This form contains 381 fields organized into 119 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Aboriginal or Torres Strait Islander Descent
Not of Aboriginal or Torres Strait Islander Descent	Text	Indicate if you are not of Aboriginal or Torres Strait Islander Australian descent. Fill only if 'No' is 'No'. Depends on: No
No	Checkbox	Check this box if you are not of Aboriginal or Torres Strait Islander Australian descent.
Yes - Aboriginal Australian	Checkbox	Check this box if you are of Aboriginal Australian descent.
Yes - Torres Strait Islander Australian	Checkbox	Check this box if you are of Torres Strait Islander Australian descent.
Applicant Name
Mr	Checkbox	Check this box if your title is Mr.
Mrs	Checkbox	Check this box if your title is Mrs.
Miss	Checkbox	Check this box if your title is Miss.
Ms	Checkbox	Check this box if your title is Ms.
Mx	Checkbox	Check this box if your title is Mx.
Other Title	Text	Provide the applicant's title if it is not Mr, Mrs, Miss, Ms, or Mx. Fill only if 'Mx' is 'Yes'. Depends on: Mx
Family Name	Text	Provide the applicant's family name.
First Given Name	Text	Provide the applicant's first given name.
Second Given Name	Text	Provide the applicant's second given name.
Are you employed and earning money?
No	Checkbox	Check this box if you are not employed and not earning money.
Employment Type	Text	Please provide your employment type, such as full-time, part-time, casual, or supported employment (Australian Disability Enterprise). Fill only if 'Yes' is 'Yes'. Depends on: Yes
Yes	Checkbox	Check this box if you are employed and earning money, including full-time, part-time, casual, or supported employment.
Are you self-employed?
	CheckBox
Yes	Checkbox	Check this box if you are self-employed and need to provide further details as instructed below.
Arrival Visa Details
Visa Subclass	Text	Enter the subclass of your visa on arrival. Fill only if 'Yes', 'Permanent', 'Temporary' is 'Yes' for any. Depends on: Yes, Permanent, Temporary
Visa Grant Day	Text	Enter the day the visa was granted. Fill only if 'Yes', 'Permanent', 'Temporary' is 'Yes' for any. Max length: 2 characters Depends on: Yes, Permanent, Temporary
Visa Grant Month	Text	Enter the month the visa was granted. Fill only if 'Yes', 'Permanent', 'Temporary' is 'Yes' for any. Max length: 2 characters Depends on: Yes, Permanent, Temporary
Visa Grant Year	Number	Enter the year the visa was granted. Fill only if 'Yes', 'Permanent', 'Temporary' is 'Yes' for any. Max length: 4 characters Depends on: Yes, Permanent, Temporary
Arrival Visa Type
Permanent	Checkbox	Check this box if you arrived in the country on a permanent visa.
Temporary	Checkbox	Check this box if you arrived in the country on a temporary visa.
New Zealand passport (Special Category visa)	Checkbox	Check this box if you arrived in the country using a New Zealand passport under a Special Category visa.
Temporary Visa Type	Text	Please provide the specific type of temporary visa you arrived on.
Not sure	Checkbox	Check this box if you are not sure what type of visa you arrived on.
Assurance of Support for Migration
No	Checkbox	Check this box if no one provided you with an assurance of support for your migration to Australia.
Not sure	Checkbox	Check this box if you are not sure whether someone provided you with an assurance of support for your migration to Australia.
Yes	Checkbox	Check this box if someone did provide you with an assurance of support for your migration to Australia.
Australian Citizen Born in Australia Check
No	Checkbox	Check this box if you are an Australian citizen but were not born in Australia.
Yes	Checkbox	Check this box if you are an Australian citizen and were born in Australia.
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Australian Disability Enterprise Employment (First Employer)
No	Checkbox	Check this box if you do not work for an Australian Disability Enterprise. Fill only if 'No' is 'Yes'. Depends on: No
Yes	Checkbox	Check this box if you work for an Australian Disability Enterprise. Fill only if 'No' is 'Yes'. Depends on: No
Australian Disability Enterprise Employment (Second Employer)
No	Checkbox	Check this box if you do not work for an Australian Disability Enterprise. Fill only if 'No' is 'Yes'. Depends on: No
Yes	Checkbox	Check this box if you do work for an Australian Disability Enterprise. Fill only if 'No' is 'Yes'. Depends on: No
Australian South Sea Islander Descent
No	Checkbox	Check this box if you are not of Australian South Sea Islander descent.
