Fill - Free fillable declaration Medicare levy variation (Australian Taxation Office) PDF form

Instructions and form for taxpayers

NAT 0929-06.2019

Medicare levy variation

declaration

Who should use this

declaration?

You should complete this declaration if you want to:

 increase the amount withheld from payments to you to cover

your Medicare levy surcharge

 claim an exemption from the Medicare levy

 reduce the pay as you go (PAYG) amount withheld that

covers Medicare levy from payments to you

 claim an exemption from compulsory Higher Education

Loan Program (HELP), VET Student Loan (VSL),

FinancialSupplement (FS), Student Start-up Loan (SSL)

orTrade Support Loan (TSL) repayments.

These instructions are current to 30 June 2020.

Youmustlodge a new declaration if either:

 you leave your current job and start work for

someoneelse

 your circumstances change.

If you give the wrong information, you may have a tax

debtat the end of the income year.

Claiming an exemption or

varying the amount withheld

Complete this declaration to claim an exemption from the

Medicare levy or to vary the amount withheld for the levy if

oneof the following applies:

 you are in one of the Medicare levy exemption categories

 the combined weekly income of you and your spouse is less

than $891 or, if you maintain a child or student, less than the

relevant amount shown in Table A on page 2

 you are a sole parent with a weekly income of less than $973

or, if you maintain more than one child or student, less than

the relevant amount shown in Table A on page 2

 you have to pay the Medicare levy surcharge and want

toincrease the amount withheld from payments to you to

cover the surcharge (for more information, see question 4

onpage 3).

Also complete this declaration if you want to claim an

exemption from HELP, VSL, FS, SSL or TSL repayments for a

year because you are entitled to a reductionofthe Medicare

levy or you do not have to pay theMedicare levy, due to having

a spouse or dependants andlow family income.

Introduction

Most people in Australia have the Medicare levy automatically

withheld from their wages. However, some people:

 may qualify for an exemption from the levy

 can pay a reduced levy

 may have to pay the Medicare levy surcharge.

Refer to table A to check if your weekly income qualifies

youtoeither:

 be exempt from the Medicare levy

 vary the amount withheld for the levy.

Table A: Weekly income

Number of dependent

children

Weekly income

($)

0 891

1 973

2 1,055

3 1,137

4 1,219

5 1,300

6 1,382

7 1,464

8 1,546

9 1,628

10 1,710

How to complete this form

Section A: Payee’s declaration

Question 1

What is your tax file number (TFN)?

We and your payer are authorised by the Taxation

Administration Act 1953 to request your tax file number (TFN).

Itis not an offence not to quote yourTFN. However, quoting

your TFN reduces the risk of administrative errors and having

extra tax withheld. Your payer is required to withhold the top

rate of tax from all payments made to you if you do not provide

your TFN or claim an exemption from quoting your TFN.

How do you find your TFN?

You can find your TFN on any of the following:

 your income tax notice of assessment

 correspondence we send you

 a payment summary your payer issues to you.

If you have a tax agent, they may also be able to give you

yourTFN.

If you still can’t find your TFN, you can:

 phone us on 13 28 61 between 8.00am and 6.00pm,

Monday to Friday

 visit your nearest shopfront (phone us on 13 28 61 to make

an appointment)

 complete a Tax file number – application or enquiry for

individuals (NAT 1432).

If you phone or visit us, we need to know we are talking to

the correct person before discussing your tax affairs. We will

ask you for details only you, or your authorised representative,

would know.

Find out more

Refer to Tax file number on our website at ato.gov.au

Questions 2 and 3

Complete with your personal information.

2 Medicare levy variation declaration

Question 4

Do you want your payer to increase the

amounts withheld from you to cover the

Medicare levy surcharge?

You are liable for the Medicare levy surcharge if you meet all of

the following conditions:

 you and your dependants (including your spouse) are not

in any of the three Medicare levy exemption categories on

page4

 you do not have private patient hospital cover for yourself,

your spouse and all your dependent children

 you are either 

– single, have no dependants and your income for surcharge

purposes is more than $90,000

– a member of a family that has a combined income for

surcharge purposes of $180,000 or more. If you have

more than one child, add $1,500 for the second and

subsequent children.

