This form contains 234 fields organized into 84 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Activity Stop Date
Stop Date - Day Date
Enter the day the activity stopped. Fill only if 'Are you doing voluntary work for a charitable, welfare or community organisation?' is 'No'.
Max length: 2 characters
Depends on: No
Stop Date - Month Date
Enter the month the activity stopped. Fill only if 'Are you doing voluntary work for a charitable, welfare or community organisation?' is 'No'.
Max length: 2 characters
Depends on: No
Stop Date - Year Date
Enter the year the activity stopped. Fill only if 'Are you doing voluntary work for a charitable, welfare or community organisation?' is 'No'.
Max length: 4 characters
Depends on: No
Australian Business Number
ABN Part 1 Text
Enter the first segment of your Australian Business Number. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
ABN Part 2 Text
Enter the second segment of your Australian Business Number. Fill only if 'Yes' is 'Yes'.
Max length: 3 characters
Depends on: Yes
ABN Part 3 Text
Enter the third segment of your Australian Business Number. Fill only if 'Yes' is 'Yes'.
Max length: 3 characters
Depends on: Yes
ABN Part 4 Text
Enter the fourth segment of your Australian Business Number. Fill only if 'Yes' is 'Yes'.
Max length: 3 characters
Depends on: Yes
Australian Business Number (ABN)
ABN Segment 1 Text
Please enter the first segment of your Australian Business Number. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 2 characters
Depends on: Yes
ABN Segment 2 Text
Please enter the second segment of your Australian Business Number. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 3 characters
Depends on: Yes
ABN Segment 3 Text
Please enter the third segment of your Australian Business Number. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 3 characters
Depends on: Yes
ABN Segment 4 Text
Please enter the fourth segment of your Australian Business Number. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 3 characters
Depends on: Yes
Australian Disability Enterprise Employment Question
No Checkbox
Check this box if you do not work for an Australian Disability Enterprise. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you work for an Australian Disability Enterprise. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Australian Disability Enterprise Status
No Checkbox
The user should check this box if they do not work for an Australian Disability Enterprise. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Yes Checkbox
The user should check this box if they do work for an Australian Disability Enterprise. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Benefit and Obligation Status
No, not receiving JobSeeker, Youth Allowance, or Parenting Payment Checkbox
Check this box if you are not receiving JobSeeker Payment, Youth Allowance (job seeker), or Parenting Payment with mutual obligation requirements.
Yes, receiving JobSeeker, Youth Allowance, or Parenting Payment Checkbox
Check this box if you are receiving JobSeeker Payment, Youth Allowance (job seeker), or Parenting Payment with mutual obligation requirements.
Business Details
Business Name Text
Please enter the full legal name of your business. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Business Address Line 1 Text
Please provide the first line of your business's street address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Business Address Line 2 Text
Please provide the second line of your business's street address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Business Suburb/City Text
Please enter the suburb or city of your business's address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Business Postcode Text
Please enter the postal code for your business's address. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Type of Work Text
Please describe the type of work you are currently performing for your business. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Court-Ordered Voluntary Work Question
No Checkbox
Check this box if your voluntary work is NOT part of a court order or community service order. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if your voluntary work IS part of a court order or community service order. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Current Motor Vehicle Possession Status
No Checkbox
Check this box if you no longer have the motor vehicle you were given by the Department of Veterans' Affairs.
Yes Checkbox
Check this box if you still have the motor vehicle you were given by the Department of Veterans' Affairs.
Acknowledgement Text
Please enter your acknowledgement or initials as required.
Declaration
Signature Text
Provide your signature to declare the information is complete and correct.
Phone Number Text
Enter your phone number, including the area code.
Max length: 10 characters
Date Day Date
Enter the day of the month for the declaration date.
Max length: 2 characters
Date Month Date
Enter the month for the declaration date.
Max length: 2 characters
Date Year Date
Enter the year for the declaration date.
