A-Z list of Winz application forms. PDF versions of our forms are available here for you to print. If you need help to read a form, please contact us.
A
Accommodation Supplement – apply online
If you’re not getting any payments from us, or only getting childcare payments, you can apply online for an Accommodation Supplement. Otherwise, call us on 0800 559 009.Accommodation Supplement Application for current clients (PDF 227.41KB)
S01 – APR 2026
For clients already receiving Work and Income benefits or payments, who want to apply for help with accommodation costs.Adverse Event – Payments to hosts for accommodation (PDF 117.58KB)
CD1 – JUN 2010
For hosts providing temporary accommodation in an adverse event, including a Civil Defence emergency.Appointment of an Agent (PDF 204.64KB)
V01 – Dec 2026
To appoint someone to act on your behalf for Ministry of Social Development matters.Automatic Payments – Australia (PDF 22.45KB)
Complete this form to arrange regular automatic payments to repay your debt if you’re living in AustraliaAway From Home Allowance application form (PDF 682.19KB)
M36W – DEC 2026
Apply for the Away from Home Allowance if your child is 16-17 years old, and is living away from home while on a tertiary or training course.top
B
Budget plan step 1 (PDF 299.58KB)
BUD101 – MAY 2026
Budgeting form to help work out your costs and income.Budget plan step 2 (PDF 296.81KB)
BUD102 – MAY 2026
Budgeting form to help plan your financial goals.Budget plan step 3 (PDF 296.85KB)
BUD103 – MAY 2026
Budgeting form to help review your budgeting progress and future financial plans.top
C
Change of Address/Accommodation Costs (PDF 218.41KB)
R02 – JUN 2026
Tell us about a change of address and/or accommodation costs if you’re already getting payments from us. Or you can update this online using MyMSD.Change of Bank Account (PDF 187.91KB)
V03 – MAY 2026
Use this form to change your bank accountChange of Living Situation for Seniors (PDF 216.76KB)
R32 – SEP 2026
For Seniors clients to declare any changes in their living situation, eg change in relationship status, living with others, or living alone.Child Disability Allowance Application (PDF 736.92KB)
M08 – JAN 2026
Apply for this payment if you’re caring for a child with a serious health condition.Child Disability Allowance Medical Certificate (PDF 198.13KB)
V12CW – JAN 2026
To be completed by a health practitioner if you’re applying for a Child Disability Allowance.Child Inclusion Form (PDF 238.03KB)
R30 – APR 2026
Tell us if a child has come into your care while you’re getting a benefit from us.Childcare and OSCAR subsidy application form (PDF 699.75KB)
S02 – NOV 2026
Apply for a Childcare subsidy (for pre-school childcare) or the OSCAR subsidy (for before or after school care).Childcare Assistance – Change of Circumstances (PDF 176.43KB)
R24 – AUG 2012
Tell us about any changes of circumstances while you’re getting childcare payments from us.Childcare Subsidy Verification Form (PDF 70.92KB)
S33W – AUG 2009
To be completed by a childcare supervisor, if you’re applying for a Childcare subsidy.Civil Defence Payments to evacuees application form (PDF 248.76KB)
CD2 – Dec 2026
Apply for help for essential costs during a civil defence emergency.Civilian Amputee Assistance application form (PDF 480.4KB)
SW288W – DEC 2026
Apply for help with some of the costs of going to an Artificial Limb Centre.Community Costs Payment Application (PDF 453.08KB)
S29W – Dec 2026
A weekly payment for people in short-term residential treatment programmes to help meet essential ongoing living costsCommunity Services Card application form (PDF 670.3KB)
CSC1 – APR 2026
Apply for a Community Services Card to help with the costs of health care (eg. some health services and prescriptions) for you and your family.Course Participation Assistance application form (PDF 221.26KB)
LAB300 – DEC 2026top
D
Debt Repayments Authority Form (PDF 71.37KB)
ISS570 – JAN 2011
Complete this form to repay debt to the Ministry of Social Development if you are not getting payments from us.Disability Allowance – apply online
If you’re not getting any payments from us, or only getting childcare payments, you can apply online for Disability Allowance. Otherwise, call us on 0800 559 009.Disability Allowance application form for current clients (PDF 118.13KB)
S03 – OCT 2026