The Medicare levy surcharge is income tested against the

following income tier thresholds:

Income tier thresholds

  Tier 1 Tier 2 Tier 3

Single $90,000

or less

$90,001

–

$105,000

$105,001

–

$140,000

$140,001

or more

Families $180,000

or less

$180,001

–

$210,000

$210,001

–

$280,000

$280,001

or more

Rate 0% 1% 1.25% 1.5%

For the definition of Medicare levy – income for

surchargepurposes, see ‘Definitions’ on page 6.

For more information, refer to Income for Medicare levy

surchargepurposes available on our website

at ato.gov.au/incometests

If you and your spouse’s combined income for surcharge

purposes exceeded the family surcharge threshold described

above, but your own income for surcharge purposes did not

exceed $21,980, you are not liable for the surcharge for any

part of the year. However, your spouse may still be liable for

thesurcharge.

If you take out private patient hospital cover during the year, or

cancel your cover, you may be liable for the surcharge for the

part of the year when you and all your dependants (including

your spouse) were not covered.

Questions 5, 6, 7 and 8

Claiming a Medicare levy exemption or

reduction

Do you have more than one job?

If you are entitled to an exemption and have more than

one job, you must lodge this declaration only with the

payers you are claiming the tax-free threshold from.

If you receive income from more than one source, contact

us to arrange for a reduced amount to be withheld from

your income from other sources.

Full exemption

You are entitled to a full Medicare levy exemption if any of the

following apply:

 you and all your dependants are in one of the Medicare levy

exemption categories

 you are in exemption category 1 and your dependants had to

pay the Medicare levy (for example, your only dependant is

your spouse who is not in an exemption category but has to

pay the Medicare levy)

 you are in exemption category 1 and have a dependent child

who is not in an exemption category but the child is also a

dependant of your spouse, who has to pay the Medicare

levy.

If you are entitled to a full exemption, answer yes at questions 5

and 6 to claim the exemption.

Half exemption

You are exempt from half the Medicare levy if you are in

exemption category 1 and have dependants who are not in an

exemption category and do not have to pay the Medicare levy

(for example, they are low income earners).

If you are entitled to a half exemption, answer yes at

question5, no at question 6, and yes at question 7.

Medicare levy variation declaration 3

Medicare levy exemption categories

You are in an exemption category if you are one of the

following:

 a blind pensioner or you receive the sickness allowance

fromthe Department of Human Services – category 1

 entitled to full free medical treatment for all conditions under

Defence Force arrangements or Veterans’ Affairs Repatriation

Health Card (Gold Card) or repatriation arrangements –

category 1

 not an Australian resident for tax purposes – category 2

 a member of a diplomatic mission or consular post in

Australia (or a member of such a person’s family and you

were living with them) and you are not an Australian citizen

and you do not ordinarily live in Australia – category 3

 have a certificate from the Medicare Levy Exemption

Certification Unit of the Department of Human Services

showing that you are not entitled to Medicare benefits.

A letter from the Department of Human Services is not

sufficient – category 3.

For more information about how to apply for an

exemptionstatement:

 phone the Department of Human Services on

1300300271

 visit the Department of Human Services website at

humanservices.gov.au

Reduction based on family income

If you are not in an exemption category, you may be able to

claim a reduction based on your family income. To be eligible,

you must be in one of the following categories:

 you had a spouse on the last day of the financial year

 your spouse died during the year and you did not have

another spouse before the end of the year

 you were a sole parent at some time during the year (that is,

you had sole care of any dependent children or students).

This includes any child for whom you had sole care, not just

your own child.

If you are eligible, one of the following must also apply:

 you are a sole parent with a gross weekly income of less than

$973 or, if you have more dependants, less than the relevant

amount shown in table A on page 2

 you have a spouse and your combined gross weekly income

is less than $891 or, if you have one or more dependants,

less than the relevant amount shown in table A on page 2.

For example, the relevant income amount for both parents with

two dependent children is $1,055 a week. If your combined

weekly income is less than this amount, you should answer

yesat question 8.