Yes	Checkbox	Check this box if you are of Australian South Sea Islander descent.
Benefit Recipient Inquiry
No (receiving payments)	Checkbox	Check this box if you are not receiving JobSeeker Payment, Youth Allowance (job seeker), or Parenting Payment with mutual obligation requirements.
Job Search Activities Details	Text	Provide a detailed list or description of the job search activities you are currently undertaking.
Yes (receiving payments)	Checkbox	Check this box if you are receiving JobSeeker Payment, Youth Allowance (job seeker), or Parenting Payment with mutual obligation requirements.
Bi-weekly Work Hours (First Employer)
Bi-weekly Work Hours	Number	Please enter the total number of hours you spend at work over a two-week period. Fill only if 'Yes' is 'Yes'. Max length: 3 characters Depends on: Yes
Bi-weekly Work Hours (Second Employer)
Bi-weekly Work Hours	Number	Enter the total number of hours spent working over a two-week period for the second employer. Fill only if 'Yes' is 'Yes'. Max length: 3 characters Depends on: Yes
Business Details
	Text	Depends on: Yes
	Text	Depends on: Yes
	Text	Depends on: Yes
	Text	Max length: 4 characters Depends on: Yes
Country of Birth
Country of Birth	Text	Enter the country where you were born. Fill only if 'No' is 'Yes'. Depends on: No
Country of Citizenship Details
Australia	Checkbox	Check this box if Australia is your country of citizenship.
	Text
Australian Citizenship Granted Day	Text	Enter the day your Australian citizenship was granted. Fill only if 'No', 'Australia' is 'Yes' for all. Max length: 2 characters Depends on: No, Australia
Australian Citizenship Granted Month	Text	Enter the month your Australian citizenship was granted. Fill only if 'No', 'Australia' is 'Yes' for all. Max length: 2 characters Depends on: No, Australia
Australian Citizenship Granted Year	Text	Enter the year your Australian citizenship was granted. Fill only if 'No', 'Australia' is 'Yes' for all. Max length: 4 characters Depends on: No, Australia
Other	Checkbox	Check this box if your country of citizenship is not Australia and you need to specify it.
Other Citizenship Country	Text	Enter the name of your other country of citizenship. Fill only if 'No', 'Other' is 'Yes' for all. Depends on: No, Other
Other Citizenship Granted Day	Text	Enter the day your citizenship for the other country was granted. Fill only if 'No', 'Other' is 'Yes' for all. Max length: 2 characters Depends on: No, Other
Other Citizenship Granted Month	Text	Enter the month your citizenship for the other country was granted. Fill only if 'No', 'Other' is 'Yes' for all. Max length: 2 characters Depends on: No, Other
Other Citizenship Granted Year	Text	Enter the year your citizenship for the other country was granted. Fill only if 'No', 'Other' is 'Yes' for all. Max length: 4 characters Depends on: No, Other
Court Order Inquiry
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 Country of Residence
Australia	Checkbox	Check this box if Australia is your current country of residence.
Other	Checkbox	Check this box if your current country of residence is not Australia.
Country of Residence	Text	Enter the name of the country where you currently reside.
Additional Country Details	Text	Provide any additional details or clarification about your country of residence. Fill only if 'Other' is 'Yes'. Depends on: Other
Current Motor Vehicle Status
No	Checkbox	Check this box if you no longer have the motor vehicle that was given to you by the Department of Veterans' Affairs. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Yes	Checkbox	Check this box if you still have the motor vehicle that was given to you by the Department of Veterans' Affairs. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Customer Reference Number
Customer Reference Number, Part 1	Text	Enter the first part of your customer reference number. Fill only if 'No' is 'Yes'. Max length: 3 characters Depends on: No
Customer Reference Number, Part 2	Text	Enter the second part of your customer reference number. Fill only if 'No' is 'Yes'. Max length: 3 characters Depends on: No
Customer Reference Number, Part 3	Text	Enter the third part of your customer reference number. Fill only if 'No' is 'Yes'. Max length: 3 characters Depends on: No
Customer Reference Number, Part 4	Text	Enter the fourth part of your customer reference number. Fill only if 'No' is 'Yes'. Max length: 1 characters Depends on: No
Date of Birth
Date of Birth Day	Text	Please provide the day of your birth (e.g., 01 for the 1st). Max length: 2 characters
Date of Birth Month	Text	Please provide the month of your birth (e.g., 12 for December). Max length: 2 characters
Date of Birth Year	Text	Please provide the four-digit year of your birth (e.g., 1990). Max length: 4 characters
Declaration Agreement
I have read, understood and agree to the above.	Checkbox	Check this box to confirm you have read, understood, and agree to the declaration provided in this section.
