Work and Income / Te Hiranga Tangata

Printed from: https://services.workandincome.govt.nz

Printed: 12 July 2026

Residential Care Subsidy historic review request

About this form

Use this form to request a historic review of a financial means assessment.

The information you provide in this form will be used to check whether you've been affected by the May 2019 Court of Appeal decision in relation to Residential Care Subsidy.

If you're an agent you can complete this form on someone's behalf. We'll ask for proof of this if we don't already have it.

If you're an executor of their estate, an example of proof is a copy of their will. Once you've completed the form - email this proof to us at: RCS_historic_review@msd.govt.nz

Please note the questions in this form may change dynamically based on your answers to previous questions.

Keeping a copy of this form

After you submit the form, you’ll see a confirmation page with all the information you entered. If you want to keep a copy, you can print that page or save it as a PDF using the browser’s print function. We can’t provide you with a copy of the form later.

Who you are

This form can be completed for yourself, or if you're an agent, on behalf of someone else.
Are you completing this form for yourself or on behalf of someone else? (required)

Agent's details

Questions saying 'you' refer to the person in care (MSD's client)

Client details

This is a 9-digit number we issue you, the first time you deal with us. You can find this on letters from us, or on your Community Services or SuperGold Card. If you don't have one, or can't find it, you can request one using the Request a client number form

Contact information

How would you prefer that we get in touch with you about this form? (required)
This must be a valid New Zealand number.

Residential care subsidy details

Rest home or private hospital address
If you're not sure what the postcode is for this address, you can find it with the NZ Post postcode finder

This includes selling an asset, a change in your income or relationship status

You can write up to 1000 characters, including spaces.
Apart from your own money, was there any other money you could have used? (required)
This includes whether you could have used money from a trust, estate, family member or someone else to pay for your care. If there was, we may ask why you chose not to access that support. If yes, we will be in touch to talk with you about this

Please include the name of the person or entity (for instance trust or estate) who gave the money and their relationship to you.

You can write up to 1000 characters, including spaces.
You can write up to 1000 characters, including spaces.

For instance was it weekly, monthly or a one-off payment? And for how long - was it the whole time in residential care or just some of the time?

You can write up to 1000 characters, including spaces.

Please include the name of the person or entity (for instance trust or estate) and their relationship to you.

You can write up to 1000 characters, including spaces.
You can write up to 1000 characters, including spaces.

For instance was it weekly, monthly or a one-off payment? And for how long - was it the whole time in residential care or just some of the time?

You can write up to 1000 characters, including spaces.
Was there a formal, written agreement? (required)
We might be in touch to talk with you about this.
You can write up to 1000 characters, including spaces.

Past financial support means money that doesn't need to be paid back. This includes receiving free accommodation, distributions of income and/or assets from a trust or an estate, or someone paying costs on your behalf.

You can write up to 1000 characters, including spaces.

If yes tell us about that financial hardship, for instance the family had to re-mortgage their house to pay for care.

You can write up to 1000 characters, including spaces.

Bank account details

If we owe you a refund, we'll pay it into the bank account we already have for you.
If the client has died, we'll pay the executor or administrator of their estate. If this is you, please ensure you provide us with evidence of this. This can be done with a copy of the will or probate which you can email to us at RCS_historic_review@msd.govt.nz if you have this ready now.

Declarations