If you are entitled to a reduction, answer yes at question 8.

4 Medicare levy variation declaration

Questions 9 and 10

Complete with your personal information.

Question 11

Do you have a Higher Education Loan Program

(HELP), VET Student Loan (VSL), Financial

Supplement (FS), Student Start-up Loan (SSL)

or Trade Support Loan (TSL) debt?

Answer yes if you have a HELP, VSL, FS, SSL or TSL debt.

Answer no if you do not have a HELP, VSL, FS, SSL or TSL

debt, or you have repaid your debt in full.

You have a HELP debt if either:

 the Australian Government lends you money under

HECS-HELP, FEE-HELP, OS-HELP, VET FEE-HELP,

VET Student loans prior to 1 July 2019 orSA-HELP

 you have a debt from the previous Higher Education

Contribution Scheme (HECS).

You have a SSL debt if you have an ABSTUDY SSL debt.

You have a separate VSL debt that is not part of your

HELP debt if you incurred it from 1 July 2019.

Find out more

Information about HELP, VSL, FS, SSL, or TSL debts:

 visit ato.gov.au/getloaninfo

 phone us on 13 28 61 between 8.00am and 6.00pm,

Monday to Friday.

Question 12

Do you have dependent children?

Answer yes if you have dependent children and write the

number of children at this question.

For a definition of dependent children for Medicare levy family

income reduction purposes, see ‘Definitions’ on page 6.

Declaration

Make sure that you have signed and dated the declaration.

Give your completed declaration form to your payer.

Section B: Payer’s declaration

This section is to be completed by the payer. The following

information will help you comply with your PAYG withholding

obligations.

Payer obligations

If you withhold amounts from payments, or are likely to withhold

amounts, your payee may give you this form with section A

completed. A Medicare levy variation declaration applies to

payments made after the declaration is provided to you. The

information provided on this form is used to work out the

amount of tax to be withheld from payments based on the

PAYG withholding tax tables we publish. If your payee gives

youanother declaration, it overrides any previous one.

Medicare levy variation declaration 5

Definitions

Child

A child includes:

 your child

 your adopted child, stepchild or ex-nuptial child

 a child of your spouse

 someone who is a child of yours within the meaning of

theFamily Law Act1975.

Dependant

There are three different categories of dependants:

1 a dependant for Medicare levy surcharge purposes

2 a dependant for Medicare levy or half levy exemption

purposes

3 a dependent child for Medicare levy family income

reductionpurposes.

Dependant for Medicare levy

surchargepurposes

A dependant for Medicare levy surcharge purposes is a person

wholly or partly maintained by you who is:

 your spouse (of any sex)

 a child aged under 21 years

 a child aged 21 years to under 25 years who is a full-time

student at a school, college or university.

Dependant for Medicare levy or half levy

exemption purposes

A dependant for Medicare levy exemption purposes means a

person who is:

 a spouse (of any sex)

 a child aged under 21 years

 a child aged 21 years to under 25 years who is a full-time

student at a school, college or university and has adjusted

taxable income of less than $1,786 for the year.

If both you and your spouse are in Medicare levy exemption

category 1 or 2 (see page 4) and you have dependent children

who are not in any exempt category, one of you can claim a full

levy exemption and the other a half levy exemption. You must

complete a family agreement to nominate who will pay the half

Medicare levy and keep it with your financial records.

Dependent child for Medicare levy family

income reduction purposes

A dependent child for Medicare levy reduction purposes means

a person maintained by you who is a child aged:

 under 21 years who is not a full-time student and whose

adjusted taxable income is less than $1,786 for the first child

or $1,410 for any additional child

 under 25 years and is a full-time student at a school, college

or university and has adjusted taxable income of less than

$1,786 for the year.

If you were not married on the last day of the income year or

were married but living apart from your spouse, you must have

received family tax benefit for that child or student for some part

of the income year for them to be considered a dependant for

family income reduction purposes.

Spouse

Your spouse is a person (of anysex) who:

 you are in a relationship with that is registered under a

prescribedstate or territory law

 although not legally married to you lives with you on a

genuine domestic basis in a relationship as a couple.