Declaration Date
Declaration Day	Text	Enter the day of the declaration date. Fill only if 'I have read, understood and agree to the above.' is 'Yes'. Max length: 2 characters Depends on: I have read, understood and agree to the above.
Declaration Month	Text	Enter the month of the declaration date. Fill only if 'I have read, understood and agree to the above.' is 'Yes'. Max length: 2 characters Depends on: I have read, understood and agree to the above.
Declaration Year	Number	Enter the year of the declaration date. Fill only if 'I have read, understood and agree to the above.' is 'Yes'. Max length: 4 characters Depends on: I have read, understood and agree to the above.
Disability/Parenting Payment Inquiry
No	Checkbox	Check this box if you are not receiving Disability Support Pension or Parenting Payment (without mutual obligation requirements).
	Text
Yes	Checkbox	Check this box if you are receiving Disability Support Pension or Parenting Payment (without mutual obligation requirements).
Documents Checklist
Identity documents	Checkbox	Check this box if you are providing identity documents with this form.
Details of vocational training	Checkbox	Check this box if you are providing details of vocational training, especially if you answered Yes at question 32.
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, especially if you answered Yes at question 33.
Details of self-employment	Checkbox	Check this box if you are providing details of self-employment, especially if you answered Yes at question 34.
Details of employment	Checkbox	Check this box if you are providing details of employment, especially if you answered Yes at question 35.
Details of voluntary work	Checkbox	Check this box if you are providing details of voluntary work, especially if you answered Yes at question 36.
Proof of job search activities	Checkbox	Check this box if you are providing proof of job search activities, especially if you answered Yes and it was required at question 37.
Authorising a person or organisation to enquire or act on your behalf (SS313) form	Checkbox	Check this box if you are providing the Authorising a person or organisation to enquire or act on your behalf (SS313) form, especially if you answered Yes at question 48.
Employment Services Program Question
No	Checkbox	Check this box if you are not participating in a program with an employment services provider.
Yes	Checkbox	Check this box if you are participating in a program with an employment services provider.
Employment Services Program Details	Text	Please provide details regarding your participation in an employment services program.
Employment Services Provider 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 address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Address Line 2	Text	Enter the second line of the employment services provider's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Address Line 3	Text	Enter the third line 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 full phone number, including the area code, for the employment services provider. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Provider Name	Text	Please enter the full name of your employment services provider. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Provider Address Line 1	Text	Please enter the first line of the employment services provider's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Provider Address Line 2	Text	Please enter the second line of the employment services provider's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Provider Address Line 3	Text	Please enter the third line of the employment services provider's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Provider Postcode	Text	Please enter the postcode of the employment services provider. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Provider Phone Number	Text	Please 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
Expected Work Duration
Less than 3 months	Checkbox	Check this box if you expect your 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 work to last for 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 work to last for more than 6 months. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Less than 3 months	Checkbox	Check this box if you expect the 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 the voluntary work to last for 3 to 6 months. Fill only if 'Yes' is 'Yes'. Depends on: Yes
More than 6 months	Checkbox	Check this box if you expect the voluntary work to last for more than 6 months. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Expected Work Duration (First Employer)
Less than 3 months	Checkbox	Check this box if you expect your work duration to be less than 3 months.
3 to 6 months	Checkbox	Check this box if you expect your work duration to be between 3 and 6 months.
More than 6 months	Checkbox	Check this box if you expect your work duration to be more than 6 months.
Expected Work Duration (Second Employer)
Less than 3 months	Checkbox	Check this box if you expect the work with your second employer to last less than 3 months.
3 to 6 months	Checkbox	Check this box if you expect the work with your second employer to last between 3 and 6 months.
More than 6 months	Checkbox	Check this box if you expect the work with your second employer to last more than 6 months.
Expected Work Finish Date
Expected Work Finish Day	Date	Provide the day of the month when you expect this work to finish. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Expected Work Finish Month	Date	Provide the month when you expect this work to finish. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Expected Work Finish Year	Date	Provide the year when you expect this work to finish. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Family Arrival on Refugee/Humanitarian Visa Check
No	Checkbox	Check this box if your partner and neither of your parents arrived on a refugee or humanitarian visa.
