Document text
Request for Review of a Family Tax Benefit Decision
Full name: [YOUR FULL NAME]
Customer Reference Number (CRN): [CRN]
Date of birth: [DATE OF BIRTH]
Address: [YOUR ADDRESS]
Phone: [PHONE]
Email: [EMAIL]
To: Services Australia — Family Tax Benefit
[ADDRESS OR CHANNEL FROM YOUR DECISION LETTER]
[DATE]
Request for formal review by an Authorised Review Officer — decision dated [DATE OF DECISION]
Dear Sir or Madam,
I apply under section 109A of the A New Tax System (Family Assistance) (Administration) Act 1999 for a review of the decision dated [DATE OF DECISION], which I was told about on [DATE NOTIFIED]. Please arrange for an Authorised Review Officer to review it.
The decision
[WHAT THE DECISION SAYS — for example: reconciliation of Family Tax Benefit Part A and Part B for [INCOME YEAR], result: [DEBT OF $AMOUNT / NO TOP-UP / REDUCED RATE]; care percentage for [CHILD'S NAME]; cancellation from [DATE]].
Why I think it is wrong (tick all that apply)
( ) The income used is wrong. My adjusted taxable income for [INCOME YEAR] was $[AMOUNT], as shown in my notice of assessment dated [DATE]. My partner's was $[AMOUNT].
( ) The care arrangements used are wrong. [CHILD'S NAME] has been in my care [NUMBER] nights a fortnight since [DATE].
( ) The dates are wrong. [EXPLAIN].
( ) Other: [EXPLAIN IN YOUR OWN WORDS].
Time limit
This request is made within 52 weeks of the notice (section 109D(1)(b)). [IF THE DECISION IS ABOUT FTB PAID BY INSTALMENT: There is no fixed time limit for this kind of decision (section 109D(6)).] [IF LATE: I could not apply earlier because [SPECIAL CIRCUMSTANCES, WITH DATES]. Please accept this application under section 109D(2).]
Payment while the review runs
[IF YOUR FTB WAS STOPPED OR REDUCED:] Please consider declaring under section 109G that my Family Tax Benefit continues at the previous rate until the review is decided.
Evidence enclosed
[NOTICE OF ASSESSMENT / TAX RETURN]
[CARE RECORDS, PARENTING PLAN OR COURT ORDER]
[OTHER EVIDENCE]
Please contact me on [PHONE] before deciding, and send me the review decision in writing.
Yours faithfully,
____________________
[YOUR FULL NAME]
For me
[ ] Date I was told about the decision: [DATE]; 52 weeks ends [DATE]
[ ] Decision about instalments or a debt? No fixed limit, but asking within 52 weeks protects back pay
[ ] Copy of the letter and proof of sending kept
[ ] After the review decision: Administrative Review Tribunal within 90 days if I still disagree