Spouse weekly income

If the income of your spouse consists solely of salary or wages,

the amount to be taken into account is the gross weekly

earnings before tax. If your spouse has income other than

earnings (for example, share dividends), you must take into

account the weekly equivalent of all their income. To obtain

thisamount, divide their estimated taxable income from all

sources by 52.

Medicare levy – income for

surchargepurposes

A person’s income for surcharge purposes for a financial year

isthe sum of their:

 taxable income including the net amount you have paid

family trust distribution tax on (excluding any First home

super saver released amount)

 exempt foreign employment income (if your taxable income

is$1 or more)

 reportable fringe benefits as reported on your payment

summary

 reportable super contributions (this includes both reportable

employer superannuation contributions and deductible

personal super contributions)

 If you have a spouse, their share of the net income of a trust

on which the trustee must pay tax (under section 98 of the

Income Tax Assessment Act 1936) and which has not been

included in their taxable income

 total net investment loss (this includes both net financial

investment loss and net rental property loss).

6 Medicare levy variation declaration

CommonwealthofAustralia, 2019

You are free to copy, adapt, modify, transmit and distribute this material as

youwish (but not in any way that suggests the ATO or the Commonwealth

endorses you or any of your services or products).

Published by

Australian Taxation Office

Canberra

June 2019

DE-6534

Our commitment to you

We are committed to providing you with accurate, consistent and clear

information to help you understand your rights and entitlements and meet

yourobligations.

If you follow our information in this publication and it turns out to be incorrect,

oritis misleading and you make a mistake as aresult, we must still apply the law

correctly. If that means you owe us money, we must ask you to pay it but we will

not charge you a penalty. Also, if you acted reasonably and in good faith we will

not charge you interest.

If you make an honest mistake in trying to follow our information in this publication

and you owe us money as a result, we will not charge you a penalty. However, we

will ask you to pay the money, and we may also charge you interest. If correcting

the mistake means we owe you money, we will pay it to you. We will also pay you

any interest you are entitled to.

If you feel that this publication does not fully cover your circumstances, or you

areunsure how it applies to you, you can seek further assistance from us.

We regularly revise our publications to take account of any changes to the law,

somake sure that you have the latest information. If you are unsure, you can

checkfor more recent information on our website at ato.gov.au or contact us.

This publication was current at June 2019.

If you were aged from your preservation age to under 60 years

old, any taxed element of a super lump sum, other than a death

benefit, which you received that does not exceed your low rate

cap is excluded from yourincome for surcharge purposes.

More information

Useful products

You can get the following forms and publications from

our website at ato.gov.au/onlineordering or by phoning

1300720092:

 Tax file number declaration (NAT3092)

 Withholding declaration (NAT3093)

 Tax file number – application or enquiry for individuals

(NAT1432)

 Medicare levy adjustment weekly tax table (NAT1010).

For more information about income tests for a number of tax

offsets and government benefits, refer to Income tests on our

website at ato.gov.au

Phone

Personal tax enquiries phone 13 28 61 between 8.00am

and6.00pm, Monday to Friday. You can:

 get help to complete this form

 receive information about 

– HELP, VSL, FS, SSL or TSL debts

– claiming the tax-free threshold

– Medicare Levy Surcharge.

Other services

If you do not speak English well and need help from the ATO,

phone the Translating and Interpreting Service on 131450.

If you are deaf, or have a hearing or speech impairment, phone

the ATO through the National Relay Service (NRS) on the

numbers listed below:

 TTY users, phone 133677 and ask for the ATO number

youneed

 Speak and Listen (speech-to-speech relay) users, phone

1300555727 and ask for the ATO number you need

 internet relay users, connect to the NRS on

relayservice.com.au and ask for the ATO

number you need.

If you would like further information about the NRS, phone

1800555660 or email helpdesk@relayservice.com.au

Medicare levy variation declaration 7

Medicare levy variation declaration form

Sensitive (when completed)

6 Do you want to claim a full exemption

from the Medicare levy?

No Yes Go to question 9.

YesNo

Go to

question 8.