Yes	Checkbox	Check this box if your partner or either of your parents arrived on a refugee or humanitarian visa.
Fifth Country Lived In
Fifth Country Name	Text	Please enter the name of the fifth country you have lived in. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Fifth Country Start Date Day	Text	Please enter the day you started living in the fifth country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Fifth Country Start Date Month	Text	Please enter the month you started living in the fifth country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Fifth Country Start Date Year	Text	Please enter the year you started living in the fifth country. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
First Country Lived In
First Country Name	Text	Please provide the name of the first country you lived in. Fill only if 'Yes' is 'Yes'. Depends on: Yes
First Country Date From Day	Text	Please provide the day you started living in this country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
First Country Date From Month	Text	Please provide the month you started living in this country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
First Country Date From Year	Text	Please provide the year you started living in this country. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
First Employer's Address
Address Line 1	Text	Please provide the first line of the employer's address.
Address Line 2	Text	Please provide the second line of the employer's address.
Address Line 3	Text	Please provide the third line of the employer's address.
Postcode	Text	Please enter the postcode for the employer's address. Max length: 4 characters
First Employer's Australian Business Number (ABN)
ABN Segment 1	Text	Please enter the first numerical segment of the employer's Australian Business Number. Max length: 2 characters
ABN Segment 2	Text	Please enter the second numerical segment of the employer's Australian Business Number. Max length: 3 characters
ABN Segment 3	Text	Please enter the third numerical segment of the employer's Australian Business Number. Max length: 3 characters
ABN Segment 4	Text	Please enter the fourth numerical segment of the employer's Australian Business Number. Max length: 3 characters
First Employer's Name
Employer's Name	Text	Provide the full name of the first employer.
First Employer's Phone number
First Employer Phone Number	Text	Please provide the phone number for the first employer, including the area code. Max length: 10 characters
First Other Name Details
Other Name	Text	Provide the other name by which you have been known. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Other Name Type	Text	Indicate the type of other name, such as name at birth, name before marriage, or an alias. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Four-weekly Work Hours (First Employer)
Four-weekly Hours	Number	Enter the total number of hours you spend at work over a 4-week period. Fill only if 'Yes' is 'Yes'. Max length: 3 characters Depends on: Yes
Four-weekly Work Hours (Second Employer)
Four-weekly Work Hours	Number	Provide the total number of hours worked over a 4-week period for the second employer. Fill only if 'Yes' is 'Yes'. Max length: 3 characters Depends on: Yes
Fourth Country Lived In
Fourth Country Name	Text	Please enter the name of the fourth country you have lived in. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Fourth Country Start Date Day	Text	Please provide the day you started living in the fourth country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Fourth Country Start Date Month	Text	Please provide the month you started living in the fourth country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Fourth Country Start Date Year	Text	Please provide the year you started living in the fourth country. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Gender
Male	Checkbox	Check this box if your gender is Male.
Female	Checkbox	Check this box if your gender is Female.
Non-binary	Checkbox	Check this box if your gender is Non-binary.
General
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Holiday Trips Exclusion
Country Lived	Text	Please enter the name of a country where you have lived, excluding short trips or holidays.
Hours worked over 2 weeks
Hours in 2 Weeks	Number	Provide the total number of hours you spent at work over a two-week period. Fill only if 'Yes' is 'Yes'. Max length: 3 characters Depends on: Yes
Hours worked over 4 weeks
Hours Worked (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'. Max length: 3 characters Depends on: Yes
Independent Living Skills Course Details
	Text
Course Name	Text	Please enter the full name of the independent living skills course. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Course Hours per 4 Weeks	Number	Please enter the total number of hours you spend at this course over a 4-week period. Fill only if 'Yes' is 'Yes'. Max length: 3 characters Depends on: Yes
Independent Living Skills Training Expected Finish Date
Expected Finish Day	Text	Please provide the day you expect to finish your independent living skills or life skills training. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Expected Finish Month	Text	Please provide the month you expect to finish your independent living skills or life skills training. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Expected Finish Year	Text	Please provide the year you expect to finish your independent living skills or life skills training. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Independent Living Skills Training Organisation Details
Name of Training Organisation	Text	Please provide the full name of the training organisation for independent living skills or life skills. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Address Line 1	Text	Please provide the first line of the training organisation's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Address Line 2	Text	Please provide the second line of the training organisation's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Suburb/Town/City	Text	Please provide the suburb, town, or city of the training organisation's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Postcode	Text	Please enter the postcode of the training organisation's address. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Phone Number	Text	Please provide the phone number of the training organisation, including the area code. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Independent Living Skills Training Start Date
Start Day	Text	Please provide the day you started the independent living skills training. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Start Month	Text	Please provide the month you started the independent living skills training. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Start Year	Text	Please provide the year you started the independent living skills training. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Independent Living Skills Training Status
	CheckBox
Yes	Checkbox	Check this box if you are doing independent living skills or life skills training and need to provide details.
