This form is part of your claim for payment. The information asked for on this form is needed to decide whether the Australian Government Department of Human Services can grant your claim. Under section 192 of the Social Security (Administration) Act 1999, we have the authority to collect this information. Under section 196 of the Social Security (Administration) Act 1999, you must complete and return this form within 14 days.
SCI
1 1 Type of work (e.g. fishing)
Employer and contact details Period worked Date started work / /
Your full name Date of birth Centrelink Reference Number Partner’s name (if applicable) / / Phone number ( )
Please list the work you and/or your partner have done in the last 6 months that was seasonal, contract or intermittent. If you and/or your partner have done more than 4 jobs, please attach a separate sheet with details. Seasonal work is work that is available for part or parts of the year at approximately the same time each year. Contract work is any intermittent work that is performed under a contract for a specific function and/or period including sub-contract work. Intermittent work is work that is available from time to time, can reasonably be predicted to end or not be available for a period, is less than a year in duration and does not accrue leave entitlements. Allowable Deductions can be made if they are in relation to the seasonal, contract or intermittent work and are allowed by the Australian Taxation Office. Work completed by You Your partner Employer and contact details
2 Type of work (e.g. fishing)
Work completed by You Your partner
Date finished work / /
Gross amount earnt from this work $
Period worked Date started work / /
Date finished work / /
Gross amount earnt from this work $
Allowable deductions (if any) for this work and amount $ $ $ $
If there are more deductions, attach a separate sheet with details.
Allowable deductions