Mobility Allowance Claim for Advance Payment - Australia
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MA007T.1403
If you are eligible for Mobility Allowance, you can receive
an advance on your payments. The advance equals 13
fortnightly payments.
It is only paid once every 12 months and any part of the
advance cannot be returned in order to resume
fortnightly payments. When the 6 month advance period
ends, you automatically go back to fortnightly payments.
Did someone help you complete this form?
Statement
15
16
Name of person who helped you
18
I declare that:
• the information provided in this form is complete and
correct.
I understand that:
• if someone has helped me complete this form, the
Australian Government Department of Human Services
may contact them to clarify details provided.
• giving false or misleading information is a serious
offence.
• the Australian Government Department of Human
Services can make relevant enquiries to make sure I
receive my correct entitlement.
Would you like to receive a 6 month lump sum payment?
Why did you need help to complete this form?
No
Yes
Go to next question
Give details below
No
Yes
Your signature
Date
/ /
When do you expect to finish?
Will an
y of the activities you selected in question 7 continue
for the next 6 months?
11
Go to next question
12
You will not be eligible for an advance
payment of Mobility Allowance. For more
information call us on 132 717.
Ongoing
No
Yes
/ /
Do you expect to leave Australia in the next 6 months (even
for a short holiday)?
When do you expect to leave?
13
Go to 15
Go to next question
14
No
Yes
/ /
17
Privacy and your personal information
Your personal information is protected by law, including
the
Privacy Act 1988
, and is collected by the Australian
Government Department of Human Services for the
assessment and administration of payments and
services. This information is required to process your
application or claim.
Your information may be used by the department or given
to other parties for the purposes of research,
investigation or where you have agreed or it is required
or authorised by law.
You can get more information about the way in which the
Department of Human Services will manage your
personal information, including our privacy policy at
www.
humanservices.gov.au/privacy or by requesting a copy
from the department.
IMPORTANT INFORMATION
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