Interpreter Requirement
No	Checkbox	Check this box if you do not need an interpreter.
Other Sign Language	Text	Please specify any other sign language that you may require an interpreter for.
Yes	Checkbox	Check this box if you need an interpreter.
Job Plan Work Search
No	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 Job Plan.
Yes	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 Job Plan.
Job Search Activities Details
Job Search Activities List	Text	Provide details or a list of your job search activities if you do not have a Job Plan with an employment service provider. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Job Search Activities Inquiry
No	Checkbox	Check this box if you are not undertaking job search activities. Selecting this option will direct you to question 43.
Type of Job Search Activity	Text	Please specify any particular type or nature of job search activities you are undertaking. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Yes	Checkbox	Check this box if you are undertaking job search activities. Selecting this option requires you to provide details below.
Known By Other Names
No	Checkbox	Check this box if you have not been known by any other name(s).
Yes	Checkbox	Check this box if you have been known by other name(s) and need to provide details below.
Other Name 1	Text	Please provide the first alternative name you have been known by, such as a name at birth, previous married name, alias, or foster name.
Last Entry Details
Year of Last Entry	Text	Please provide the year you last entered Australia. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Passport Number	Text	Please enter your passport number. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Passport Country of Issue	Text	Please enter the country that issued your passport. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Lived in Australia Before 1965 Check
No	Checkbox	Check this box if you did not start living in Australia before 1965.
Yes	Checkbox	Check this box if you started living in Australia before 1965.
Lived in Australia Before 1965 Confirmation	Text	Indicate your confirmation of having lived in Australia before 1965 by typing 'Yes' or providing a brief detail.
Lived Outside Australia Question
No	Checkbox	Check this box if you have never lived outside Australia for any period.
Yes	Checkbox	Check this box if you have lived outside Australia for any period.
Lump Sum Payment Preference
No	Checkbox	Check this box if you do not wish to receive a 6-month lump sum payment.
Lump Sum Decision Reference	Text	Please provide a reference number or code if you are declining the 6-month lump sum payment and proceeding to question 48.
Yes	Checkbox	Check this box if you would like to receive a 6-month lump sum payment.
Minimum Wage Employment Status (First Employer)
	Text
No	Checkbox	Check this box if you are not employed at or above the relevant minimum wage.
Yes	Checkbox	Check this box if you are employed at or above the relevant minimum wage.
Minimum Wage Employment Status (Second Employer)
Employed Below Minimum Wage	Text	Indicate if you are employed below the relevant minimum wage.
No	Checkbox	Check this box if you are not employed at or above the relevant minimum wage for your second employer.
Yes	Checkbox	Check this box if you are employed at or above the relevant minimum wage for your second employer.
Most Recent Visa Details
Most Recent Visa Subclass	Text	Please enter the subclass of your most recent visa. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Most Recent Visa Granted Day	Text	Please enter the day your most recent visa was granted. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Most Recent Visa Granted Month	Text	Please enter the month your most recent visa was granted. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Most Recent Visa Granted Year	Text	Please enter the year your most recent visa was granted. Fill only if 'Yes' is 'Yes'. Max length: 4 characters 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).
Organisation Details
Organisation Name	Text	Provide the full legal name of the organisation you work for. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organisation Address Line 1	Text	Enter the first line of the organisation's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organisation Address Line 2	Text	Enter the second line of the organisation's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organisation Address Line 3	Text	Enter the third line of the organisation's address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organisation Postcode	Text	Enter the postcode of the organisation's address. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Organisation Phone Number	Text	Provide the phone number of the organisation, including the area code. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Payment Details
Bank Name	Text	Please enter the full name of your bank, building society, or credit union where the payment should be made.
BSB Number	Number	Please enter the Branch State Bank (BSB) number for your account. Max length: 6 characters
Account Number	Number	Please enter your bank account number.
Account Holder Name(s)	Text	Please enter the full name(s) of the individual(s) or entity in whose name the account is held.
