ALP
Application for child support assessment (paying parent)

CSA 2717-1.2005

This form can be submitted online.

When to use this form
Use this form to apply for an assessment of how much child support you should pay. You can apply for an assessment if:

the child is under 18;
the child is not married or in a de facto relationship;
you are the natural or adoptive parent of the child/ren named in this application; and
the parents separated on or after 1 October 1989, or one of the children was born on or after 1 October 1989.

You can 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.

Do not use this form if:

there is already an assessment in place for the children;
you already have a child support assessment and your personal details have changed;
there have been changes which affect the amount of child support payable (use form CMD); or
you want to register a child support agreement (use form 102).

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 the CSA to use in letters to you and the person to whom you want to pay child support
Current name Previous name

3. Your postal address


State	Postcode

4. Your home address

(if different to your postal address)
State	Postcode

5. Your phone numbers

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

6. Are you a resident of Australia for tax purposes? Yes No Don't know

7. Do you live with the person to whom you want to pay child support? Yes No

8. Your date of birth

You do not have to answer question 9, but if you do it will help us to improve our services to customers

9. 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 that you would prefer to use when dealing with the CSA?	Yes No If yes, which language?

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

11. Do you have a court order or court registered agreement for payment of child support? Yes Is the CSA collecting for you? Yes No
No

12. Do you have a parenting plan or court order concerning the care arrangements
of the children in this application? Yes If yes, please provide a copy
No

13. 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.

Yes If yes, your Tax File Number Note: It is not an offence if you choose not to quote your Tax File Number
No
Currently applying

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 If yes $

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

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

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

About the person to whom you want to pay child support

15. Full name

Title	Mr Mrs Miss Ms
Surname
Given names

16. Previous name - if name 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 postal address
State	Postcode

19. Telephone numbers

Home
Work
Mobile

20. Date of birth

Other contact details of the person to whom you want to pay child support

If you could not answer question 17, 18 and 19, please give any other information which might help find this person - for example, name, address and phone number of a friend or relative with whom they may be staying.

About the children for whom you are applying to pay child support

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

Child 1
A Surname
B Given names
C
D Date of birth

E Will you share the care of this child more or less equally with the person to whom you want to pay child support over the next 12 month period?
Yes No

F Is the person you want to pay child support to a parent of this child?
Yes No

G Does the person you want to pay child support to care for this child under child welfare law?
Yes No
If yes, what is their relationship to this child? (e.g. Aunt etc.)

H How much time do you estimate this child will stay with you over the next 12 month period?
The period of time the child spends with you may affect the amount of child support you pay

	0-109 nights - Go to I
	110-145 nights - you have substantial contact
	146-219 nights - you have shared care
	220-255 nights - you have major contact
	256-365 nights - you have sole care, you should not apply to pay child support for this child

I Do you and the person agree that you have substantial contact with this child?
Note: Parents can agree that the paying parent has substantial contact with the child even if the child stays 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 you child support assessment.
Yes No

Child 2

A Surname
B Given names
C
D Date of birth

E Will you share the care of this child more or less equally with the person to whom you want to pay child support over the next 12 month period?
Yes No

F Is the person you want to pay child support to a parent of this child?
Yes No

G Does the person you want to pay child support to care for this child under child welfare law?
Yes No
If yes, what is their relationship to this child? (e.g. Aunt etc.)

H How much time do you estimate this child will stay with you over the next 12 month period?
The period of time the child spends with you may affect the amount of child support you pay

	0-109 nights - Go to I
	110-145 nights - you have substantial contact
	146-219 nights - you have shared care
	220-255 nights - you have major contact
	256-365 nights - you have sole care, you should not apply to pay child support for this child

Child 3

A Surname
B Given names
C
D Date of birth

E Will you share the care of child 3 more or less equally with the person to whom you want to pay child support over the next 12 month period?
Yes No

F Is the person you want to pay child support to a parent of this child?
Yes No

G Does the person you want to pay child support to care for this child under child welfare law?
Yes No
If yes, what is their relationship to this child? (e.g. Aunt etc.)