5 Do you qualify for a Medicare levy

exemption?

For a definition of spouse,

see Definitions on page6.

9 Do you have a spouse?

No Yes

Do you have a Higher Education Loan

Program (HELP), VET Student Loan

(VSL), Financial Supplement (FS),

Student Start-up Loan (SSL) or Trade

Support Loan (TSL) debt?

Yes

If you also answered yes at question10,

you are exempt from having additional

PAYG amounts for HELP, VSL, FS, SSL

or TSL withheld from payments to you.

10 Is the combined weekly income of you

and your spouse, or your income as

a sole parent, less than the relevant

amount in table A on page 2?

YesNo

Section A: Payee’s declaration

To be completed by payee.

1 Whatisyourtaxlenumber(TFN)?

For information about tax

filenumbers, see instructions.

8 Do you want to claim a Medicare

levy reduction?

No Yes

7 Do you want to claim a half levy

exemption from the Medicare levy?

No Yes Go to question 9.

2 What is your name?

Family name

Given names

OtherTitle:

Mrs Miss Ms

3 What is your home address?

Street address

Suburb/town State/Territory Postcode

Go to

question 5.

4 Do you want your payer to increase

the amounts withheld from you to

cover the Medicare levy surcharge?

Yes

Select one of the following rates

1% 1.25% 1.5%

If you want to make other variations using this form, go to question5.

Otherwise, sign and date the declaration and give it to your payer.

NAT 0929-06.2019

Complete this declaration to authorise your payer to adjust

theamount withheld from payments made to you.

You must provide, or have previously provided, your payer with

acompleted Tax file number declaration (NAT 3092) quoting your

taxfile number or claiming an exemption from quoting it, before

youcan make a Medicare levy variation declaration.

Refer to the Instructions to help you complete this declaration.

Print neatly in BLOCK LETTERS.

Print

in the appropriate boxes.

STORINGANDDISPOSINGOFMEDICARELEVYVARIATIONDECLARATIONS

The information in the completed Medicare levy variation declaration form must be

treated as sensitive. Once you have completed, signed and dated the declaration,

youshould file it. Do not send it to us.

Under the TFN guidelines in the Privacy Act 1988, you must use secure methods when

storing and disposing of TFN information. Under tax laws, if a payee submits a new

Medicare levy variation declaration or leaves your employment, you must still keep this

declaration for the current and next financial year.

Do not send this declaration form to us.

The tax laws impose heavy

penalties for giving false or

misleading statements.

Sensitive (when completed)

Section B: Payer’s declaration

To be completed by payer.

HOW MUCH SHOULD YOU WITHHOLD?

A yes answer at question 4 will require

increasing the amount you withhold

by1%, 1.25% or 1.5% of the payee’s

gross earnings.

A yes answer at questions 6, 7 or 8

will require the special Medicare levy

adjustment weekly tax table (NAT 1010)

to calculate the correct amount to

withhold.

A yes answer at question 10 will require

thespecial Medicare levy adjustment

weekly tax table (NAT 1010) to calculate

thecorrect amount to withhold. If the

payeealso has a HELP, VSL, FS, SSL

or TSL debt, do not withhold additional

amounts to cover the HELP, VSL, FS,

SSLor TSLrepayment.

YOURDETAILS

1 WhatisyourAustralianbusinessnumber(ABN)

(or your withholding payer number if you are not in business)?

2 What is your registered business name or trading name

(or your individual name if you are not a business)?

Signature of payer

Date

YearMonthDay

DECLARATIONBYPAYER

I declare that the information I have given on this form is true and correct.

The tax laws impose heavy

penalties for giving false or

misleading statements.

Privacy

For information about your privacy, visit our website at ato.gov.au/privacy

Give your completed declaration to your payer.

DECLARATIONBYPAYEE

I declare that the information I have given on this form is true and correct.

Signature of payee

Date

YearMonthDay

Privacy

For information about your privacy, visit our website at ato.gov.au/privacy

For a definition of dependent children, see Definitions on page6.

12 Do you have dependent children?

Sign and

date the

declaration.

Yes How many?

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