Fillable Child Support Application to assess child support by (Inland Revenue Department New Zealand)

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Child Support Application to assess child support by (Inland Revenue Department New Zealand)

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  • 265 other fields

Country of origin: NEW-ZEALAND
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Tell us about yourself (ll in as much as you can)
1
Your IRD number
(8 digit numbers start in the second box.
)
2
Your name (Tick one)
Mr Mrs Miss Ms
Date of birth
Day Month Year
First name(s) Surname
If you are known by or have ever used any other names please give the details.
First name(s) Surname
3
If you want the parents to know you by another name, please enter it here. Read the note about "Alias names".
First name(s) Surname
4
Are there any safety reasons why you don't want the parents to know your name? Yes No
(Please note: We don't give the parents your contact details.)
If you answered "yes" we may be able to take your name off correspondence sent to the parents. If you have documents supporting
your safety reasons, attach a copy to this form. If we need more information we'll contact you. Please make sure we have your
correct contact details. Read the notes "Safety concerns about your name."
5
Your home address
Street address Suburb
Town or city Postcode Country
6
Your postal address
(if different from above)
Street address or PO Box Suburb
Town or city Postcode Country
Please tick if you prefer your child support mail to be sent to your postal address
7
Your contact details
(
) (
) (
)
Day Evening Mobile
Email
Child Support www.ird.govt.nz/childsupport
Page 1
Application to assess child support by a non-parent carer
IR954
April 2017
Child Support
Complete this form if you want to
apply for child support for children in
your care that you are not a parent of.
You must have at least 35% care to
apply.
If you receive an unsupported child's benefit for
these children, you must apply for child support.
If the care of the
child is shared
with someone
else, use our
online calculator
to see if you meet the criteria
for recognised care.
Read the
notes pages
to help you
understand
this form.
More information
about child
support can be
found on our
website
www.ird.govt.nz/childsupport
8
Your bank account
Account name
Bank Branch Account number Suffix
9
Do you receive, or have you applied to receive, a benet? Ye s No
Work and Income number (if known)
Tell us about the child's parents (ll in as much information as you know)
Non-parent carers must apply for child support from both parents.
Parent 1
10
Their IRD number Their date of birth Age (if date of birth not known)
Day Month Year
11
Their name (Tick one)
Mr Mrs Miss Ms
First name(s) Surname
12
Are they known by another name? Give the name they use now or have used in the past.
First name(s) Surname
13
Are they a New Zealand citizen? Ye s No Don't know
Do they live overseas? Ye s No Don't know
Did they leave New Zealand in the last 12 months (excluding short-term holidays)? Ye s No
Don't know
14
Their home address
Street address Suburb
Town or city Postcode Country
15
Their postal address
(if different from above)
Street address or PO Box Suburb
Town or city Postcode Country
16
Their contact details
(
) (
) (
)
Day Evening Mobile
Email
17
Income
Does this parent receive a benet? Ye s No Don't know
If "yes", please specify benet type. Work and Income number (if known)
Child Support www.ird.govt.nz/childsupport
Page 2
Does this parent have a job
(including any self-employed
work)?
Ye s No Don't know
If "yes", write who they work for here
( )
Work name Phone
Work address
Town or city Postcode Country
Parent 2
18
If you do not know the name of the other parent, please tick here and go to Question 27
If you cannot name a second parent
There are times when it is not appropriate to assess the other parent, or we cannot assess them (eg, they are deceased).
Read the notes pages to nd out more information about when we can complete a one-parent assessment. If you think you
meet our criteria for a one-parent assessment, please give the reason in the space below. We may contact you if we need
more information.
You will still need to complete the rest of the questions about this parent. For deceased parents we only require their name.
19
Their IRD number Their date of birth Age (if date of birth not known)
Day Month Year
20
Their name (Tick one)
Mr Mrs Miss Ms
First name(s) Surname
21
Are they known by another name? Give the name they use now or have used in the past.
