AU FA012 Form - Fill, Sign Online, Download & Print - No Signup
FA012.2407
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Details of your
child’s care arrangements
(FA012)
When to use this form
Important information
Use this form to confirm your child’s care arrangements, or if you are applying for or receiving
Family Tax Benefit or Child Care Subsidy and your child(ren) spends time with someone other
than you and/or your current partner. For example, weekends, school holidays.
The information you provide is needed to calculate your rate of payment under family assistance
law.
This is not a claim for Family Tax Benefit and Child Care Subsidy. If you are not currently receiving
Family Tax Benefit or Child Care Subsidy for any children, and wish to claim, log into your
Centrelink online account through myGov, then select
Make a Claim
. You can claim for a range of
family assistance including Family Tax Benefit and Child Care Subsidy online. If you are already
receiving Family Tax Benefit for any children, you are not required to claim online as we will
automatically reassess your existing entitlement using the information provided in this form.
If there is a permanent change to your care arrangements after you have lodged this form,
call us on
136 150
as soon as you are aware of the change. If there are minor variations to your
care arrangements, for example a sick child does not stay with a contact parent for a weekend,
you do not need to tell us.
You can upload this form, with any supporting documents, online.
For more information about how to access an online account or how to lodge documents online,
go to
www.
servicesaustralia.gov.au/centrelinkuploaddocs
Returning this form
Check that all required questions are answered and that the form is signed and dated.
If you have been asked to provide the information in this form, you should complete and return
this form
within 14 days
.
Return this form and any supporting documents:
•
online
using your Centrelink online account through myGov. For more information, go to
www.
servicesaustralia.gov.au/centrelinkuploaddocs
• by post to
Services Australia, Families, PO Box 7802, CANBERRA BC ACT 2610
• in person at one of our service centres.
For more information
Go to
www.
servicesaustralia.gov.au/families
or visit one of our service centres.
Call us on
136 150
.
Information in your language
We can translate documents you need for your claim or payments for free.
To speak to us in your language, call
131 202
.
Call charges may apply.
Hearing and speech assistance
If you have a hearing or speech impairment, you can use:
• the National Relay Service
1800 555 660
, or
• our TTY service on
1800 810 586
. You need a TTY phone to use this service.
For more information about help with communication, go to
www.
servicesaustralia.gov.au
and search
‘other support and advice’.
Online account
Instructions
FA012.2407
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Having a partner
We consider you to have a partner and be a member of a couple if you are either:
• married
• in a registered relationship. This is when your relationship is registered under a law of a state
or territory.
• in a de facto relationship. This is when you and your partner are in a marriage like relationship
but you are not married or in a registered relationship.
We may still consider you a member of a couple if you are not actually living with your partner.
For example, your partner may fly-in fly-out or live away for work, like military or oil rig workers.
For more information, go to
www.
servicesaustralia.gov.au/moc
Information about
shared care
For both family assistance and child support purposes the same rules are used to work out your
level of care. This means one determination for shared care is used. If you share the care of a
child for at least 35% of the time, you may be entitled to Family Tax Benefit. The percentage of
Family Tax Benefit you can receive is based on the actual percentage of care you have of a child.
These are 2 different percentage calculations. The percentage of time the child is in your care
may not be the same as the percentage of Family Tax Benefit you are paid.
Sharing the care with a current partner or child care provider is
not
shared care.
How is shared care assessed?
• If you and the child’s other parent, carer or guardian have an agreed percentage of care, or an
agreed care arrangement, the care percentage applied to your Family Tax Benefit is based on
your care agreement.
• If you
do not
have an agreed percentage of care, or an agreed care arrangement, we will
decide the care percentage to be applied to your Family Tax Benefit based on the evidence of
your care arrangements.
If you think the number of nights the child is in your care does not accurately reflect the amount
of time you have care, you can tell us the total number of days and hours you have care. This
gives the total time you have care in the care period.
You can use the care calendar to let us know how often you care for a child. We will use this to
work out your percentage of care to calculate Family Tax Benefit payments and child support if
you are unsure or unable to calculate it. For more information, go to
www.
servicesaustralia.gov.au/carecalendar
Note: For the purposes of Family Tax Benefit, a person with the overnight care of a child is
generally regarded as having had care of the child for that day.
