Document text
Request for Review of a "Member of a Couple" Decision and for Payment Pending Review
Full name: [YOUR FULL NAME]
Customer Reference Number (CRN): [CRN]
Date of birth: [DATE OF BIRTH]
Address: [YOUR ADDRESS]
Phone: [PHONE]
To: Services Australia — Centrelink
[ADDRESS OR CHANNEL FROM YOUR DECISION LETTER]
[DATE]
Formal review by an Authorised Review Officer — decision dated [DATE OF DECISION] that I am a member of a couple with [OTHER PERSON'S NAME]
Dear Sir or Madam,
I apply under section 129 of the Social Security (Administration) Act 1999 for review of the decision dated [DATE OF DECISION]. The decision treats me as a member of a couple from [START DATE] and pays my [NAME OF PAYMENT] at the partnered rate. I am not a member of a couple.
1. Payment pending review
The decision reduced my payment and depends on the Secretary's opinion about my relationship. Please declare under section 131 that my payment continues at the single rate until the review is decided.
2. Why the decision is wrong (section 4(3) of the Social Security Act 1991)
(a) Money: [NO JOINT ACCOUNTS, LOANS OR ASSETS; HOW RENT AND BILLS ARE SPLIT, E.G. EACH PAYS $AMOUNT].
(b) Household: [SEPARATE BEDROOMS; WHO CARES FOR THE CHILDREN; EACH DOES OWN SHOPPING, COOKING, WASHING].
(c) Social life: [WE DO NOT PRESENT AS A COUPLE; FRIENDS AND FAMILY KNOW US AS [HOUSEMATES / FORMER PARTNERS]].
(d) Sexual relationship: [NONE / ENDED ON DATE].
(e) Commitment: [NO PLANS TOGETHER; WE DO NOT SEE IT AS A MARRIAGE-LIKE RELATIONSHIP].
[IF MARRIED OR REGISTERED: We have lived separately and apart since [DATE OF SEPARATION] (section 4(2)(a)).]
[IF THERE IS A SPECIAL REASON: Please also consider a determination under section 24 because [REASON].]
3. Evidence enclosed
[LEASE OR ROOMING AGREEMENT]
[BANK STATEMENTS SHOWING SEPARATE FINANCES]
[STATEMENTS FROM [NAME] AND FROM FRIENDS OR FAMILY]
[OTHER EVIDENCE]
This request is made within 13 weeks of the notice. If the review is in my favour, please restore the single rate from the date the decision took effect (section 109(1)).
Please contact me on [PHONE] before deciding, and send me the decisions in writing.
Yours faithfully,
____________________
[YOUR FULL NAME]
For me
[ ] Notice date: [DATE]; 13 weeks ends [DATE]
[ ] Ask about the pause on any debt repayments while the review runs
[ ] Copy of the letter and proof of sending kept
[ ] After the ARO decision: Administrative Review Tribunal within 13 weeks if I still disagree