Change of circumstances

Transcription

1 Change f circumstances Participants f the Natinal Disability Insurance Scheme and peple wh are waiting n the utcmes f their access requests must by law tell the NDIA f any changes in their circumstances. What is a change f circumstances? A change f circumstances is an event r change in yur life that may affect: yur access request yur status as a participant in the NDIS yur plan. Fr example, yu must tell us if: yur disability supprt needs change yur infrmal care arrangements change significantly yu apply fr, receive, r are entitled t cmpensatin fr injury yu plan n mving (r have mved) huse yu plan n mving (r have mved) verseas, r yu plan n mving (r have mved) permanently int aged care residential accmmdatin. When d I need t tell NDIA my circumstances have changed? Yu must let the NDIA knw as sn as reasnably practicable after yu becme aware that a change f circumstances has happened r is likely t happen. If yu d nt infrm the NDIA f a change f circumstances, fr example a change f cntact details r address, yur plan and payment f supprts might nt be able t be reviewed by the scheduled date. A change f circumstances may als result yur plan needing t be reviewed fr any changes in yur supprts. If yu fail t ntify the NDIA f a change in yur circumstances and yu cntinue t receive supprts that yu are nt entitled t, yu may be asked t repay an amunt in respect f the funded supprt services. Hw d I tell the NDIA my circumstances have changed? Use this frm t tell the NDIA f a change f circumstances. Yu can als tell the NDIA: in persn by visiting yur lcal NDIS ffice ndis.gv.au/abut-uscntact-us/visit-us n the phne by calling ndis.gv.au/abut-us/cntact-us If yu are a TTY user phne and ask fr ur number r yur lcal ffice number. If yu are a Speak and Listen (speech-tspeech relay) user phne and ask fr number r yur lcal ffice number. in writing: using enquiries@ndis.gv.au, using the Participant Prtal (see the ndis.gv.au/participants/participantprtal-user-guide fr mre infrmatin n the See yur NDIA Cntacts r the Make an Enquiry screens). r mailing t - Natinal Disability Insurance Agency GPO Bx 700 Canberra ACT 2601 Yur persnal infrmatin held by NDIA is prtected under the Natinal Disability Insurance Scheme Act 2013 and the Privacy Act Persnal In-Cnfidence when cmplete Page 1 February

2 CHANGE OF CIRCUMSTANCES ADVICE FORM Part A: Infrmatin abut yu See Part B if yu are cmpleting this frm n behalf f a persn under 18 years fr whm yu have parental respnsibility, r a persn fr whm yu are a legal guardian r representative. Yur current cntact details Date f birth Pstal Address Pstcde: Hme phne Mbile Phne address What is yur status with the NDIA? a) Participant please tell us yur NDIS number: NDIS Number b) Awaiting utcme f access request please tell us yur Access Receipt Number and the date yu requested access Number: Date: Cmmunicatin with yu: Hw wuld yu like us t cntact yu? Hme phne Mbile phne By pst Other (please specify) Hw wuld yu like t receive letters? Pst D yu need an interpreter t assist us t cmmunicate with yu? N Yes (Language: ) 2

3 Part B: Parent, legal guardian r representative Only fill ut this sectin if yu are cmpleting this frm n behalf f a persn under 18 years fr whm yu have parental respnsibility, r a persn fr whm yu are a legal guardian r representative. Yu may need t prvide infrmatin t cnfirm that yu are authrised t represent the persn with disability. Yur current cntact details Relatinship t the persn requesting access Pstal address Pstcde: Hme phne Mbile phne address What is the status f the persn yu are representing with the NDIA? a) Participant please tell us their NDIS number: NDIS Number b) Awaiting utcme f access request please tell us their Access Receipt Number and the date yu requested access Number: Date: Cmmunicatin with yu Hw wuld yu like us t cntact yu? Hme phne Mbile phne By pst Other (please specify) Hw wuld yu like t receive letters? Pst D yu need an interpreter t assist us t cmmunicate with yu? N Yes (Language: ) 3

4 Part C: Change f circumstances I wuld like t tell the NDIA f the fllwing change in circumstances (please tick): Change in cntact details Change in phne cntact details Change f address Mve/change f address: within my state/territry (Example Mving frm Geelng t Melburne; mving frm Hbart t Launcestn; mving frm Newcastle t Maitland) Mve/change f address: within Australia (Example Mving interstate: e.g. frm the ACT t NSW) Mve/change f address: t utside Australia (Example Leaving Australia t live in anther cuntry e.g. t New Zealand) New Pstal address Pstcde: New Hme phne New Mbile phne New address Other changes Change in infrmal supprt r ther living arrangements (Example: Yur family member wh prvides infrmal supprt has a new jb and this means that yu may need mre frmal supprt) Change in emplyment arrangements (Example: Yu are ging frm part-time t full-time wrk) Change in financial arrangements (Example: Anther persn r the state has started managing yur persnal mney r yu have gne bankrupt) Change in disability (The effect f yur disability has imprved r wrsened) Change in health and wellbeing (If yu have been diagnsed with a health cnditin that is unrelated t yur disability but may have an effect n yur disability) Other (please tell us) 4

5 Abut the changes What is the date that these changes f circumstances started t happen r are likely t happen? START DATE OF CHANGES / / END DATE OF CHANGES Permanent Temprary until / / Unsure Because f the change f circumstances, yu have tld us, d yu need assistance frm the NDIA e.g. a meeting t discuss if these changes might affect yur plan? Yes N Unsure Please tell us any ther details: Part D: Signature In signing this frm: I certify that the infrmatin prvided in this frm is crrect. Signature Please type name if returning via r the participant Prtal. Please sign if returning a printed cpy Date 5