Percentage of actual care
for the child
Percentage of Family Tax Benefit
you may receive
0% to less than 14%
0%
14% to less than 35%*
0%*
35% to less than 48%
25% plus 2% for each percentage point over 35%
48% to 52%
50%
More than 52% to 65%
51% plus 2% for each percentage point over 53%
More than 65% to 100%
100%
* If you have care of a child for 14% to less than 35% of the time, you will not be entitled to receive
Family Tax Benefit, but you may be entitled to receive additional family assistance (Rent Assistance, a
Health Care Card, the lower threshold of the Medicare Safety Net, Remote Area Allowance, Child Care
Subsidy). To be eligible for these benefits you will need to meet the other family assistance requirements
for that benefit. You can claim these benefits by logging into your Centrelink online account through
myGov or complete a
Claim for Parental Leave Pay and Family Tax Benefit (FA100)
form or go online
to make a claim for Child Care Subsidy. For more information, go to
www.
servicesaustralia.gov.au/childcaresubsidy
Continued
Family and
domestic violence
If you are affected by family and domestic violence, there is help available. Call
132 850
Monday to Friday, 8 am to 5 pm local time, and ask to speak to a social worker. Otherwise,
you can contact 1800RESPECT (
1800 737 732
), a 24 hour service. If you are in immediate
danger, call
000
. For more information, go to
www.
servicesaustralia.gov.au/domesticviolence
FA012.2407
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It is in your interest to confirm your care arrangements with the other parent, carer or guardian to
avoid any incorrect payments. If you share the care of your children with someone else, they may
be able to claim Family Tax Benefit.
If you have care of a child for more than 65% of the time, you may be entitled to all of the Family
Tax Benefit.
Example 1
Lewis lives with Maria, their mother. Lewis spends every second weekend from Friday night
until Monday morning and 10 weeks of school holidays with Danny, their father.
The number of nights per year that Lewis stays with their mother is 231 and stays with their
father for the remaining 134 nights.
Maria has care of Lewis for 64% of the year (that is, 231 nights divided by 365 nights x 100 = 63.28%,
because Maria’s percentage is over 50% their care is rounded up to 64%). Danny’s care is 36%
(134 nights divided by 365 nights x 100 = 36.71%, because Danny’s percentage is under 50%
their percentage is rounded down to 36%).
Example 2
Michael works night shift and cares for 3 year old child Erin for 6 hours per day Monday to
Thursday and 7 hours on Fridays. The rest of the time, Erin lives with Claire, their mother.
Michael cares for Erin 31 hours each week, or 1612 hours per year. By dividing 1612 hours by
24 hours, we can work out how many ‘days’ Michael cares for Erin – in this case, 67 days.
This is 18% of the year (that is, 67 days divided by 365 days x 100=18%). As this is less than
35%, Michael is not entitled to Family Tax Benefit, while Claire will receive 100%.
What is a care period?
A care period refers to the period that the care arrangements for a child will be in place.
It is used by us to calculate the correct rate of Family Tax Benefit for each child in your care.
A care period:
• begins on the day on which the care of a child starts to be shared between two or more
people, or the day on which the pattern of care changes
• ends when there is a subsequent change in care.
Written Agreements for care arrangements
Where both carers sign the
Details of your child’s care arrangements (FA012)
form and
agree that the care arrangements are ongoing/indefinite, this form can be considered a written
agreement. If this form is considered a written agreement and one carer departs from the care
arrangements without the agreement of the other carer, family assistance and child support may
be assessed based on this original written agreement for an interim period.
Children from a
previous relationship
Situations where you may have a child from a previous relationship include when you are either:
• a single parent
• partnered and your current partner is not the child’s parent
• partnered where you are not the child’s parent, but your partner is.
Your payments will be affected if you do not provide your child support details.
If any dependent child, in your care, is from a previous relationship, you must apply for a child
support assessment within 13 weeks (91 days) of the latest of the following dates:
• the date the child was born
• the date you separated from the child’s other parent
• the date the child came into your care
• the date your percentage of care increased to 35% or above
• such later date that you first became entitled to apply for child support.