Max length: 4 characters
Disability/Parenting Payment without Mutual Obligation Status
No Checkbox
Check this box if you are NOT receiving Disability Support Pension or Parenting Payment without mutual obligation requirements.
Yes Checkbox
Check this box if you ARE receiving Disability Support Pension or Parenting Payment without mutual obligation requirements.
Employer's Address
Employer Address Line 1 Text
Please provide the first line of the employer's address. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Employer Address Line 2 Text
Please provide the second line of the employer's address. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Employer Address Line 3 Text
Please provide the third line of the employer's address. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Employer Postcode Text
Please provide the employer's postcode. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Employer's Name
Employer's Name Text
Please enter the full name of your employer. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Employer's Phone Number
Employer's Phone Number Text
Please provide the employer's full phone number, including the area code. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Employment and Earnings Status
No Checkbox
Check this box if you are not employed and earning money, and proceed to question 10. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Yes Checkbox
Check this box if you are employed and earning money, and proceed to the next question. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Employment Hours
Hours Worked Over 2 Weeks Number
Please enter the total number of hours you spend at work over a 2-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Hours Worked Over 4 Weeks Number
Please enter the total number of hours you spend at work over a 4-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Employment Services Program Participation Status
No Checkbox
Check this box if you are not participating in a program with an employment services provider.
Next Question Number Text
Enter the number of the next question or section to proceed to if you are not participating in an employment services program. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you are participating in a program with an employment services provider.
Employment Services Provider Contact Details
Provider Name Text
Enter the full name of the employment services provider. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 1 Text
Enter the first line of the employment services provider's street address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 2 Text
Enter the second line of the employment services provider's street address, if applicable. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Suburb / City Text
Enter the suburb or city of the employment services provider's address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Postcode Text
Enter the postcode for the employment services provider's address. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Phone Number Text
Enter the phone number of the employment services provider, including the area code. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Employment Services Provider Details
Provider Name Text
Please provide the full name of the employment services provider. Fill only if 'A11_Yes#20-#20give#20details#20below' is 'Yes'.
Depends on: A11_Yes#20-#20give#20details#20below
Address Line 1 Text
Please provide the first line of the employment services provider's address. Fill only if 'A11_Yes#20-#20give#20details#20below' is 'Yes'.
Depends on: A11_Yes#20-#20give#20details#20below
Address Line 2 Text
Please provide the second line of the employment services provider's address. Fill only if 'A11_Yes#20-#20give#20details#20below' is 'Yes'.
Depends on: A11_Yes#20-#20give#20details#20below
Address City/Suburb Text
Please provide the city or suburb of the employment services provider's address. Fill only if 'A11_Yes#20-#20give#20details#20below' is 'Yes'.
Depends on: A11_Yes#20-#20give#20details#20below
Postcode Text
Please provide the postcode of the employment services provider's address. Fill only if 'A11_Yes#20-#20give#20details#20below' is 'Yes'.
Max length: 4 characters
Depends on: A11_Yes#20-#20give#20details#20below
Phone Number Text
Please provide the phone number of the employment services provider, including the area code. Fill only if 'A11_Yes#20-#20give#20details#20below' is 'Yes'.