For current clients to apply for help with on-going medical costs.Disability Allowance Medical Alarm Assessment Form (PDF 132.35KB)
S21 – SEP 2011
Apply for help with on-going costs of a Medical Alarm.Disability Certificate (PDF 197.1KB)
S22 – APR 2026
To be completed by a health practitioner if you’re applying for Disability Allowance, or to tell us about a new cost.Disability Certificate – Counselling (PDF 118.42KB)
S23 – AUG 2011
To be completed by a health practitioner and a counsellor if you’re applying for a Disability Allowance for counselling.top
E
Early Learning Payment application form (PDF 829.17KB)
S32W – MAR 2026
Families in a Family Start or Early Start programme can apply for Early Learning Payment.Emergency Dental Treatment Information (PDF 167.81KB)
V15 – JUN 2026
Your dentist can complete this form if you’re applying for help to pay for emergency dental treatment.Employment and earnings – information for applications (PDF 232.64KB)
V06 – JUN 2026
To be completed by your employer as verification of income, if we’ve asked you to do this as part of an application.Employment and earnings – information for reviews (PDF 215.52KB)
V26 – Jul 2014
To be completed by your employer as verification of income if we’ve asked you to do this as part of a review of your benefit.Extra Help application form (PDF 690.17KB)
M43 – FEB 2026
This form includes application for Accommodation Supplement, Disability Allowance and Temporary Additional Support for people not receiving Work and Income assistanceExtraordinary Care Fund Grant Application (PDF 426.34KB)
S54W – DEC 2018
If you are receiving an Orphan’s or Unsupported Child’s Benefit for a child in your care, you can apply to the Extraordinary Care Fund for a grant of between $100 and $2,000 each financial year (1 July – 30 June).top
F
Failed pre-employment drug test result confirmation form (PDF 57.85KB)
V28W – JUL 2013
An employer can use this form to record the results of a pre-employment drug-test.Funeral Grant Application (PDF 169.43KB)
S04 – JUN 2017
Apply for financial help with the costs of a funeral and other associated costs.top
G
Guaranteed Childcare Assistance Payment Application (PDF 623.38KB)
YS008W – DEC 2026
Apply for help with the cost of childcare for children under 5, if you’re a young parent in education, training or work-based learning.top
H
Home Help Payments application form (PDF 587.04KB)
M29 – DEC 2026
If you’re a parent or carer we may be able to help you with the cost of home help to complete household tasks or training in parenting skills.Home Help timesheet (PDF 106.18KB)
ISS221W – MAR 2018
You can use this timesheet to record imformation about the work you have done for a person who has had Home Help approved by the Ministry of Social Development.Housing Modification Grant Income and Asset Details (PDF 115.28KB)
M27W – AUG 2009
Declare your income and assets if you’re applying for a Housing Modification Grant.top
I
Including a partner form (PDF 430.37KB)
R31 – APR 2026
If you receive a benefit from Work and Income and now have a partner, your partner will need to be included in your benefit and may receive payments as well.Income and Asset Information (PDF 223.08KB)
R03 – OCT 2026
Declare any income and/or assets.Increased payment while in hospital form (PDF 66.8KB)
SO6W – JUL 2018
If you get a benefit or NZ Super and you’re in hospital for more than 13 weeks, your payments need to change to our hospital rate. If you still have costs to pay, you need to complete this form so we can work out the right rate to pay you while you’re in hospital.International Custody Dispute payment application form (PDF 516.24KB)
S30W – DEC 2026
Apply for help with costs if you’re a parent involved in an international custody or access dispute over the care of your children.top
J
Jobseeker Support – Apply Online
The quickest way to apply for Jobseeker Support is online. If you can’t apply online, call us on 0800 559 009 to talk to us about other ways to apply.Jobseeker Support obligations and privacy form (PDF 412.09KB)
M111-Obs – JAN 2026
Complete this form if you’re applying for Jobseeker Support, to show you understand your obligations and what happens to information you give us.top
N
New Zealand Payment Overseas application (PDF 325.54KB)
Apply to get your payment if you’ll be living in another country, or travelling for more than 26 weeks. Talk to International Services on 0800 777 227 before you complete this.New Zealand Superannuation – Apply online