H How much time do you estimate this child will stay with you over the next 12 month period?
The period of time the child spends with you may affect the amount of child support you pay

	0-109 nights - Go to I
	110-145 nights - you have substantial contact
	146-219 nights - you have shared care
	220-255 nights - you have major contact
	256-365 nights - you have sole care, you should not apply to pay child support for this child

Child 4

A Surname
B Given names
C
D Date of birth

E Will you share the care of this child more equally or less equally with the person to whom you want to pay child support over the next 12 month period?
Yes No

F Is the person you want to pay child support to a parent of this child?
Yes No

G Does the person you want to pay child support to care for this child under child welfare law?
Yes No
If yes, what is their relationship to this child? (e.g. Aunt etc.)

H How much time do you estimate this child will stay with you over the next 12 month period?
The period of time the child spends with you may affect the amount of child support you pay

	0-109 nights - Go to I
	110-145 nights - you have substantial contact
	146-219 nights - you have shared care
	220-255 nights - you have major contact
	256-365 nights - you have sole care, you should not apply to pay child support for this child

Child 5

A Surname
B Given names
C
D Date of birth

E Will you share the care of this child more or less equally with the person to whom you want to pay child support over the next 12 month period?
Yes No

F Is the person you want to pay child support to a parent of this child?
Yes No

G Does the person you want to pay child support to care for this child under child welfare law?
Yes No
If yes, what is their relationship to this child? (e.g. Aunt etc.)

H How much time do you estimate this child will stay with you over the next 12 month period?
The period of time the child spends with you may affect the amount of child support you pay

	0-109 nights - Go to I
	110-145 nights - you have substantial contact
	146-219 nights - you have shared care
	220-255 nights - you have major contact
	256-365 nights - you have sole care, you should not apply to pay child support for this child

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 No
If yes, date of marriage

(b) Are the parents divorced?
Yes No Not applicable, never married
If yes, date of divorce

(c) Have the parents ever lived together in a de facto relationship?
Yes No Go to question 23
If yes, date they started living together

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

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

23. Are you the parent, either natural or by legal adoption, of any children, who live mainly with you,
other than those named in question 21?The assessment will be affected in cases where the care of the children is split between the parents.
Yes If yes, list any children under 18
No Go to the Declaration

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

IMPORTANTYou will be required to make your own private arrangements to pay the child support payments. Only the person to whom you pay child support is entitled to ask the CSA to collect the payments on their behalf and they can choose to do this at any time, once an assessment is made.

DeclarationI apply for an assessment of child support for the children named in this application and declare that:
I am a parent of these children (either natural or by legal adoption). All the children are under 18 years of age, are not married nor living in a de facto relationship, and are Australian citizens or currently or usually living in Australia. To the best of my knowledge, the information I have given in this form is complete and correct.

Date

Your privacy
The information requested in this form is needed for child support purposes and is required by child support law. Some information may be passed to Centrelink, the Australian Taxation Office or to a law enforcement officer. Only the information which is relevant to the assessment may be passed on to the other parent. We will not give your address or phone number to the other parent.

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

Important There are penalties for deliberately giving false or misleading information

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

CSA office addresses:

NSW	Sydney	GPO Box 9815	Sydney	2001

VIC/TAS	Melbourne	GPO Box 9815	Melbourne	3001

QLD	Brisbane	GPO Box 9815	Brisbane	4001

SA/NT	Adelaide	GPO Box 9815	Adelaide	5001

WA	Perth	PO Box 9815	Perth	6848

Need help to complete this form?

telephone CSA on 131 272 (local call charge excluding mobile and public phones).
visit your nearest Centrelink Customer Service Centre.

If you have a complaint

please contact us on 131 272.
if you are still not satisified call the Complaints Service on 132 919.

ALPApplication for child support assessment (paying parent)

About you - the person applying for a child support assessment

About the person to whom you want to pay child support

About the children for whom you are applying to pay child support

About the parents’ relationship

ALP
Application for child support assessment (paying parent)