Max length: 10 characters
Depends on: A11_Yes#20-#20give#20details#20below
Employment Start Date
Start Date Day Text
Enter the day the employment started. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Max length: 2 characters
Depends on: No
Start Date Month Text
Enter the month the employment started. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Max length: 2 characters
Depends on: No
Start Date Year Text
Enter the year the employment started. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Max length: 4 characters
Depends on: No
Employment System Information
Employer's Name Text
Provide the full name of your employer. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Employment Travel Question
No Checkbox
Check this box if you do not travel to and from home for this work (e.g., to your place of work or visiting clients). Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Yes Checkbox
Check this box if you travel to and from home to do this work (e.g., to your place of work or visiting clients). Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Expected Employment Duration
Less than 3 months Checkbox
Check this box if you expect your employment to last less than 3 months. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
3 to 6 months Checkbox
Check this box if you expect your employment to last between 3 and 6 months. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
More than 6 months Checkbox
Check this box if you expect your employment to last more than 6 months. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Expected Independent Living Skills Course Finish Date
Expected Finish Date Day Date
Please enter the day of the month you expect the independent living skills course to finish. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Expected Finish Date Month Date
Please enter the month you expect the independent living skills course to finish. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Expected Finish Date Year Date
Please enter the year you expect the independent living skills course to finish. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Expected Self-Employment Duration
Less than 3 months Checkbox
Check this box if you expect your self-employment to last for a duration of less than 3 months. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
3 to 6 months Checkbox
Check this box if you expect your self-employment to last for a duration of 3 to 6 months. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
More than 6 months Checkbox
Check this box if you expect your self-employment to last for a duration of more than 6 months. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Expected Vocational Training Finish Date
Expected Finish Day Text
Please enter the expected day of the month for the vocational training course to finish. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Expected Finish Month Text
Please enter the expected month for the vocational training course to finish. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Expected Finish Year Text
Please enter the expected year for the vocational training course to finish. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Expected Voluntary Work Duration
Less than 3 months Checkbox
Check this box if you expect your voluntary work to last for less than 3 months. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
3 to 6 months Checkbox
Check this box if you expect your voluntary work to last for a duration between 3 and 6 months. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
More than 6 months Checkbox
Check this box if you expect your voluntary work to last for more than 6 months. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Expected Voluntary Work End Date
Expected End Date Day Date
Please enter the day when you expect this voluntary work to finish. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Expected End Date Month Date
Please enter the month when you expect this voluntary work to finish. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Expected End Date Year Date
Please enter the year when you expect this voluntary work to finish. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Expected Work Duration
Less than 3 months Checkbox
Check this box if you expect the work to last for less than 3 months. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
3 to 6 months Checkbox
Check this box if you expect the work to last for 3 to 6 months. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
More than 6 months Checkbox
Check this box if you expect the work to last for more than 6 months. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
First Employer Details
Employer's Name Text
Please provide the full legal name of your first employer. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Employer's Address Line 1 Text
Please provide the first line of your first employer's street address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Employer's Address Line 2 Text
Please provide the second line of your first employer's street address, such as suburb or city. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Employer's Postcode Text
Please provide the postcode for your first employer's address. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Employer's Phone Number Text
Please provide your first employer's phone number, including the area code. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Form Identification Details
Date of Issue Date
Please enter the date when the form was issued.
Customer Reference Number Text
Please provide your customer reference number.
Return Date Date
Please enter the date by which the form needs to be returned.
General
Instructions button for fillable form Button
Clear button Button
Button - Click to go to question 21 Button
Button - Click to go to question 4 Button
Button - Click to go to question 21 Button
Button - Click to go to question 10 Button
Enter - Street address Text
Enter - Street address Text
Button - Click to go to question B Button
Button - Click to go to question D Button
Button - Click to go to question C Button
Button - Click to go to question E Button
Button - Click to go to question B Button
Button - Click to go to question D Button
Button - Click to go to question C Button
Button - Click to go to question E Button
Dummycalc Text
Button - Click to go to question 17 Button
Dummycalc Text
Button - Click to go to question 14 Button
Dummycalc Text
Button - Click to go to question 16 Button
Button - Click to go to question 16 Button
Dummycalc Text
Button - Click to go to question 16 Button
DummyCalcQ17 Text
Q17GoToQ19 Button
Dummycalc Text
Q18GoToQ20 Button
Button - Click to go to question 20 Button
Privacy text Text
Independent Living Skills Course Hours
Hours Spent Per 4 Weeks Text
