Easypay Deduction Authority (Centrelink) 

Easypay Deduction Authority (Centrelink) 
EASY PAY DEDUCTION AUTHORITY FOR HOUSING PAYMENTS
Please complete this form if you want Centrelink to send your housing payments directly to the Department of
Housing and Public Works.
Please ensure that you sign the Authorisation on the second page of this form and return to your nearest
Housing Service Centre.
About you
Surname (Family name)
Given names
If you use a different name
with Centrelink, please state
it here
Date of birth
This number can be found on your Health Care
Card, Pension Concession Card or Centrelink
correspondence.
Your Centrelink Reference
Number CRN
Type of Centrelink payment
Your rental address
Suburb/Town
State: Queensland
Your telephone number
Home (
Postcode
)
Work (
)
About your payments to the Department of Housing and Public Works
What date do you want the deductions to
start?
/
/
Centrelink will send you a letter advising you of the date the direct deductions will commence.
Please continue to make your payments in the usual way until you receive this advice. You must ensure that
your rent payments are up to date when the deductions commence
The department will credit your payments to the account/s you have indicated below:
AMOUNT TO BE TAKEN OUT OF YOUR CENTRELINK PAYMENT EACH FORTNIGHT
Type of payment
Fortnightly Amount ($)
Rental Agreement
Rent
Rent arrears repayment
Maintenance/other repayments
Extra payments
Department of Housing and Public Works
www.hpw.qld.gov.au
Z_PRH099 Centrelink (29/01/2015)
Authorisation
•
I authorise Centrelink to take out of my pension payment each fortnight the amount/s stated above and pay them
directly to the Department of Housing and Public Works. These amounts relate to my agreement with the
department.
•
I understand that it is my choice to have the above amounts deducted from my Centrelink pension, and that I can
withdraw from the scheme at any time.
•
I agree that Department of Housing and Public Works may provide the answers on this form to the Centrelink and
confirm, where necessary, information I have provided on this form with the Centrelink .
•
I understand that if the household rent changes, the Department of Housing and Public Works will tell Centrelink
and the new amount will be taken out of my pension payment from the next available payday.
•
I understand that if there is more than one person having payments deducted for rent, any change to the amount to
be deducted will be divided in the same percentage proportion as stated on this form unless otherwise advised by
me.
•
I agree that if a person other than the tenant contributes to payments that are the tenant’s legal responsibility, no
rights or claims against the Department of Housing and Public Works are conferred on that other person.
•
I agree that the Department of Housing and Public Works rights or obligations to me or any other occupant of the
property are not diminished in any way by the fact that housing payments are received from Centrelink.
•
I agree that any credit due at the end of a Department of Housing and Public Works tenancy can be paid to any
person whose name was on the State Tenancy Agreement as a tenant of the property.
Your signature
___________________________________________________
PLEASE SIGN THE
AUTHORITY FORM
Date:______ / ______ / ______
Privacy Notice The Department of Housing and Public Works is collecting personal information on this form to provide you with housing assistance.
To assist you with your housing needs and services, your personal information may be disclosed to partner agencies, service providers, local
governments and non-governmental organisations that may be able to provide you with housing or support services. They may, to assist you with
your housing needs and services, pass on the information to other partner agencies, service providers, local governments and non-governmental
organisations that may be able to provide you with housing or support services. Limited personal information may be used for housing related
research, policy or planning functions. Unless authorised or required by law, your personal information will not otherwise be disclosed to any other
third party without your consent. More information about the Department’s privacy policy is available on our website at www.hpw.qld.gov.au.
.
Other things that are important
•
•
•
•
Any information you give may be used by Centrelink to check that you are getting your correct
entitlement.
If you have applied to receive a Centrelink payment but have not yet been paid, wait until you start
getting paid before completing this form.
To avoid any difficulties with this deduction, you should immediately advise Centrelink of your new
address if you just moved.
These deductions will continue until you advise in writing either the Department of Housing and Public
Works or Centrelink to stop them.
Housing Services office use only
Date form received:
______/______/______
Transfer:
New application:
Processing officer’s name:
_____________________________________________
Date entered into SAP:
______/______/______
Please return completed form to your nearest Housing Service Centre.
Department of Housing and Public Works
www.hpw.qld.gov.au
Z_PRH099 Centrelink (29/01/2015)
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