The quickest way to apply for NZ Super is online. Or, you can call us for free on 0800 552 002 to talk about other ways you can apply.New Zealand Superannuation application form (PDF 672.05KB)
M12 – JUL 2026
Apply for New Zealand Superannuation if you’re not already getting a main benefit from Work and Income.New Zealand Superannuation application form for current clients (PDF 599.46KB)
M11 – JUL 2026
Apply for NZ Super if you’re already getting a main benefit from Work and Income.top
O
Orphan’s or Unsupported Child’s Benefit application form (PDF 594.35KB)
M14 – APR 2026
Apply for help with the costs of raising someone else’s child.OSCAR Subsidy Declaration (PDF 138.65KB)
R18 – DEC 2011
If you’re getting an OSCAR subsidy, you need to tell us whether your children will attend an OSCAR programme over the school holidays.OSCAR Subsidy Verification Form (PDF 123.69KB)
S34W – DEC 2011
To be completed by the OSCAR programme supervisor if you’re applying for an OSCAR subsidy.top
P
Privacy Statement (PDF 164.68KB)
V30W – DEC 2026
Explains how we collect, use and share your information, treat it with respect and keep it safe to protect your privacy.top
R
Re-application (within 52 weeks) form (PDF 686.98KB)
M26 – DEC 2026
Re-apply for your payment every 52 weeks.Re-apply (within 52 weeks) online
The quickest way to re-apply for your payment is online.Redirection of Benefit Payment (PDF 213.91KB)
V19 – MAY 2026
Complete this form if you want part or all of your payments to be paid to another person or organisation.Reimbursement of Health Overcharges application form (PDF 214.94KB)
C04W – APR 2026
Apply for a reimbursement if you have a Community Services Card and were charged the full price for health services or prescriptions because you didn’t have your card with you.Relationship status verification form for Sole Parent Support (PDF 195.5KB)
V24W – DEC 2026
This form is used to record information from someone nominated by you, about your relationship status when applying for Sole Parent Support.Rent arrears assistance application form (PDF 466.9KB)
S63W – NOV 2026
Use this form if you need help to pay your overdue rent so you can stay in your home.Repayment Financial Circumstances Form (PDF 602.02KB)
D003W – May 2012
If you are unable to afford to pay the standard repayment rate on the amount you owe us, please use this form to provide us with more information about the amount you may be able to repay.Repayment Form (PDF 579.78KB)
D002W – OCT 2010
This form provides you with different options on how you can repay Work and Income.Residential Care – Deferred Loan Application (PDF 530.08KB)
RSU09W – DEC 2026
Apply for a Deferred Loan if you cannot repay your Residential Care Loan.Residential Support Subsidy – Sole Parent’s Dependent Children Notification (PDF 181.87KB)
RSU13W – NOV 2026
Complete this form if you’re a sole parent, get a Residential Support Subsidy and continue to financially support your children.Residential Support Subsidy authorisation form (PDF 661.8KB)
RSU08W – SEPT 2026
Apply for Residential Support Subsidy. The Residential Service Provider will also need to complete this form.Residential Support Subsidy Residents Details Notification Form (PDF 191.08KB)
RSU12W – JAN 2026
Tell us if someone getting a Residential Support Subsidy has had a change in details, like changing address or being admitted to hospital.Review of Decision Application (PDF 269.6KB)
R10 – MAR 2013
If the Ministry of Social Development has made a decision you don’t agree with you can apply for a review of this decision.Rural Assistance Payment application form (PDF 404.87KB)
RUR01W – DEC 2026
Apply for help if you’re a farmer or grower who needs temporary financial help after an adverse event, such as severe drought or flood.Rural Assistance Payment continuation form (PDF 175.08KB)
RUR02W – DEC 2026
Apply for help if you’re already getting a Rural Assistance Payment, and need to keep getting this payment a while longer.top
S
Seasonal Work Assistance form (PDF 417.7KB)
M46W – DEC 2026
Apply for help if you’re doing seasonal work in horticulture but can’t work because of bad weather.Self-Assessment questionnaire (PDF 204.24KB)
HDS016 – MAY 2026