Payment Requirements
No	Checkbox	Check this box if you are not required to meet specific requirements to receive your payment.
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Yes	Checkbox	Check this box if you are required to meet specific requirements to receive your payment.
Planned Leave from Australia
No	Checkbox	Check this box if you do not plan to leave Australia within the next 6 months.
Yes	Checkbox	Check this box if you plan to leave Australia within the next 6 months (even for a short holiday).
Planned Departure Day	Text	Enter the day you plan to leave Australia (e.g., '01' for the first day of the month).
Planned Departure Month	Text	Enter the month you plan to leave Australia (e.g., '07' for July). Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Planned Departure Year (First Two Digits)	Text	Enter the first two digits of the year you plan to leave Australia (e.g., '20' for the year 2023). Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Planned Departure Year (Last Two Digits)	Text	Enter the last two digits of the year you plan to leave Australia (e.g., '23' for the year 2023). Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Pre-1965 Arrival Details
Ship or Airline Name	Text	Enter the name of the ship or airline on which you arrived. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Place of Arrival/Disembarkation	Text	Enter the name of the place where you first arrived in Australia or disembarked. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Name at Arrival	Text	Enter the name you used when you first arrived in Australia. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Preferred Spoken Language
Preferred Spoken Language	Text	Please provide your preferred spoken language. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Preferred Written Language
Preferred Written Language	Text	Please provide your preferred written language. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Previous Payments Claim
No	Checkbox	Check this box if you (and/or your partner) have NOT received or claimed any of the listed payments in the last 14 days.
Yes	Checkbox	Check this box if you (and/or your partner) HAVE received or claimed any of the listed payments in the last 14 days.
Next Question if No	Text	Please enter the number of the next question to proceed to if you have not received or claimed any payments.
Program Expected Completion Date
Expected Completion Day	Text	Please enter the day of the month when you expect to complete this program. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Expected Completion Month	Text	Please enter the month when you expect to complete this program. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Expected Completion Year	Text	Please enter the year when you expect to complete this program. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Program Start Date
Start Day	Text	Please provide the day you started this program. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Start Month	Text	Please provide the month you started this program. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Start Year	Number	Please provide the year you started this program. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Proof Description
Proof Details	Text	Provide a brief detail or reference for the proof of hours spent at work. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Rehabilitation Program Travel Question
No	Checkbox	Check this box if you do not travel to and from home to do your rehabilitation program. 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 rehabilitation program. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Second Country Lived In
Second Country Name	Text	Please provide the name of the second country you have lived in. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Second Country Date From Day	Text	Please enter the day you started living in this second country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Second Country Date From Month	Text	Please enter the month you started living in this second country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Second Country Date From Year	Text	Please enter the year you started living in this second country. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Second Employer's Address
Address Line 1	Text	Please enter the first line of the second employer's address.
Address Line 2	Text	Please enter the second line of the second employer's address.
Address Line 3	Text	Please enter the third line of the second employer's address, which may include suburb, city, or state.
Postcode	Text	Please enter the postcode for the second employer's address. Max length: 4 characters
Second Employer's Australian Business Number (ABN)
ABN Part 1	Text	Please enter the first segment of the second employer's Australian Business Number. Max length: 2 characters
ABN Part 2	Text	Please enter the second segment of the second employer's Australian Business Number. Max length: 3 characters
ABN Part 3	Text	Please enter the third segment of the second employer's Australian Business Number. Max length: 3 characters
ABN Part 4	Text	Please enter the fourth segment of the second employer's Australian Business Number. Max length: 3 characters
Second Employer's Name
Employer's Name	Text	Please provide the full legal name of the second employer.
Second Employer's Phone number
Second Employer's Phone Number	Text	Please provide the phone number for the second employer, including the area code. Max length: 10 characters
Second Other Name Details
Other Name 2	Text	Provide the second other name associated with the individual. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Other Name 2 Type	Text	Specify the type of the second other name, for instance, name before marriage or an alias. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Self-Employment Travel
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 (e.g., to your place of work or visiting clients). Fill only if 'Yes' is 'Yes'. Depends on: Yes
Signature
Signature	Text	Provide your signature in this field to acknowledge and agree to the declaration details. Fill only if 'I have read, understood and agree to the above.' is 'Yes'. Depends on: I have read, understood and agree to the above.