First name(s) Surname
22
Are they a New Zealand citizen? Ye s No Don't know
Do they live overseas? Ye s No Don't know
Did they leave New Zealand in the last 12 months (excluding short-term holidays)? Ye s No Don't know
23
Their home address
Street address Suburb
Town or city Postcode Country
24
Their postal address
(if different from above)
Street address or PO Box Suburb
Town or city Postcode Country
25
Their contact details
(
) (
) (
)
Day Evening Mobile
Email
Child Support www.ird.govt.nz/childsupport
Page 3
26
Income
Does this parent receive a benet? Ye s No Don't know
If "yes", please specify benet type Work and Income number (if known)
Does this parent have a job
(including any self-employed
work)?
Ye s No Don't know
If "yes", write who they work for here
( )
Work name Phone
Work address
Town or city Postcode Country
Payment waiver
27
If you're not receiving an unsupported child's benet for the child you are applying for, or a sole parent benet, and you have
applied against both of the child's parents, you can ask us not to collect the payments from one of these parents. This does not
apply if an assessment is only against one of the parents. Read the notes pages for more information about payment waivers.
Which parent do you want to waive payment from? Parent 1 or Parent 2
The waiver will start from: the date we receive this form another date (specify below)
Day Month Year
Name the children you do not want to receive child support for from this parent. Note that this includes any payments that may
already be owed to you by the liable parent for the children you have named.
Tell us about the children (ll in as much as you know)
All children must have an IRD number. If they don't have one, read the notes pages to nd out how to get one.
Recognised care
We need to know if someone else cares for the child/children two nights per week (on average). Read the "Recognised care"
notes pages for more information.
Qualifying children (These are the children you want child support assessed for)
Read the notes pages to nd out about children who qualify for child support, and what we accept as proof of parentage and
date of birth.
28
Child 1
First name(s)
Surname
Date of birth IRD number
Day Month Year
Was this child born while the parents were married to each other? Ye s No
If the father is not named on the birth certicate, is paternity action
being taken?
Ye s No
What date did the child come into your care? From birth or from
Day Month Year
Do you receive an unsupported child's benet for this child? Ye s No
Is there a court order or agreement in place for the care of this child? Yes (attach copy) No
Do you provide more than ve nights per week (on average) of this
child's care?
Yes - go to next
child
No - continue
Child Support www.ird.govt.nz/childsupport
Page 4
Your amount of care
Number of nights How often? Weekly Fortnightly Monthly Yearly
Full name of other carer
First name(s)
Surname
Other carer's amount of care
Number of nights How often? Weekly Fortnightly Monthly Yearly
Note: If your or the other carer's pattern of care for any child named in this form is not covered by the options above, please
provide the care details at Question 31 on page 6. Be sure to include the same details as shown here. If there are additional
carers for any child, please provide their details on a separate piece of paper and attach it to this form. Be sure to include the
same details as shown here, and include your name and IRD number at the top of the page.
29
Child 2
First name(s)
Surname
Date of birth IRD number
Day Month Year
Was this child born while the parents were married to each other? Ye s No
If the father is not named on the birth certicate, is paternity action
being taken?
Ye s No
What date did the child come into your care? From birth or from
Day Month Year
Do you receive an unsupported child's benet for this child? Ye s No
Is there a court order or agreement in place for the care of this child? Yes (attach copy) No
Do you provide more than ve nights per week (on average) of this
child's care?
Yes - go to next
child
No - continue
Tick here if the care details for this child are the same as for the rst child. If the care details for this child are
different, enter them in the elds below before going to the next question.
Your amount of care
Number of nights How often? Weekly Fortnightly Monthly Yearly
Full name of other carer
First name(s)
Surname
Other carer's amount of care
Number of nights How often? Weekly Fortnightly Monthly Yearly
30
Child 3
First name(s)
Surname
Date of birth IRD number
Day Month Year
Was this child born while the parents were married to each other? Ye s No
If the father is not named on the birth certicate, is paternity action
being taken?
Ye s No
What date did the child come into your care? From birth or from
Day Month Year
Do you receive an unsupported child's benet for this child? Ye s No
Is there a court order or agreement in place for the care of this child? Yes (attach copy) No
Child Support www.ird.govt.nz/childsupport
Page 5
Do you provide more than ve nights per week (on average) of this
child's care?