Enter the total number of hours you spend at the independent living skills course over a 4-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Independent Living Skills Course Name
Independent Living Skills Course Name Text
Please provide the name of the independent living skills or life skills course. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Independent Living Skills Course Start Date
Start Date Day Date
Provide the day of the month when the independent living skills course started. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Start Date Month Date
Provide the month when the independent living skills course started. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Start Date Year Date
Provide the year when the independent living skills course started. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Independent Living Skills Training Details Summary
Hours Per 4-Week Period Number
Enter the number of hours over a 4-week period of your course that relate to independent living skills or life skills. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Independent Living Skills Training Organisation Address
Address Line 1 Text
Please enter the first line of the independent living skills training organization's address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 2 Text
Please enter the second line of the independent living skills training organization's address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 3 Text
Please enter the third line of the independent living skills training organization's address, including suburb or city. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Postcode Text
Please enter the postcode of the independent living skills training organization. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Independent Living Skills Training Organisation Name
Training Organisation Name Text
Please provide the full name of the training organisation that provides independent living skills training. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Independent Living Skills Training Organisation Phone Number
Organisation Phone Number Text
Enter the phone number of the independent living skills training organisation, including the area code. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Independent Living Skills Training Question
No Checkbox
Check this box if you are NOT currently doing independent living skills or life skills training. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Yes Checkbox
Check this box if you ARE currently doing independent living skills or life skills training. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Instructional Box Example
Where you see a box like this CheckBox
Job Search Activities Details
Job Search Activities Details Text
Provide a detailed list of all job search activities you are undertaking. Fill only if 'A11_Yes#20-#20give#20details#20below' is 'Yes'.
Depends on: A11_Yes#20-#20give#20details#20below
Job Search Activities Status
A11_No#20-#20go#20to#2017 CheckBox
A11_Yes#20-#20give#20details#20below CheckBox
Minimum Wage Employment Question
Minimum Wage Employment Status Number
Please provide additional numerical information regarding your employment status in relation to the minimum wage. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
No (below minimum wage) Checkbox
Check this box if you are not employed at or above the relevant minimum wage. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Yes (at or above minimum wage) Checkbox
Check this box if you are employed at or above the relevant minimum wage. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Minimum Wage Status
Minimum Wage Status Text
Please indicate if you are employed at or above the relevant minimum wage. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
No Checkbox
Check this box if you are not employed at or above the relevant minimum wage. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you are employed at or above the relevant minimum wage. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
NDIS Support Status
No Checkbox
Check this box if you are not receiving a funded package of support from the National Disability Insurance Scheme (NDIS).
Yes Checkbox
Check this box if you are receiving a funded package of support from the National Disability Insurance Scheme (NDIS).
NDIS Status Details Text
Please provide any additional details regarding your NDIS support status.
Organisation Address
Organisation Address Line 1 Text
Enter the first line of the organisation's street address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Organisation Address Line 2 Text
Enter the second line of the organisation's street address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Organisation Address Line 3 Text
Enter the third line of the organisation's street address, such as the suburb or city. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Organisation Postcode Text
Enter the postcode for the organisation's address. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Organisation Name
Organisation Name Text
Please enter the name of the organisation. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Program Expected Finish Date
Expected Finish Day Text
Please provide the day your program is expected to finish. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Expected Finish Month Text
Please provide the month your program is expected to finish. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Expected Finish Year Text
Please provide the year your program is expected to finish. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Program Start Date
Program Start Day Date
Provide the day the program started. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Program Start Month Date
Provide the month the program started. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Program Start Year Date
Provide the year the program started. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Program Travel Status
No Checkbox
Check this box if you do not travel to and from home to do your program. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you travel to and from home to do your program. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Provided Documents
Details of vocational training Checkbox
Check this box if you are providing details of vocational training, as indicated by your 'Yes' answer at question 5. Fill only if 'Are you doing vocational training?' is 'Yes'.
Depends on: Yes
Details of independent living skills or life skills training Checkbox
Check this box if you are providing details of independent living skills or life skills training, as indicated by your 'Yes' answer at question 6. Fill only if 'Are you doing independent living skills or life skills training?' is 'Yes'.