Sixth Country Lived In
Country Name	Text	Enter the name of the sixth country you have lived in. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Start Date Day	Text	Enter the day you started living in the sixth country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Start Date Month	Text	Enter the month you started living in the sixth country. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Start Date Year	Text	Enter the year you started living in the sixth country. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Studying and Allowance Status
No	Checkbox	Check this box if you are not studying and receiving Youth Allowance or Austudy.
Austudy Reference	Text	Please provide any relevant reference number or code related to your Austudy status.
Yes	Checkbox	Check this box if you are studying and receiving Youth Allowance or Austudy.
Supported Wage System Employment (First Employer)
No	Checkbox	Check this box if you are not employed under the Supported Wage System. Fill only if 'No' is 'Yes'. Depends on: No
Yes	Checkbox	Check this box if you are employed under the Supported Wage System. Fill only if 'No' is 'Yes'. Depends on: No
Supported Wage System Employment (Second Employer)
No, not employed under Supported Wage System	Checkbox	Check this box if you are not employed under the Supported Wage System, or if your employer confirms you are not. Fill only if 'No' is 'Yes'. Depends on: No
Yes, employed under Supported Wage System	Checkbox	Check this box if you are employed under the Supported Wage System, or if your employer confirms you are. Fill only if 'No' is 'Yes'. Depends on: No
Third Country Lived In
Third Country Name	Text	Please enter the name of the third country you have lived in. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Third Country Lived In Start Day	Text	Please enter the day you started living in the third country (DD). Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Third Country Lived In Start Month	Text	Please enter the month you started living in the third country (MM). Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Third Country Lived In Start Year	Text	Please enter the year you started living in the third country (YYYY). Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Third Party Authorisation
No	Checkbox	Check this box if you do not want to authorise a person or organisation to make enquiries, updates, act, or get payments on your behalf.
Yes	Checkbox	Check this box if you want to authorise a person or organisation to make enquiries, updates, act, or get payments on your behalf.
Travel for Independent Living Skills Training
No	Checkbox	Check this box if you do not travel to and from home for 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 for 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 your study requirements.
Yes	Checkbox	Check this box if you travel to and from home for your study requirements.
Travel for Vocational Training
No	Checkbox	Check this box if you do not travel from home to do your vocational training. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Yes	Checkbox	Check this box if you travel from home to do your vocational training (for example, school, library, residential course). Fill only if 'Yes' is 'Yes'. Depends on: Yes
Travel for Work Activities
No	Checkbox	Check this box if you do not travel to and from home to do the looking for work activities.
Yes	Checkbox	Check this box if you travel to and from home to do the looking for work activities.
Travel Outside Australia Check
No	Checkbox	Check this box if you have never travelled outside Australia, including short trips and holidays.
Yes	Checkbox	Check this box if you have ever travelled outside Australia, including short trips and holidays.
	Text
Type of Voluntary Work
Type of Work	Text	Please specify the nature or category of the voluntary work you are performing. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Type of work
Type of Work	Text	Please describe the specific type of work you are currently doing. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Vehicle Assistance Scheme Status
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.
	Text
Yes	Checkbox	Check this box if you have been given a motor vehicle under the Vehicle Assistance Scheme from the Department of Veterans' Affairs.
Visa Change Since Arrival Check
No	Checkbox	Check this box if your visa has not changed since you arrived in Australia.
Yes	Checkbox	Check this box if your visa has changed since you arrived in Australia.
Most Recent Visa Details Indicator	Text	Please provide any additional identifier or indicator for the most recent visa details, if applicable.
Vocational Training Course Details
Course Proof Details	Text	Please provide detailed information about your vocational training course, including proof of hours spent over a 4-week period.
Course Name	Text	Please enter the full name of the vocational training course. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Hours Per 4 Weeks	Number	Please enter the total number of hours you spend on this course over a 4-week period. Fill only if 'Yes' is 'Yes'. Max length: 3 characters Depends on: Yes
Vocational Training Expected Finish Date
Expected Finish Day	Text	Enter the day of the month when you expect to finish the vocational training. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Expected Finish Month	Text	Enter the month when you expect to finish the vocational training. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Expected Finish Year	Text	Enter the year when you expect to finish the vocational training. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Vocational Training Organisation Details
Organisation Name	Text	Provide the full name of the vocational training organisation. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Address Line 1	Text	Enter the first line of the training organisation's street address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Address Line 2	Text	Enter the second line of the training organisation's street address. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Address Line 3 (City/Suburb)	Text	Enter the third line of the training organisation's address, typically the city or suburb. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Postcode	Text	Enter the postcode of the training organisation's address. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Phone Number	Text	Enter the phone number of the training organisation, including the area code. Fill only if 'Yes' is 'Yes'. Max length: 10 characters Depends on: Yes
Vocational Training Start Date
Start Day	Text	Please provide the day you started this vocational course. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Start Month	Text	Please provide the month you started this vocational course. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Start Year	Text	Please provide the year you started this vocational course. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Vocational Training Status
No	Checkbox	Check this box if you are not currently engaged in vocational training.
