Disability Allowance Form NZ: How to Fill It In Step by Step

The April 2026 S03 form is for current clients applying for help with ongoing medical costs. If you are not receiving a Work and Income payment, or receive only childcare assistance, Work and Income directs you to apply online through MyMSD or use the Extra Help application instead.

Download the latest form from Work and Income on the day you start. Old saved copies can omit changed declarations, evidence requests or rate-year information.

The form begins with your client number, name, date of birth, address, contact details and relationship status. It then asks who lives with you, whether anyone pays board or rent, and details about your accommodation costs. Answer the branch questions carefully so you do not fill sections that do not apply.

Use the same names and relationship details Work and Income already holds, and explain genuine changes. A blank answer can look like a missed question, so use “not applicable” where the form needs a clear response.

S03 asks about many income sources over the last 52 weeks and expected income over the next 52 weeks, including wages, ACC, self-employment, interest, rent, board, child support, pensions, trusts and other payments. Use before-tax figures and attach proof when the form asks for it.

If income varies, gather payslips, accounts or payment records before guessing. Do not leave out income because it seems unrelated to the disability—the agency decides how it is treated.

Question 39 asks for the type of cost, amount, frequency and the family member it relates to. Write entries so another person can reproduce the weekly figure: “prescriptions, $24 monthly” is clearer than “medicine varies”. Include insurance or ACC reimbursement in the earlier questions so the uncovered portion is visible.

For example, $15.00 every month for medical visits becomes about $3.46 a week, while $18.00 weekly travel remains $18.00. Keep the original frequency on the form and let your evidence support it; the weekly conversion is a check, not a replacement for the source amount.

Use practitioner or pharmacy print-outs for visits and prescriptions, tickets or mileage details for travel, summer and winter bills for extra heating, and contracts or receipts for medical alarms. Special food and counselling costs can need additional forms. A bank statement may show that money left your account but not what the purchase was for.

The strongest proof shows what the cost is, how much it is and how often it occurs. If you cannot obtain a normal receipt, ask Work and Income what alternative it will accept before submitting an unexplained total.

The medical pages ask whether the condition meets the Disability Allowance definition, its expected duration, the necessary practitioner visits and the items, services, treatments or medicines with therapeutic value. Give the practitioner your cost list so the medical evidence and application describe the same expenses.

Do not complete or sign the practitioner declaration yourself. A receipt proves price; it does not prove medical necessity. The medical certificate and cost evidence do different jobs, and most claims need both.

Read the change-reporting obligations, sign the applicant section and obtain a partner signature where required. Copy or photograph the completed pages and attachments. Paper documents can be delivered or posted to a service centre; Work and Income also explains when documents can be uploaded through MyMSD.

Record when you first contacted Work and Income. Its current guidance says assistance can be granted from that date when the completed application is returned within 20 working days. If a cost is declined, ask which rule or missing evidence led to the decision and request a review if you believe it is wrong.