Section 1: The Applicant
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Section 1: Completed by the Applicant or Representative Part A: Applicant’s Information In Part A, you need to provide some information about yourself and where you live. To be eligible for the NDIS you must be under 65, live in Australia and be an Australian citizen or hold a permanent or special category visa. Applicant…
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Part B: Privacy and Consent Declaration In Part B, you need to read through the declaration and complete the information below to tell us if you give your consent for us to collect your information. The National Disability Insurance Agency (NDIA) collects your personal and sensitive information to decide if you are eligible for the…
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Part C: Contact Methods In Part C, you need to answer some questions about how you would like us to contact you. Your Communication Preferences 1. Would you prefer us to send you letters or emails? 2. Who would you like us to contact about your application? 3. How would you like us to contact…
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Part D: Parent, Legal Guardian or Representative You should complete Part D if you are filling out this form for: someone aged under 18 for whom you have parental responsibility, or someone for whom you are a representative or a legal guardian. You do not need to complete this section if you are just helping…
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Part E: Overview of Disability In Part E, you need to give us some information about your disability. You may be eligible for the NDIS if you have a permanent and significant disability and it impacts your ability to perform everyday activities. Applicant’s Disability 1. What is your main disability? 2. Do you have any…
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Part F: Signature and Declaration You can only complete this section if you: are the applicant, have parental responsibility for the applicant (under 18 years of age), have legal authority to act for the applicant, and have provided evidence in Part D. By signing this document: – I certify that the information I have provided…
Section 2: The Treating Professional
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Section 2: Completed by the Treating Professional Part A: Treating Professional’s Information The National Disability Insurance Agency (NDIA) collects your personal information, such as name, contact details, and qualifications to process the applicant’s NDIS application. We may need to communicate with you about the applicant’s request while we are determining their eligibility for the NDIS.…
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Part B: Evidence of Disability In Part B, you will need to provide information about the applicant’s disability. This information should provide evidence of: their primary disability and any other disabilities they may have, if their disability is permanent. 1. What is the applicant’s main disability? 2. Does the applicant have any other disabilities? 3.…
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Part C: Early Intervention An applicant may be eligible for the NDIS if they meet the early intervention requirements. Early intervention is intended to reduce the long term impacts of a person’s disability, reduce their future support needs and sustain their informal supports. Applicant’s Early Intervention support needs 1. Are Early Intervention supports likely to…
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Have any of the following assessments been completed with the applicant? Yes – Provide details below No – Go to Part E Providing copies of existing assessments helps the applicant to get a quick and accurate eligibility decision and reduces delays for the person when they have to provide more information.
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Part E: Evidence of functional capacity Part E asks you to describe the ways an applicant’s disability impacts their functional capacity across key domains. This information is required to demonstrate whether they experience substantially reduced functional capacity in one or more life activities. 1. How does the applicant’s disability substantially impact their functional capacity? Key…
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Part F: Additional Notes Do you want to provide any further information?
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Part G: Treating Professional’s Signature and Declaration You must complete Part G. Section 2 cannot be processed without the Treating Professional’s endorsement (i.e. signature and date) below. By signing this document: – I certify that the information I have provided is true and correct, and that I have supplied all of the available information and…
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