Emergency Benefit
Interview form 
You must complete this form for people who have applied for a main benefit – but instead may qualify 
for an Emergency Benefit.
You don’t need to complete this form when the client is applying because they’re:
• a seasonal worker
• serving a sentence of imprisonment in a psychiatric hospital or
• a spouse/partner of a client who has entered long-term residential care.
Once you’ve completed the form you must scan it and link it to the application client event note.
Client’s details
Client number
1
What is the person’s name?
First and middle names
Surname or family name
2
What date was the person born?
Day
Month
Year
Residency 
3
Is the person a New Zealand citizen or do they have permanent residence?
details
No 
Do they have a current temporary permit to be lawfully in New Zealand?
No
Yes
Yes
How long has the client lived in New Zealand?
Months
Years
Existing 
4
Does the person already get an Emergency Benefit?
benefit 
information
No 
Go to question 6
Yes
5
What was the reason the Emergency Benefit was granted?
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Hardship
6
Has the client said they’re in hardship?
No
Yes
Write down the client’s reason for this.
HOW TO ANSWER Q7:
Some examples could 
Before the person came to New Zealand, they would have told officials how they intended to 
include working, being 
support themselves and their dependent family for the first few years after arriving.
sponsored by a family 
member, living  
off savings.
7
How did the client intend to support themselves after they arrived in 
New Zealand?
HOW TO ANSWER Q8:
8
What has changed that means they can’t support themselves or be 
The answer should  
supported this way now?
tell us what’s changed 
from the original 
intention.
9
Could we reasonably expect the person to support themselves and their 
dependent family now?
No
Yes
Please give reasons for your answer.
Barriers to 
10
Are there any specific barriers preventing the person from working to 
working
support themselves and their family?
No
Yes
What are the barriers?
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11
Can these barriers be addressed?
No
Why not?
Yes
What could be done to address the barriers?
Options 
12
What has the person done to try to support themselves and their family?
INFORMATION FOR Q13:
13
Is there any other help that could improve their situation?
There may be help 
available from agencies 
No
Why not?
other than the Ministry of 
Social Development.
Yes
What help could they receive?
Main benefit
Extra help
One-off assistance
Other (for example help from other agencies)
Please describe below
Analogous 
benefit
An analogous benefit is the benefit that best fits the person’s circumstances and reasons for not 
being able to work.
14
Based on the questions and responses above, is the person still eligible for 
Emergency Benefit?
No 
Go to the signature panel
Yes
15
What is the analogous benefit for the person?
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16
What rate will it be granted at?
$
17
What obligations will the client have?
18
In SWIFTT, what ‘reason for emergency service’ will be used?
19
What date will the person be eligible for a statutory benefit?
Day
Month
Year
20
Have you entered the Expiry Date in SWIFTT?
Yes
Case manager’s name (print)
Case manager’s signature
Date
Day
Month
Year
Next Steps:
Check you’ve entered an Expiry Date in SWIFTT.
Scan this form.
Save and link this form to the application client event note.
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