FA012.2407
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Applying for a child
support assessment
To get more than the base rate of Family Tax Benefit Part A, you are required to apply for child
support from the other parent if you are not currently partnered to that person. The requirement
to apply for child support, also applies to your current partner if they have a child from a previous
relationship in their care.
For more information, go to
www.
servicesaustralia.gov.au/childsupport
Exemptions from
seeking child support
If you are unable to apply for a child support assessment, for any reason such as family domestic
violence or parentage unknown, you should discuss your situation with us. In some cases,
exemptions need to be assessed by a social worker.
If you have not already, you will need to provide your child’s birth certificate. You can call
136 150
Monday to Friday, 8 am and 5 pm local time, to discuss your situation and if required, you will be
referred to a social worker.
Family Relationship
Centres
Family Relationship Advice Line
— provide information, advice and dispute resolution to help
parents/carers focus on the needs of the children and develop workable arrangements for the
children without going to court.
Visit
www.
familyrelationships.gov.au
or call Freecall™
1800 050 321
Providing evidence to
support your claim
Evidence may be required to support your claim. We will need evidence for informal changes
in care.
Evidence of a formal care arrangement may include:
• a Family Law Order
• a Parenting Plan or Order. Parenting plans can be made without the involvement of a third party,
however assistance is available from Family Relationship Centres
• a Custody Order
• a Foster Care placement
• a Court Order for graduated return to care where a child is being integrated back into the family.
Evidence to support an informal care arrangement may include:
• playgroup, day care, kindergarten, preschool or school enrolment listing the emergency
contact or who registered the child
• proof of attendance or membership of organisations or activities indicating your caring
responsibilities
• receipts for expenses incurred while in your care
• proof of travel arrangements such as, airline bookings or passports showing travel dates
• social worker reports
• records from other government departments which may confirm patterns of care
• a diary or calendar to show when you care for the child.
Assistance with child
care fees
If you share the care of a child for at least 14% of the time who is attending approved child care
and you have liability for the fees, you may be eligible for Child Care Subsidy.
In order to receive Child Care Subsidy, each person liable for the fees needs to make a claim.
For more information, go to
www.
servicesaustralia.gov.au/childcaresubsidy
FA012.2407
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2
Your name
Family name
First given name
Second given name
3
Your date of birth (DD MM YYYY)
Your Customer Reference Number (if known)
1
4
Your permanent address
Postcode
5
Your postal address (if different to above)
Postcode
6
Read
this before answering the following question.
Provide at least one phone number we can contact you on
during business hours and an email address.
Providing a mobile phone number or an email address means
you may receive SMS or emails from us. To read the terms and
conditions, go to
www.
servicesaustralia.gov.au/em
Your contact details
Home phone number
(including area code)
Mobile phone number
Work phone number
(including area code)
You can fill this form digitally in some browsers, or you can open
it in Adobe Acrobat Reader. If you do not have Adobe Acrobat
Reader, you can print this form and complete it.
If you have a printed form:
• Use black or blue pen.
• Print in BLOCK LETTERS.
• Where you see a box like this
Go to 1
skip to the question
number shown.
Filling in this form
Other
Mr
Mrs
Ms
Mx
Miss
CLK0FA012 2407
Instructions
FA012.2407
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10
Your partner’s name
Family name
First given name
Second given name
11
Your partner’s date of birth (DD MM YYYY)
12
Your partner’s permanent address (if different to your address)
Postcode
13
Your partner’s contact details
7
8
For more information about relationship status, see ‘Having a
partner’ in the
Notes Booklet
.
If you have
ever been separated
, give the date that you most
recently got back together (reconciled) with your partner.
If none of the above describes your current relationship
status, call us on
136 150
.
Do you give permission for your partner to make enquiries with
us on your behalf?
You can change this authority at any time.
No
Yes
Tick
one
of the boxes below to tell us about your relationship
status right now.