Depends on: Yes
Details of self-employment Checkbox
Check this box if you are providing details of self-employment, as indicated by your 'Yes' answer at question 7. Fill only if 'Are you self-employed?' is 'Yes'.
Depends on: Yes
Details of employment Checkbox
Check this box if you are providing details of employment, as indicated by your answer at question 9. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Details of voluntary work Checkbox
Check this box if you are providing details of voluntary work, as indicated by your 'Yes' answer at question 10. Fill only if 'Are you doing voluntary work for a charitable, welfare or community organisation?' is 'Yes'.
Depends on: Yes
Proof of job search activities Checkbox
Check this box if you are providing proof of job search activities, as indicated by your 'Yes' answer and the requirement at question 11. Fill only if 'Are you undertaking job search activities?' is 'Yes'.
Depends on: A11_Yes#20-#20give#20details#20below
Qualifying Activity Cessation Details
Stopped Activity Description Text
Please describe the qualifying activity you were doing that you are no longer performing. Fill only if 'Are you doing voluntary work for a charitable, welfare or community organisation?' is 'No'.
Depends on: No
Return Address
Return Address Text
Provide the complete mailing address where the form should be returned.
Self-Employment Hours
Hours in a 2-week period Number
Enter the total number of hours you spend working over a 2-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Hours in a 4-week period Number
Enter the total number of hours you spend working over a 4-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Self-Employment Start Date
Start Day Text
Please enter the day you started this self-employment work. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Start Month Text
Please enter the month you started this self-employment work. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Start Year Text
Please enter the year you started this self-employment work. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Self-Employment Status
No Checkbox
Check this box if you are not self-employed. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Yes Checkbox
Check this box if you are self-employed. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Self-Employment Details Text
Please provide any additional details regarding your self-employment status. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Self-Employment Travel Question
No Checkbox
Check this box if you do not travel to and from home for your self-employment. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you do travel to and from home for your self-employment, for example, to get to your place of work or visiting clients. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Study and Allowance Status
No Checkbox
Check this box if you are not studying and not receiving Youth Allowance or Austudy payment.
Yes Checkbox
Check this box if you are studying and receiving Youth Allowance or Austudy payment.
Supported Wage System Employment Question
No Checkbox
Check this box if you are not employed under the Supported Wage System. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you are employed under the Supported Wage System. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Supported Wage System Status
No Checkbox
Check this box if you are not employed under the Supported Wage System. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Yes Checkbox
Check this box if you are employed under the Supported Wage System. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Travel for Independent Living Skills Training Question
No Checkbox
Check this box if you do not travel to and from home to do your independent living skills or life skills training. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you do travel to and from home to do your independent living skills or life skills training. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Travel for Study
No Checkbox
Check this box if you do not travel to and from home for study purposes, such as attending an educational institution or library.
Yes Checkbox
Check this box if you do travel to and from home for study purposes, such as attending an educational institution or library.
Travel for Vocational Training Question
No Checkbox
Check this box if you do not travel to and from home for your vocational training. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you do travel to and from home for your vocational training (e.g., school, library, residential course). Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Travel for Work Search
No Checkbox
Check this box if you do not travel to and from home to undertake work-related activities.
Yes Checkbox
Check this box if you do travel to and from home to undertake work-related activities.
Type of Work
Type of Work Text
Please enter the type of voluntary work you are currently performing. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Vehicle Assistance Scheme Status
Dummycalc Text
No Checkbox
Check this box if you have not been given a motor vehicle under the Vehicle Assistance Scheme from the Department of Veterans' Affairs.
Yes Checkbox
Check this box if you have been given a motor vehicle under the Vehicle Assistance Scheme from the Department of Veterans' Affairs.
