that the paying parent has substantial contact even if the child is with the paying parent less than 110 nights. If you do agree to the level of care of the child, that agreement can be reflected in your child support assessment.

Yes No

Child 2

A Surname
B Given name
C Other given name
D Date of birth
E Sex of child:	Male Female
F State/territory where birth is registered
G Are you a parent (either natural or by legal adoption) of this child?	Yes - go to I No
If no, date that you took on daily care of this child
H Do you care for this child under a child welfare law?	Yes No
If yes, what is your relationship to this child? (e.g. Aunt)
I Have you always had daily care of the child?	Yes No
If no, the most recent date on which you took on daily care of this child
J Will you share the care of this child more or less equally with the paying parent over the next 12 month period?	Yes No

Yes No

Child 3

A Surname
B Given name
C Other given name
D Date of birth
E Sex of child:	Male Female
F State/territory where birth is registered
G Are you a parent (either natural or by legal adoption) of this child?	Yes - go to I No
If no, date that you took on daily care of this child
H Do you care for this child under a child welfare law?	Yes No
If yes, what is your relationship to this child? (e.g. Aunt)
I Have you always had daily care of the child?	Yes No
If no, the most recent date on which you took on daily care of this child
J Will you share the care of this child more or less equally with the paying parent over the next 12 month period?	Yes No

Yes No

Child 4

A Surname
B Given name
C Other given name
D Date of birth
E Sex of child:	Male Female
F State/territory where birth is registered
G Are you a parent (either natural or by legal adoption) of this child?	Yes - go to I No
If no, date that you took on daily care of this child
H Do you care for this child under a child welfare law?	Yes No
If yes, what is your relationship to this child? (e.g. Aunt)
I Have you always had daily care of the child?	Yes No
If no, the most recent date on which you took on daily care of this child
J Will you share the care of this child more or less equally with the paying parent over the next 12 month period?	Yes No

Yes No

About the parents' relationship

In order to determine parentage we need to ask questions about the parents' relationship

22. (a) Were the parents ever legally married? Yes If yes, give date of marriage (dd/mm/yyyy)
No Got to question 22(c)

(b) Are the parents divorced?
Yes No If yes, give date of divorce (dd/mm/yyyy)

(c) Have the parents ever lived together in a de facto relationship?
Yes No If yes, date they started living together (dd/mm/yyyy)

(d) Have the parents lived together more than once?
Yes No
If yes, show the periods of living together since the first period (dd/mm/yyyy)
to
to
to

(e) Are the parents still living together?
Yes No If no, date of separation (dd/mm/yyyy)

IMPORTANT
Were any of the children born while the parents were not married? If yes, do you have any of the following documents:

a birth certificate
an adoption certificate
a statutory declaration signed by the paying parent
a statutory declaration signed by you stating that the paying parent is named on the birth certificate
a court document

Please attach a copy of the relevant document for each child if you have any of these documents available.
Write the name of the document you are providing:

23. Are any of the children of your relationship with the paying parent living mainly with the paying parent? The assessment will be affected in cases where the children of the relationship are living with different parents.
Yes List any children under 18
No Go to question 24

Child 1
Surname
Given names
Date of birth
Child 2
Surname
Given names
Date of birth
Child 3
Surname
Given names
Date of birth
Child 4
Surname
Given names
Date of birth

24. Are you the parent of any other children (this includes, natural and legally adopted child/ren
or step child/ren you have a duty to maintain) who live with you besides those already named in
questions 21 and 23? For example, you may have a child or children from another relationship living with you.
Yes List any children under 18
No Go to question 25

Child 1
Surname
Given names
Date of birth
Child 2
Surname
Given names
Date of birth
Child 3
Surname
Given names
Date of birth
Child 4
Surname
Given names
Date of birth

About Child Support payments

IMPORTANT Did you know that you can collect child support payments yourself? You can make your own private arrangements to collect the payments from the paying parent, or you can ask the CSA to collect the payments for you from the paying parent.

25. Do you want CSA to collect the payments for you? Yes Go to question 26
No Go to question 29
Don't know Ring CSA on 131 272 to discuss your options for collection

If you don't tick one of the boxes or if you ticked 'Don't know' and CSA does not hear from you before it makes the child support assessment, it must collect the payments for you.

26. Which bank account do you want your child support paid into? Please complete details.

Name of bank, building society or credit union
Branch where your account is held
Branch (BSB) number
Account number
Account name (you must be a party to the account)

27. Does the paying parent receive a salary or wage?

Yes If yes, give details of the paying parent's employer below. These details will assist CSA to collect the payments for you.
No
Don't know
Business name of employer
Address of employer
Email address of employer
Telephone numbers of employer		Mobile

28. What is the paying parent's occupation?

29. Declaration I apply for an assessment of child support for the child/ren named in this application and declare that, to the best of my knowledge, the information I have given in this form is complete and correct.

Date

Please note: There are penalties for deliberately giving false or misleading information.

CSA cannot guarantee the security of personal information sent via the Internet.

Where to send this form Please send this form to the address shown on CSA letters to you, or to the nearest CSA office.

Child Support Agency Offices
NSW/ACT	Sydney	GPO Box 9815	Sydney	2001

VIC/TAS	Melbourne	GPO Box 9815	Melbourne	3001

QLD	Brisbane	GPO Box 9815	Brisbane	4001

SA	Adelaide	GPO Box 9815	Adelaide	5001

WA	Perth	PO Box 9815	Perth	6848

If you have a complaint

please contact us on 131 272 (local call charge excluding mobile and public phones).
if you are still not satisified call the Complaints Service on 132 919.

Who is eligible to apply?
You can apply for a child support assessment if:

The parents of the children separated, or one of the child/ren were born on or after 1 October 1989.
The person who is to be paid the child support (called the 'payee' in this form) has at least substantial care of the child/ren. ('Substantial care' means caring for the child/ren for at least 30% of nights in the year or where it is agreed that substantial care exists.)
The person who is to pay the child support (called the 'payer' in this form) is an Australian resident for tax purposes.
The children are under 18 and unmarried and not in a de facto relationship.
The children are Australian citizens or currently or usually living in Australia, or living in a reciprocating country. Please contact CSA for a list of reciprocating countries.
The payee and the payer must not be living together in a domestic relationship.

Note: You do not need to be the child/ren's parent to apply for child support.

The Australian Government Services Fraud tip-off line

The Australian Government Services Fraud tip-off line provides people with a place to report suspected fraud against Centrelink, Medicare, the Pharmaceuticals Benefits Scheme or the Child Support Agency. If you have information about someone who is misusing government services, call 13 15 24.

101Application for child support assessment

About you - the person applying for a child support assessment

About the paying parent - the parent from whom you are claiming child support payments

About the child/ren you are applying for child support for

About the parents' relationship

About Child Support payments

101
Application for child support assessment