Yes	Checkbox	Check this box if you are currently engaged in vocational training, including tertiary education, secondary education, TAFE, courses for academic or trade qualifications, high school studies, or special schools.
Voluntary Work Hours
Total Voluntary Work Hours	Number	Provide the total number of hours you spend doing voluntary work over a four-week period. Fill only if 'Yes' is 'Yes'. Max length: 3 characters Depends on: Yes
Voluntary Work Inquiry
No	Checkbox	Check this box if you are not currently doing voluntary work for a charitable, welfare, or community organization.
Yes	Checkbox	Check this box if you are currently doing voluntary work for a charitable, welfare, or community organization.
	Text	Depends on: Yes
Voluntary Work Start Date
Voluntary Work Start Day	Text	Please enter the day you started this voluntary work. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Voluntary Work Start Month	Text	Please enter the month you started this voluntary work. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Voluntary Work Start Year	Text	Please enter the year you started this voluntary work. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Voluntary Work Travel Inquiry
No	Checkbox	Check this box if you do not travel to and from home to do your voluntary work. 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 voluntary work. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Work Requirement Inquiry
No	Checkbox	Check this box if, as part of your Job Plan, you are NOT required to look for work of 15 hours or more per week or participate in activities aimed at making you ready to look for such work.
	Text
Yes	Checkbox	Check this box if, as part of your Job Plan, you ARE required to look for work of 15 hours or more per week or participate in activities aimed at making you ready to look for such work.
Work Start Date
Work Start Date Day	Date	Please provide the day you started this work. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Work Start Date Month	Date	Please provide the month you started this work. Fill only if 'Yes' is 'Yes'. Max length: 2 characters Depends on: Yes
Work Start Date Year	Date	Please provide the year you started this work. Fill only if 'Yes' is 'Yes'. Max length: 4 characters Depends on: Yes
Work Start Date (First Employer)
Start Date Day	Text	Please enter the day you started this work. Max length: 2 characters
Start Date Month	Text	Please enter the month you started this work. Max length: 2 characters
Start Date Year	Text	Please enter the year you started this work. Max length: 4 characters
Work Start Date (Second Employer)
Start Date Day	Text	Please enter the day your work with the second employer started. Max length: 2 characters
Start Date Month	Text	Please enter the month your work with the second employer started. Max length: 2 characters
Start Date Year	Text	Please enter the year your work with the second employer started. Max length: 4 characters
Work Travel Details (First Employer)
No	Checkbox	Check this box if you do not travel to and from home to do this work, such as getting to your place of work or visiting clients.
Yes	Checkbox	Check this box if you do travel to and from home to do this work, such as getting to your place of work or visiting clients.
Work Travel Details (Second Employer)
No	Checkbox	Check this box if you do not travel to and from home for this work.
Yes	Checkbox	Check this box if you do travel to and from home for this work (for example, to get to your place of work, visiting clients).
Your contact details
Home Phone Number	Text	Please provide your home phone number, including the area code. Max length: 10 characters
Mobile Phone Number	Text	Please provide your mobile phone number. Max length: 10 characters
Fax Number	Text	Please provide your fax number, including the area code. Max length: 10 characters
Work Phone Number	Text	Please provide your work phone number, including the area code. Max length: 10 characters
Alternative Phone Number	Text	Please provide an alternative phone number, including the area code. Max length: 10 characters
Email Address	Text	Please provide your email address.
Your permanent address
Address Line 1	Text	Please enter the first line of your permanent address.
Address Line 2	Text	Please enter the second line of your permanent address, such as suburb or city.
Postcode	Text	Please enter your permanent address postcode. Max length: 4 characters
Your postal address
Postal Address Line 1	Text	Please provide the first line of your postal address, including street number and street name.
Postal Address Line 2	Text	Please provide the second line of your postal address, such as suburb, city, or additional address details.
Postcode	Text	Please provide your postal code for the specified address. Max length: 4 characters

Form SY042 - Claim for Mobility Allowance Instructions