Tell us about your work and health background, so we can understand how it impacts your ability to work.Self-Assessment questionnaire – Easy-Read version (PDF 1.93MB)
HDS016ER – Oct 2014
This version is easier for people with learning disabilities or English as a second language.Sole Parent Support – Assistance for study costs (PDF 100.58KB)
S13W – JUL 2013
Apply for help if you’re getting Sole Parent Support and are studying at tertiary level 4 or above.Sole Parent Support application
The quickest way to apply for Sole Parent Support is online. If you can’t apply online, call us on 0800 559 009 to talk to us about other ways to apply.Sole Parent Support obligations and privacy form (PDF 258.73KB)
M112-Obs – JAN 2026
Complete this form if you’re applying for Sole Parent Support, to show you understand your obligations and what happens to information you give us.Special Banking Option forms
The Special Banking Option enables you to receive overseas and New Zealand benefits or pension payments as one regular payment.Supported Living Payment – Obligations and Privacy Form (PDF 374.3KB)
M113-Obs – NOV 2018
Complete this form if you’re applying for Supported Living Payment to show you understand your obligations and what happens to the information you give us.Supported Living Payment Application
The quickest way to apply for a Supported Living Payment is online. If you can’t apply online, call us on 0800 559 009 to talk about other ways to apply.Supported Living Payment medical certificate for a person being cared for (PDF 349.6KB)
M113-MCW – DEC 2026
To be completed by a health practitioner if you’re applying for a Supported Living Payment as a carer.top
T
Temporary Additional Support – apply online
If you’re not getting any payments from us, or only getting childcare payments, you can apply online for Temporary Additional Support. Otherwise, call us on 0800 559 009.Temporary Additional Support application form for current clients (PDF 285.95KB)
S26 – FEB 2026
Clients already receiving Work and Income help use this form to apply for more help with on-going costs not already covered by other Ministry of Social Development payments.Training Incentive Allowance Application (PDF 128.52KB)
S12W – JUL 2013
Apply for help to pay for employment-related training costs.Transfer to Veteran’s Pension application form (PDF 414.23KB)
S14W – DEC 2026
Complete this form if you and/or your partner get NZ Super, have Qualifying Operational Service with the New Zealand Defence Force, and want to transfer to a Veteran’s Pension.Transition to Work Grant (PDF 361.37KB)
LAB995W – MAY 2026
Apply for help with the cost of looking for, or moving into, work.Transition to Work Grant Employer Verification (PDF 661.4KB)
LAB996W – Apr 2016
To be completed by your employer if you’re applying for a Transition to Work Grant for job-related costs.top
U
Unsupported Child’s Benefit or Orphan’s application form (PDF 594.35KB)
M14 – APR 2026
Apply for help with the costs of raising someone else’s child.top
V
Veteran’s Pension application form (PDF 798.81KB)
M19W – JUL 2026
Apply for the Veteran’s Pension if you have Qualifying Operational Service with the New Zealand Defence Force and aren’t getting NZ Super.top
Y
Young Parent Payment Application (PDF 849.1KB)
YS011W – AUG 2026
Apply for the Young Parent Payment if you’re a young parent aged 16-19 years old.Young Parent Payment Partner’s Application (PDF 755.74KB)
YS012W – AUG 2026
Complete this form if your partner is applying for a Young Parent Payment.Youth Payment Application (PDF 832.3KB)
YS009W – JAN 2026
Apply for a Youth Payment if you’re 16-17, can’t live with your parents or guardian, and are not being supported by them or anyone else.Youth Payment or Young Parent Payment – Parent’s Income verification Form (PDF 381.27KB)
V10W – DEC 2026
To be completed by your parents or guardians if you’re a young person applying for a payment.Youth Payment Partner’s Application (PDF 702KB)
YS010W – FEB 2026
Complete this form if your partner is applying for a Youth Payment.Youth Service Continue or stop payments form (PDF 349.97KB)
YS014W – OCT 2016
To stop your Youth Service payments if you no longer need it or qualify for it.Youth Service payment card balance transfer application (PDF 502.46KB)
YS019W – JAN 2015
Apply for a balance transfer if you want to use your Youth Service Payment Card to buy from somewhere that doesn’t accept the card.