Your partner’s Customer Reference Number (if known)
9
Married
Date married or last reconciled
with your partner (DD MM YYYY)
Go to 8
Registered relationship
(your relationship
is registered under
Australian state or
territory law)
Date registered or last reconciled
with your partner (DD MM YYYY)
Go to 8
De facto
(your relationship is
similar to a married
couple but you are
not married or in a
registered relationship)
Date you started your relationship
or last reconciled with your
partner (DD MM YYYY)
Go to 8
Separated
(previously in a
marriage, registered or
de facto relationship)
Date of last separation
(DD MM YYYY)
Go to 14
Divorced
Date of divorce (DD MM YYYY)
Go to 14
Widowed
(previously in a
marriage, registered or
de facto relationship)
Date of partner’s death
(DD MM YYYY)
Go to 14
Never married or lived
with a partner
Go to 14
Home phone number
(including area code)
Mobile phone number
Work phone number
(including area code)
Other
Mr
Mrs
Ms
Mx
Miss
FA012.2407
Child 1
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14
Give details of the dependent child(ren) in your care who spend time with someone other than your current partner.
On this form we have allowed space for two dependent children. If you share the care of more than 2 dependent children, or if any
of your dependent children spend time with more than one other parent, carer or guardian, copy and provide pages 7 and 8 for
each additional child before completing the details for child 1 and 2.
15
Child’s family name
Child’s given name(s)
16
Child’s date of birth (DD MM YYYY)
17
Your
relationship to this child
The term ‘parent’ refers to a natural, adoptive or relationship
parent (a person who is legally responsible for a child
born through an artificial conception procedure or where a
surrogacy court order is in place).
Parent
Adoptive parent
Grandparent
Step-parent
Foster carer
Other
Give details below
18
Your partner’s
(if you have one) relationship to this child
Parent
Adoptive parent
Grandparent
Step-parent
Foster carer
Other
Give details below
19
Are you (and/or your partner) currently receiving fortnightly
payments, including receiving a zero rate of Family Tax
Benefit or receiving Child Care Subsidy for this child?
No
Go to next question
Go to 21
Yes
20
Do you want to test your eligibility for Family Tax Benefit or
Child Care Subsidy for this child?
No
Yes
Go to next question
Continue to complete and return this form.
If you are
not
currently receiving Family Tax
Benefit or Child Care Subsidy for any child(ren),
and wish to make a claim for this child, log into
your Centrelink online account through myGov,
then select
Make a Claim
.
Go to next question
21
Read
this before answering the following questions.
Date the current care arrangement started
Date these arrangements are expected to end or change
(if applicable)
For shared care purposes, your percentage of
care will be assessed over a 12 month period
from the date the care commenced. This is
called a care period and the percentage will be
maintained for subsequent years unless you
advise us of a change.
For information about care periods, see ‘What is
a care period?’ on page 3.
You will need to contact us to update your care
arrangements when these arrangements end or change.
If you agree the care arrangements are indefinite/ongoing
and this form is signed by both carers, this form may be
considered a written agreement.
For more information about care arrangements, see
‘Written Agreements for care arrangements’ on page 3.
No
Go to next question
Yes
22
Your care arrangement
Are your care arrangements indefinite/ongoing?
23
Do you have a parenting plan, court order or written
agreement that shows where this child stays?
No
Go to 25
Yes
Provide a copy of the parenting plan, court
order or written agreement.
(DD MM YYYY)
(DD MM YYYY)
FA012.2407
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Child 1
25
Does this child spend time with someone other than you
(and/or your current partner) such as one of their parents
(for example, weekends, school holidays)?
To be paid Family Tax Benefit, you must have care of this
child for at least 35% of the time.
To receive Child Care Subsidy you must have care of this
child for at least 14% of the time and be liable for the fees.
For more information, see ‘Information about shared care’
on pages 2–3.
No
Go to 32
Who does this child stay with when not with you?
Yes
Name
Postcode
Address
Phone number (including area code)
26
Do you know what percentage of care you will have for the
care period stated in question 22?
Refer to ‘Information about shared care’ on pages 2–3,
for how to calculate percentages.
No
Go to 29
Go to next question
Yes
What percentage of care will you have during the care period
stated in question 22?
