You should complete this declaration if you want to:
- increase the amount withheld from payments to you to cover your Medicare levy surcharge (MLS)
- claim an exemption from the Medicare levy
- reduce the additional pay as you go (PAYG) amount withheld from payments to you to cover the Medicare levy
- claim an exemption from compulsory Higher Education Loan Program (HELP) or Financial Supplement repayments because of your low family income.
This publication is made up of two parts:
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The information in these instructions is current until 30 June 2013. You do not need to complete a new declaration unless your situation changes. You must lodge a new declaration if either:
- you leave your current payer and start to receive payments from a new payer
- your circumstances change.
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If you give the wrong information on this form, you may have insufficient amounts withheld from payments made to you and this may result in a significant tax debt at the end of the income year.
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Is this the right form for you?
Complete this declaration to claim an exemption from the Medicare levy or to vary the amount withheld for the levy if one of the following applies:
- you are in one of the Medicare levy exemption categories
- the combined weekly income of you and your spouse is less than $740 or, if you maintain a child or student, less than the relevant amount shown in table A
- you are a sole parent with a weekly income of less than $808 or, if you maintain more than one child or student, less than the relevant amount shown in table A
- you have to pay the additional 1% Medicare levy surcharge and want to increase the amount withheld from payments to you to cover the surcharge (for more information, see Who is liable for the surcharge?)
Also complete this declaration if you want to claim an exemption from HELP or Financial Supplement repayments for a year because, due to low family income, you are entitled to a reduction of the Medicare levy or you do not have to pay the Medicare levy.
Privacy of information
We are authorised by the Taxation Administration Act 1953 (TAA 1953) to collect your tax file number (TFN). You are not required by law to provide your TFN. However, quoting your TFN reduces the risk of administrative errors and having extra tax withheld.
We are authorised to collect information on this declaration by one or more of the following acts:
- Income Tax Assessment Act 1936
- Income Tax Assessment Act 1997
- Higher Education Funding Act 1988
- Higher Education Support Act 2003
- Social Security Act 1991
- Student Assistance Act 1973
- Taxation Administration Act 1953.
The information you provide will help us to administer these Acts and other tax laws.
Where we are authorised by law to do so, we may give this information to other government agencies. These agencies could include the departments of Human services, Families, Housing, Community Services and Indigenous Affairs; Veterans' Affairs; and Education, Employment and Workplace Relations.
If you need more information about how the tax laws protect your personal information, or have any concerns about how we have handled your personal information, phone 13 28 61 between 8.00am and 6.00pm, Monday to Friday.
Last Modified: Friday, 6 July 2012