Child Care Rebate Application Form
08-229 (0315-1540) (Page 1 of 2)
Application for Child Care Benefit for 24 hour care beyond
14 periods per financial year
A family may receive 24 hour care in a Child Care Benefit approved child care service (excluding occasional
care services) when because of work-related commitments or exceptional circumstances neither parent (or
the single parent) is available to care for the child for a period of 24 hours.
Child Care Benefit approved child care services have discretion to approve up to 14 periods of 24 hour care
for a child in a financial year (e.g.1 July 2015 — 30 June 2016). After 14 periods of 24 hour care are used,
this form must be completed as soon as possible and in advance of further 24 hour care being provided,
and forwarded to the Special Child Care Assistance Team in the Department of Human Services. They can
be contacted on 1800 050 021, or by fax to 1800 700 533.
1 Customer details
Family name ____________________________________
Given names ____________________________________
Home address ____________________________________
____________________________________ Postcode _________
Home telephone number ( ) ___________________________
Work telephone number ( ) ___________________________
Customer Reference Number (CRN) ___________________________
2 Child details
Child 1 Child 2 Child 3 Child 4
Family name _____________ _____________ _____________ _____________
Given names _____________ _____________ _____________ _____________
Child CRN _____________ _____________ _____________ _____________
If 24 hour care is being sought for more than 4 children, please attach a separate sheet with the above details.
3 Care required
Please provide detailed information about the reason(s) 24 hour care is required. Please attach a separate sheet if
insufficient space.
Note: The bottom one-quarter of Page 1 has been left blank here for you to provide your detailed information.
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