Child support information request form
Complete the ‘Customer’s details’ and ‘Customer authority’ sections of this form to allow the Queensland Department of Housing to contact Services Australia directly to obtain current details of your child support payments. An officer from the department will then email the form to Services Australia to complete and return. This process is allowable under the Information Protocol between Services Australia and the department.
Customer details
Customer name:

Address:

Date of birth:	Phone:

CSA Case no/Centrelink CRN (Customer Reference Number):

Customer Authority
I,

(Please print full name)
authorise Services Australia to release the child support information requested below to the Queensland Department of Housing. This authority relates only to the requested information and will lapse once the information has been provided by Services Australia.
Signature of Customer

Services Australia to complete
The Customer has authorised the release of this information to the Queensland Department of Housing. Please provide the information listed below, regarding the above Customer.

	

Monthly entitlement

Disbursement history for previous 6 months
Any other details (if required)

Department of Housing staff to email completed form to mail.handling@servicesaustralia.gov.au (subject heading “QLD HOUSING”)

Officer’s name:		Date:	
Phone No:		Fax		Email:	

PH051 - 27/07/2023