Services Australia Advice of Imprisonment or Custody (MOD F) Instructions
This form contains 92 fields organized into 23 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Approved Activity Participation Question | ||
| No | Checkbox |
Check this box if you did not participate in an activity approved by Centrelink or your Employment Services Provider up until the day before going into custody.
|
| Yes | Checkbox |
Check this box if you did participate in an activity approved by Centrelink or your Employment Services Provider up until the day before going into custody.
|
| Carer Payment/Allowance Information | ||
| No | Checkbox |
Check this box if no one receives Carer Payment or Carer Allowance to care for you.
|
| Yes | Checkbox |
Check this box if someone receives Carer Payment or Carer Allowance to care for you.
|
| Child's Details | ||
| Child's Full Name | Text |
Please provide the full name of the child. Fill only if 'Are you receiving Family Tax Benefit?' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Child's Date of Birth | Date |
Please provide the child's date of birth. Fill only if 'Are you receiving Family Tax Benefit?' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Date Child Left Care | Date |
Please provide the date the child left your care. Fill only if 'Are you receiving Family Tax Benefit?' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| No | Checkbox |
Check this box if the change related to the child's care will not last longer than 4 weeks. Fill only if 'Are you receiving Family Tax Benefit?' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Yes | Checkbox |
Check this box if the change related to the child's care will last longer than 4 weeks. Fill only if 'Are you receiving Family Tax Benefit?' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Contact Details | ||
| Email Prefix | Text |
Enter the unique prefix of the email address for Services Australia.
|
| Fax Number | Text |
Enter the fax number for Services Australia.
|
| Correctional Centre | ||
| Correctional Centre Name | Text |
Please provide the full name of the correctional centre from which this form is being sent.
|
| Current Carer's Address | ||
| Current Carer's Address Line 1 | Text |
Please enter the first line of the current carer's street address. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Current Carer's Address Line 2 | Text |
Please enter the second line of the current carer's address, such as the suburb or city. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Current Carer's Postcode | Text |
Please enter the postcode for the current carer's address. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Current Carer's Details | ||
| Current Carer's Full Name | Text |
Please provide the full name of the current carer. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Carer's Address Line 1 | Text |
Please provide the first line of the current carer's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Carer's Address Line 2 | Text |
Please provide the second line of the current carer's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Carer's Address Line 3 | Text |
Please provide the third line of the current carer's address, which might include suburb or city. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Carer's Postcode | Text |
Please provide the postcode for the current carer's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Carer's Contact Number | Text |
Please provide the contact telephone number for the current carer, including the area code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Custody Details | ||
| First Custody Location | Text |
Please provide the location where you were first held in custody, such as a police station or court cells.
|
| Date First Custody | Date |
Please provide the date when you were first held in custody.
|
| Correctional Centre Transfer Location | Text |
Please provide the name of the correctional centre to which you were transferred.
|
| Date Transferred to Correctional Centre | Date |
Please provide the date when you were transferred to the correctional centre.
|
| Customer Reference Number | ||
| Customer Reference Number Part 1 | Text |
Provide the first part of your customer reference number.
|
| Customer Reference Number Part 2 | Text |
Provide the second part of your customer reference number.
|
| Customer Reference Number Part 3 | Text |
Provide the third part of your customer reference number.
|
| Customer Reference Number Part 4 | Text |
Provide the fourth part of your customer reference number.
|
| Date of Birth | ||
| Date of Birth | Date |
Provide your date of birth.
|
| Family Tax Benefit Details | ||
| DummyCalcQ11 | Text | |
| Not Receiving Family Tax Benefit | Checkbox |
Check this box if you are not currently receiving Family Tax Benefit.
|
| DummyCalcQ14 | Text |
Depends on:
Receiving Family Tax Benefit
|
| Receiving Family Tax Benefit | Checkbox |
Check this box if you are currently receiving Family Tax Benefit.
|
| Child's Full Name | Text |
Please enter the full name of the child for whom Family Tax Benefit is being claimed. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Child's Date of Birth | Date |
Please enter the child's date of birth. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Date Child Left Care | Date |
Please enter the date the child left your care. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Change Not Longer Than 4 Weeks | Checkbox |
Check this box if the specified change will not last longer than 4 weeks. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Change Longer Than 4 Weeks | Checkbox |
Check this box if the specified change will last longer than 4 weeks. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Current Carer's Full Name | Text |
Please enter the full name of the child's current carer. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| Carer's Contact Number | Text |
Please enter the current carer's contact number, including the area code. Fill only if 'Receiving Family Tax Benefit' is 'Yes'.