27
%
How long will this child be with the other parent, carer or
guardian for the care period stated in question 22?
30
Provide the total time in nights, weeks or hours.
Only write one total time.
Total number
of nights
Total number
of weeks
Total number
of hours
or
or
You can provide further information about the care
arrangements for this child.
31
For example, this child is in care with the other parent on
alternate weekends from Friday 4:30 pm to Sunday 5 pm
or
half of the Christmas school holidays.
Do you have another child in your care who spends time with
someone other than your current partner?
32
No
Yes
Go to 33 on page 11
If you are providing details for more than 2
children, (if you have not already photocopied
pages 7 and 8) photocopy and provide pages
9 and 10 for each additional child before
completing the details for child 2.
Go to next question on the next page
What percentage of care will the other parent, carer or guardian
of this child have during the care period stated in question 22?
28
%
Go to 32
How long will this child be with you for the care period stated
in question 22?
29
Provide the total time in nights, weeks or hours.
Only write one total time.
Total number
of nights
Total number
of weeks
Total number
of hours
or
or
24
Are the arrangements in the parenting plan, court order or
written agreement being followed?
No
Go to next question
Go to 32
Yes
FA012.2407
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Child 2
15
Child’s family name
Child’s given name(s)
16
Child’s date of birth (DD MM YYYY)
17
Your
relationship to this child
The term ‘parent’ refers to a natural, adoptive or relationship
parent (a person who is legally responsible for a child
born through an artificial conception procedure or where a
surrogacy court order is in place).
Parent
Adoptive parent
Grandparent
Step-parent
Foster carer
Other
Give details below
18
Your partner’s
(if you have one) relationship to this child
Parent
Adoptive parent
Grandparent
Step-parent
Foster carer
Other
Give details below
19
Are you (and/or your partner) currently receiving fortnightly
payments, including receiving a zero rate of Family Tax
Benefit or receiving Child Care Subsidy for this child?
No
Go to next question
Go to 21
Yes
20
Do you want to test your eligibility for Family Tax Benefit or
Child Care Subsidy for this child?
No
Yes
Go to next question
Continue to complete and return this form.
If you are
not
currently receiving Family Tax
Benefit or Child Care Subsidy for any child(ren),
and wish to make a claim for this child, log into
your Centrelink online account through myGov,
then select
Make a Claim
.
Go to next question
23
Do you have a parenting plan, court order or written
agreement that shows where this child stays?
No
Go to 25
Yes
Provide a copy of the parenting plan, court
order or written agreement.
21
Read
this before answering the following questions.
Date the current care arrangement started
Date these arrangements are expected to end or change
(if applicable)
For shared care purposes, your percentage of
care will be assessed over a 12 month period
from the date the care commenced. This is
called a care period and the percentage will be
maintained for subsequent years unless you
advise us of a change.
For information about care periods, see ‘What is
a care period?’ on page 3.
You will need to contact us to update your care
arrangements when these arrangements end or change.
If you agree the care arrangements are indefinite/ongoing
and this form is signed by both carers, this form may be
considered a written agreement.
For more information about care arrangements, see
‘Written Agreements for care arrangements’ on page 3.
No
Go to next question
Yes
22
Your care arrangement
Are your care arrangements indefinite/ongoing?
(DD MM YYYY)
(DD MM YYYY)
FA012.2407
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Child 2
25
Does this child spend time with someone other than you
(and/or your current partner) such as one of their parents
(for example, weekends, school holidays)?
To be paid Family Tax Benefit, you must have care of this
child for at least 35% of the time.
To receive Child Care Subsidy you must have care of this
child for at least 14% of the time and be liable for the fees.
For more information, see ‘Information about shared care’
on pages 2–3.
No
Go to 32
Who does this child stay with when not with you?
Yes
Name
Postcode
Address
Phone number (including area code)
26
Do you know what percentage of care you will have for the
care period stated in question 22?
Refer to ‘Information about shared care’ on pages 2–3,
for how to calculate percentages.
No
Go to 29
Go to next question
Yes
What percentage of care will you have during the care period
stated in question 22?
27
%
What percentage of care will the other parent, carer or guardian
of this child have during the care period stated in question 22?
