Consent for your NDIS information

Consent is a record of the permission you have given.

If you’re 18 or older, you have the right to make decisions about your business with the NDIS. That’s why we need a record of your consent before we share your information with anyone else or let someone else do things for you.

Please use this form if you want to give your consent:

• for the National Disability Insurance Agency (NDIA) to share your National Disability Insurance Scheme (NDIS) information with a person or organisation you choose
• to allow another person or organisation (third party) to do things for you with the NDIS.

For example, you might want to give consent for a family member who supports you to view your current plan and submit a home modification request for you.

You can give consent if you’re the:

• applicant
• participant
• child representative or plan nominee for the participant
• legally appointed decision maker for an applicant.

When we say applicant, we mean someone who is applying to the NDIS.

You don’t have to use this form to give your consent. You can let us know over the phone by calling 1800 800 110 or by contacting us in any of the ways listed under How do I return this
form to the NDIA.

We’ll only share your personal information if you’ve given your consent to the NDIA to do this.

Or, if we’re required or authorised to disclose your information by law.

You can take away your consent at any time. You can let us know by mail, email, in person or over the phone that you no longer consent to us sharing information on your behalf.

How do I return this form to the NDIA?

There are a few ways you can return this form to us:

• Email for applicants: NAT@ndis.gov.au
• Email for participants: enquiries@ndis.gov.au
• Mail: NDIA, GPO Box 700, Canberra ACT 2601
• In person: Visit a local area coordinator, early childhood partner or NDIS office in your area.

Once you have completed Part A (above):

• If you’re the applicant or participant, complete Part C then sign the declaration in Part D.
• If you’re the child representative, plan nominee or other legally appointed decision maker, complete Part B and Part C. You’ll then need to sign the declaration in Part D.

Please provide your details if you’re completing this form on behalf of the applicant or participant:

• under 18 years for whom you are a child representative, or
• for whom you are a plan nominee, or
• for whom you are a legally appointed decision maker (for example, a guardian).

If there are more people or organisations you want to give consent to, you’ll need to provide consent for each one individually. Or, you can give your consent over the phone by calling 1800 800 110. You can also contact us in any of the ways listed under How do I return this form to the NDIA.

Please mark the correct box and complete the details below.

I am giving consent to a person.

I am giving consent to an organisation. To give consent to an organisation you need to give us the details for at least one key contact below.

Consent is limited to 2 key contacts in the organisation. If your key contacts change, let us know so we can update who in the organisation you have given consent to. Contact us by calling 1800 800 110 or in any of the ways listed under How do I return this form to the NDIA.

I am providing consent for the person named in section C to have the following types of consent.

We’ll do our best to include these other things. If we’re unable to do this, we’ll let you know and explain why.

This part needs to be signed by whoever completes this form. This may be the participant, applicant or child representative, plan nominee or legally appointed decision maker.

I confirm that:

• I understand I can get further information about how the NDIA handles my personal information from the Privacy Notice or Privacy Policy on the NDIS website. I can find this information on the NDIS website.
• I understand I have given the NDIA consent to give information about me to the third party or parties I have listed at Part C on this form.
• I understand that the third party or parties I have given consent to will be able to access my information and/or act on my behalf.
• I understand I can take away or change my consent to share information and/or my consent for a third party to act on my behalf at any time.
• I confirm the information provided in this form is complete and correct.
• I understand giving false or misleading information is a serious offence.
• I understand this information is protected by law and the NDIA can only share it with someone else where Commonwealth law allows, or requires it, or where I give consent.
• I have given my consent freely and no one has pressured me into doing so.

You can find out more about how we collect, use and disclose your personal and sensitive information on our website (ndis.gov.au). Select ‘About’, then select ‘Policies’, then ‘Freedom of Information’, then ‘Privacy’ from the menu on the right.

If we don’t agree to your request, we’ll let you know and explain why.

Please sign here to give your consent as indicated in this form.