Depends on:
Receiving Family Tax Benefit
|
| General | ||
| Instructions button | Button | |
| Permanent address line 1 | Text | |
| Permanent address line 2 | Text | |
| Q8GoToQ10 | Button | |
| Q11GoToQ13 | Button | |
| Carer's address line 1 | Text | |
| Carer's address line 2 | Text | |
| Clear button | Button | |
| Other Circumstance Changes | ||
| No | Checkbox |
Check this box if there have been no other changes in your circumstances apart from going into custody.
|
| Yes | Checkbox |
Check this box if there have been other changes in your circumstances, such as accommodation, rent, income, family circumstances, studies, or bank details.
|
| Change Category | Text |
Provide a brief category or summary of the other circumstance change. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Detailed Circumstance Changes | Text |
Provide comprehensive details regarding any other changes in your circumstances, such as accommodation, rent, income, family situation, studies, or bank details. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Names | ||
| Q3_No | CheckBox | |
| Q3 | CheckBox | |
| Other Name | Text |
Provide the full other name you have been known by. Fill only if 'Q3' is 'Yes'.
Depends on:
Q3
|
| Type of Other Name | Text |
Specify the type of other name, for example, name at birth, alias, or previous married name. Fill only if 'Q3' is 'Yes'.
Depends on:
Q3
|
| Other Names Declaration | ||
| Other Name Details | Text |
Please provide a detailed list of any other names you have been known by, including your name at birth, any aliases, name before marriage, previous married name, adoptive name, foster name, or Aboriginal or skin name.
|
| Paid Work Before Custody Details | ||
| No | Checkbox |
Check this box if you did not do any paid work up until the day before going into custody.
|
| Yes | Checkbox |
Check this box if you did do paid work up until the day before going into custody.
|
| DummyCalcQ10 | Text |
Depends on:
Yes
|
| Employer Name | Text |
Enter the full name of the employer for whom you performed paid work. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Gross Amount Paid | Number |
Enter the total gross amount of money you were paid for the work. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Period From | Date |
Enter the start date of the period for which you were paid. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Period To | Date |
Enter the end date of the period for which you were paid. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner Status | ||
| No | Checkbox |
Check this box if you do not have a partner.
|
| Yes | Checkbox |
Check this box if you have a partner.
|
| Partner's Paid Work Details | ||
| No | Checkbox |
Check this box if your partner did not do any paid work up until the day before you went into custody. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if your partner did some paid work up until the day before you went into custody. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| DummyCalcQ12 | Text |
Depends on:
Yes
|
| Partner's Employer Name | Text |
Enter the full name of the partner's employer. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Partner's Gross Amount Paid | Number |
Enter the gross amount paid to the partner. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Period Paid For From Date | Date |
Provide the start date for the period the partner was paid for. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Period Paid For To Date | Date |
Provide the end date for the period the partner was paid for. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Permanent Address | ||
| Permanent Address Line 1 | Text |
Please provide the first line of your permanent address, including street number and name, and any unit or apartment details.
|
| Permanent Suburb / State | Text |
Please provide the suburb, town, or state of your permanent address.
|
| Permanent Postcode | Text |
Please provide the postcode of your permanent address.
|
| Prison Identification Number | ||
| Prison Identification Number | Text |
Provide your unique identification number assigned by the prison or correctional facility.
|
| Signature Details | ||
| Signature | Text |
Please provide your signature.
|
| Signature Date | Date |
Please enter the date the signature was provided.
|
| Work/Activity Requirement Question | ||
| No | Checkbox |
Check this box if you did not need to look for work or participate in other activities to receive your Centrelink payments.
|
| DummyCalcQ8 | Text | |
| Yes | Checkbox |
Check this box if you needed to look for work or participate in other activities to receive your Centrelink payments.
|
| Your Name | ||
| Mr | Checkbox |
Check this box if your preferred title is Mr.
|
| Mrs | Checkbox |
Check this box if your preferred title is Mrs.
|
| Miss | Checkbox |
Check this box if your preferred title is Miss.
|
| Ms | Checkbox |
Check this box if your preferred title is Ms.
|
| Mx | Checkbox |
Check this box if your preferred title is Mx.
|
| Other Title | Text |
Enter any other title or salutation not listed in the options above. Fill only if 'Mx' is 'Yes'.
Depends on:
Mx
|
| Family Name | Text |
Enter your family name.
|
| First Given Name | Text |
Enter your first given name.
|
| Second Given Name | Text |
Enter your second given name, if applicable.
|