28
%
Go to 32
How long will this child be with you for the care period stated
in question 22?
29
Provide the total time in nights, weeks or hours.
Only write one total time.
Total number
of nights
Total number
of weeks
Total number
of hours
or
or
How long will this child be with the other parent, carer or
guardian for the care period stated in question 22?
30
Provide the total time in nights, weeks or hours.
Only write one total time.
Total number
of nights
Total number
of weeks
Total number
of hours
or
or
You can provide further information about the care
arrangements for this child.
31
For example, this child is in care with the other parent on
alternate weekends from Friday 4:30 pm to Sunday 5 pm
or
half of the Christmas school holidays.
Do you have another child in your care who spends time with
someone other than your current partner?
32
No
Yes
Go to next question
Provide details of each additional child.
Go to next question
24
Are the arrangements in the parenting plan, court order or
written agreement being followed?
No
Go to next question
Go to 32
Yes
FA012.2407
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33
Are the care arrangements stated in this form agreed between
all parties providing care for the children?
No
Yes
We may contact the other parent, carer or guardian
to confirm the care arrangements.
If you have concerns about us contacting the other
parent, carer or guardian, give details below.
The other parent, carer or guardian should sign the
declaration at the end of this form.
If you have concerns about the other parent, carer
or guardian signing their declaration, give details
below.
34
Use this space to tell us:
• anything else about your care arrangements, or
• any concerns you may have (for example, contacting the
other parent, carer or guardian).
35
You need to read this
Privacy notice
Privacy and your personal information
The privacy and security of your personal information
is important to us, and is protected by law. We collect
this information so we can process and manage your
applications and payments, and provide services to you.
We only share your information with other parties where you
have agreed, or where the law allows or requires it. For more
information, go to
www.
servicesaustralia.gov.au/privacypolicy
36
Your declaration
We may contact the other parent, carer or guardian to
confirm the care arrangements.
I declare that:
• the information I have provided in this form is complete and
correct.
I understand that:
• once signed by myself and the other carer, confirming
the care arrangements are indefinite/ongoing, this will be
considered a written agreement for family assistance and
child support purposes. This means that if one carer departs
from the care arrangements stated on this form without the
agreement of the other carer, family assistance entitlements
and child support may continue to be assessed based on the
care arrangements stated on this form for an interim period.
• any money I owe will need to be paid back.
• if I owe money to Services Australia, some or all of the
amount owed may be recovered from my tax refund and/or
my Centrelink payments including Family Tax Benefit
arrears, lump sum, top up and end of year supplement
payments even if I am making regular repayments.
• my Family Tax Benefit top up payments and end of year
supplement payments can also be used to offset a tax debt.
• Services Australia can make relevant enquiries to make sure
I receive my correct entitlement.
• giving false or misleading information is a serious offence.
Your signature
Date (DD MM YYYY)
What to do now
If you and the other carer agree on the care advised in this
form, you can have the other carer sign the form at question 37
on page 12.
When all details have been completed on this form, see
page
1
about ‘Returning this form’.
On completion of this form,
print and sign by hand
FA012.2407
12 of 12
37
Other carer’s declaration
• This declaration should be signed by the other parent,
carer or guardian if you answered ‘Yes’ to question 33.
• If this declaration is not signed by the other parent, carer
or guardian, it will not affect your payment.
• If one carer departs from the care arrangements stated on
this form without the agreement of the other carer, family
assistance entitlements and child support may continue
to be assessed based on the care arrangements stated on
this form until the dispute is resolved.
Other carer’s name
I understand that:
• once this form is signed by myself and the other carer, this
will be considered a written agreement for family assistance
and child support purposes. This means that if one carer
departs from the care arrangements stated on this form
without the agreement of the other carer, family assistance
entitlements and child support may continue to be assessed
based on the care arrangements stated on this form until
the dispute is resolved.
I agree with
:
• the care arrangements stated on this form.
Other carer’s signature
Give your best office hours contact phone number, so we can
verify your agreement to the care arrangements
(including area code)
Date (DD MM YYYY)
On completion of this form,
print and sign by hand
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