Vocational Training Course Hours
Hours over 4 weeks Number
Please provide the total number of hours you spend on this vocational training course over a 4-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Vocational Training Course Name
Course Name Text
Please provide the full name of the vocational training course you are undertaking. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Vocational Training Details Summary
Vocational Training Hours (4-Week Period) Number
Please enter the total number of hours you spend at the vocational training course over a 4-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Vocational Training Organisation Address
Address Line 1 Text
Enter the first line of the vocational training organization's address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 2 Text
Enter the second line of the vocational training organization's address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Address Line 3 Text
Enter the third line of the vocational training organization's address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Postcode Text
Enter the postcode of the vocational training organization. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Vocational Training Organisation Name
Vocational Training Organisation Name Text
Please provide the full name of the organization that provides your vocational training. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Vocational Training Organisation Phone Number
Vocational Training Organisation Phone Number Text
Please provide the phone number of the vocational training organization, including the area code. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Vocational Training Question
No Checkbox
The user should check this box if they are not doing vocational training. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Yes Checkbox
The user should check this box if they are doing vocational training, which includes tertiary education, secondary education and TAFE, courses at institutions offering academic or trade qualifications, high school studies, or special schools. Fill only if 'Are you receiving a funded package of support from the National Disability Insurance Scheme (NDIS)?' is 'No'.
Depends on: No
Vocational Training Start Date
Start Day Text
Please provide the day your vocational training course started. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Start Month Text
Please provide the month your vocational training course started. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Start Year Text
Please provide the year your vocational training course started. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Voluntary Work Hours
Voluntary Work Hours Number
Provide the total number of hours you spend doing this voluntary work over a 4-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Voluntary Work Question
No Checkbox
Check this box if you are not doing voluntary work for a charitable, welfare, or community organization. Fill only if 'Are you employed and earning money?' is 'No'.
Depends on: No
Yes Checkbox
Check this box if you are doing voluntary work for a charitable, welfare, or community organization. Fill only if 'Are you employed and earning money?' is 'No'.
Depends on: No
Voluntary Work Details Text
Provide details about the voluntary work you are undertaking, including the organization and the hours you spend working over a 4-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Voluntary Work Start Date
Start Day Text
Please provide the day the voluntary work started. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Start Month Text
Please provide the month the voluntary work started. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Start Year Text
Please provide the year the voluntary work started. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Work Hours (2 Week Period)
Work Hours in 2 Weeks Number
Please enter the total number of hours you spend at work over a 2 week period. Fill only if 'Yes (at or above minimum wage)' is 'Yes'.
Depends on: Yes (at or above minimum wage)
Work Hours (4 Week Period)
Hours Spent (4 Week Period) Number
Enter the total number of hours you spend at work over a 4-week period. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Work Search Activity
No (Question 15) Checkbox
Check this box if you are not looking for work of 15 hours or more per week at or above the relevant minimum wage as part of your agreement.
Yes (Question 15) Checkbox
Check this box if you are looking for work of 15 hours or more per week at or above the relevant minimum wage as part of your agreement.
Work Search Requirement
No Checkbox
Check this box if you are NOT required to look for work of 15 hours or more per week or participate in activities to prepare for work, as part of your agreement. Fill only if 'Yes, receiving JobSeeker, Youth Allowance, or Parenting Payment' is 'Yes'.
Depends on: Yes, receiving JobSeeker, Youth Allowance, or Parenting Payment
Yes Checkbox
Check this box if you ARE required to look for work of 15 hours or more per week or participate in activities to prepare for work, as part of your agreement. Fill only if 'Yes, receiving JobSeeker, Youth Allowance, or Parenting Payment' is 'Yes'.
Depends on: Yes, receiving JobSeeker, Youth Allowance, or Parenting Payment
Work Start Date
Day of Work Start Date Text
Please enter the day of the month when your work started. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Month of Work Start Date Text
Please enter the month when your work started. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Year of Work Start Date Text
Please enter the year when your work started. Fill only if 'Are you employed and earning money?' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Work Travel Question
No Checkbox
Check this box if you do not travel to and from home to do this work. Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you travel to and from home to do this work (for example, to get to your place of work, visiting clients). Fill only if 'Are you employed and earning money?' is 'Yes'.
Depends on: Yes