Yes - go to
Question 32
No - continue
Tick here if the care details for this child are the same as for the rst child. If the care details for this child are
different, enter them in the elds below before going to the next question.
Your amount of care
Number of nights How often? Weekly Fortnightly Monthly Yearly
Full name of other carer
First name(s)
Surname
Other carer's amount of care
Number of nights How often? Weekly Fortnightly Monthly Yearly
Note: If you need to tell us about more qualifying children, include their details on a separate piece of paper, giving the same
details as for the children above, and attach it to this form. Please include your name and IRD number at the top of the page.
31
Please list any additional information that may help us work out recognised care levels, for example, if the arrangements are
different for school holidays.
32
Please complete this question for children named in this application who are 18 or turn 18 within the next two months
of lling out this form.
Child’s full name
Is the child enrolled at and attending a registered
school in New Zealand or an overseas school?
Ye s No
Ye s No
Ye s No
Child support from the Australian Department of Human Services
33
Is anyone currently living in Australia claiming child support from the Australian
Department of Human Services for the same children?
Yes - read the notes pages No
Declaration
To the best of my knowledge, the information I have provided on this form is true and correct.
By signing this declaration, I:
• understand Inland Revenue will complete a calculation using the formula and let me know what I am entitled to receive in
child support
• agree to advise Inland Revenue of any changes that could affect my child support (eg, if the children leave my care)
• understand that any changes in the parents’ circumstances or changes in the care of the children could affect the amount
of child support I am entitled to.
Signature
Date
Please send this completed form to: Child Support, PO Box 39010, Wellington Mail Centre, Lower Hutt 5045
Work and Income use only
1. Has the receiving carer indicator SDT1A or SDT2A been set to “Y”? Ye s No
2. Benet start date
Day Month Year
3. Benet rate - weekly
4. Benet type (code)
Child Support www.ird.govt.nz/childsupport
Page 6
RESET FORMRESET FORM
What happens next?
This form is a request for an assessment of child support. Once we have completed the child support calculation we'll notify you of
any amount you are entitled to receive.
Please note that if you are receiving an unsupported child's benet for any of the children, your payments will go to the government
to help cover the cost of the benet.
Privacy
Meeting your child support obligations means giving us accurate information so we can assess your liabilities and entitlements
under the Child Support Act 1991.
We may also exchange information about you with:
• some government agencies
• another country, if we have an information supply agreement with them
• Statistics New Zealand (for statistical purposes only).
If you ask for the personal information we hold about you, we’ll give it to you and correct any errors, unless we have a lawful
reason not to. Call us on 0800 775 247 for more information. For full details of our privacy policy go to www.ird.govt.nz (search
keyword: privacy).
Notes to help you complete this form
Who is a parent?
A parent is a person who:
• is the birth or legally adoptive parent of a child
• was married to the other parent when the child was conceived or born
• has acknowledged before a court, or in writing, that they are a parent of the child and a court has not overturned this
• has been declared a legal step-parent by the Family Court
• a court has made a paternity order against in respect of the child.
When can Inland Revenue make a one-parent assessment?
There are times when it is appropriate to complete a child support assessment against only one parent, for example:
• a parent is deceased
• a parent is unknown
• a parent is not a New Zealand citizen or ordinarily resident in New Zealand
• there are safety concerns for the child, or any carer of the child.
Alias names
You can ask to use an alias name when you need to protect your privacy. We won’t accept a nickname.
Safety concerns about your name
If you believe that using your real name will cause safety concerns for you, a carer, or your child, we may be able to leave your
name out when communicating with the other parent.
To support your safety reasons remember to attach any relevant documents to this form. For example a court order, police report,
a letter from a social worker or Work & Income, or a letter from your doctor.
Proof of date of birth
You will need to supply one of the following for proof of date of birth:
• full New Zealand birth certicate
• overseas birth certicate
• passport
• certicate of New Zealand citizenship
• certicate of identity
• photo driver's licence
• 18+ card issued by the Hospitality Association.
