Government Information (Public Access) Act 2009 ACCESS APPLICATION

Please complete this form to apply for formal access to government information under the Government Information (Public Access) Act 2009 (GIPA Act). If you need help in filling out this form, please contact the Right to Information Officer on 02 6455 3361.

Your Details

Surname *

Title *

Other Names *

Postal Address *

Postcode *

Day-time Phone *

Facsimile

Email

The questions below are optional and the information will only be used for the purposes of providing better service.

Place of Birth

Main Language Spoken

Aboriginal or Torres Strait Islander

YesNo

Do you have special needs for assistance with this application

I agree to receive correspondence at the above email address

Proof of identity

NB: Only required when an applicant is requesting information on their own behalf.

When seeking access to personal information, an applicant must provide proof of identity in the form of a certified copy of any one of the following documents:

Australian driver’s licence (with photograph, signature and current address)

Current Australian passport

Other proof of signature and current address details

Upload supporting documents

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Government Information

Please describe the information you would like to access in enough detail to allow us to identify it. *Note: If you do not give enough details about the information, the agency may refuse to process your application.

Are you seeking personal information?

YesNo

Form of Access

How Do You Wish To Access Information? *

Inspect the document(s)A copy of the document(s)Access in another way

Please specify

Application Fee Payment Options

payment method

Cash Cheque Money orderCredit Card

(Note: please DO NOT send cash by post)

Disclosure Log

If the information sought is released to you and would be of interest to other members of the public, details about your application may be recorded in the agency’s ‘disclosure log’. This is published on the agency’s website.

Do you object to this?

YesNo

Discount In Processing Charges

You may be asked to pay a charge for processing the application ($30 / hour). Some applicants may be entitled to a 50% reduction in their processing charges. If you wish to apply for a discount, please indicate the reason:

Financial hardship

Attach supporting documents

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Please attach supporting documentation (eg a pension or Centrelink card).

Special benefit to the public

Please specify why

Applicant’s signature

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Date

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