Proof of parentage
You will need to supply one of the following for proof of parentage:
• the child's full New Zealand birth certicate
• the child's full overseas birth certicate (with a certied English translation if necessary)
• adoption order for the child
• a paternity order for the child made by a New Zealand or overseas court
• a completed Acknowledgement of paternity for child support (IR106) form*
• a document signed by the parent acknowledging they are the child's parent*
• a copy of the Family Court’s declaration of step-parentage.
Child Support www.ird.govt.nz/childsupport
Notes
*These documents can't be used to prove the child's date of birth. You must also send in a copy of one of the documents in the list under "Proof of
date of birth."
If the child's parents were married when the child was conceived or born then we do not require further proof of parentage.
However we do still require proof of the child's date of birth.
If there is no proof of parentage, we may tell the person that this application has been made naming them as a parent of
the child/children.
Recognised care
The child support formula recognises the costs of raising a child and shares these costs between the parents based on their
income and care. Care is recognised in the following situations:
• If a person provides more than 263 nights per year, or 5 nights a week on average (72% of the time) of a child's care, theirs is the
only care we take into account in the child support formula calculation.
• If a parent cares for the child at least 103 nights per year, or 2 nights per week (28% of the time) that care is taken into account in
the child support formula calculation.
• A non-parent carer eg, a grandparent, has care of a child for at least 128 night per year, or 5 nights per fortnight (35% of the
time).
Agreement or court order
If you have an agreement or court order detailing the care arrangements for the child/children, we can use this to work out your
recognised care level.
Qualifying children
To qualify for child support, a child must be:
• under 18 years of age or 18 years of age and enrolled at and attending a registered school in New Zealand or an overseas
school, and
• a New Zealand citizen or ordinarily resident in New Zealand.
The child cannot be:
• receiving a benet or student allowance, or working 30 hours or more a week (on average), or
• living with another person in a marriage, civil union or de facto relationship.
Paternity orders
If the father isn't currently named on the child's birth certicate a paternity order may be sought. If you are aware of a paternity
order being made, please send it to us: we may be able to start child support from when this application is received.
If you need more information about paternity orders, please go to the Ministry of Justice website www.justice.govt.nz (search
keyword: paternity).
IRD numbers for children
If your child doesn’t have an IRD number then you’ll need to apply for one before your child support application can be accepted.
You can do this by completing an IRD number application - resident individual (IR595) form.
However, if your child wasn’t born in New Zealand, doesn’t have an IRD number and isn’t a resident of New Zealand, you don’t
need to apply for or provide an IRD number.
Payment waiver
Non-parent carers can choose not to receive child support from one of the parents if the non-parent carer is not receiving an
unsupported child's benet for the child or a sole parent benet. We must still complete an assessment for that parent but we will
tell them they are not required to make payments. Please note that if you choose to waive payment from a parent this will include
any payments already owed to you by the parent for the children you wish to waive payment for.
A non-parent carer can cancel the waiver at any time by sending us a completed Payment Waivers (IR959) form. Payment waivers
will be cancelled if the non-parent carer starts to receive an unsupported child's benet for the child or a sole parent benet.
Cancelling a waiver means that the parent will be required to pay the child support assessed from the date the cancellation of the
waiver applies.
Child support from the Australian Department of Human Services
We have a reciprocal agreement with Australia for the assessment and collection of child support payments. The agreement allows
both countries to enforce payments of child support owing in the other country, where payments are not being made.
Only the country where the carer lives can make an assessment. If you have an assessment made in Australia but now live in
NewZealand, contact the Australian Department of Human Services (DHS) on 0800 440 953 to let them know.
If you are a carer living in Australia you must apply for child support through the Australian DHS. Call us on 1800 504 042 if you
need any help.
For more information about any of the above, please go to our website www.ird.govt.nz/childsupport
Child Support www.ird.govt.nz/childsupport
Notes
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Child Support Application to assess child support by (Inland Revenue Department New Zealand)

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Completed 30 March 2021

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