Notification about compensation relating to disability - Form 15

Purpose

For use by, or on behalf of, a person with a disability, who has received, or may receive, an amount relating to the disability. Under the Disability Services Act 2006 , a person with a disability who, in relation to the disability –

• is applying for, or is receiving –
  • funding for disability services from the Department of Communities, Child Safety and Disability Services; or
  • disability services from another organisation funded by Disability Services; and
• has received, or may receive, an amount relating to the disability

must notify Disability Services:

• if action has been taken to claim an amount in relation to the disability – of the type of action taken and
  • if an amount has been paid – of the date and amount of the payment and
• if part or all of the amount relates to future care – of the amount that relates to future care.

Where another person applies for funding on behalf of a person with a disability, that person must notify Disability Services of the above matters.

Failure to notify Disability Services about compensation relating to a disability may be an offence under the Disability Services Act 2006 .

Instructions

• Part A of this form should be completed with the personal details of the person applying for, or receiving, compensation relating to a disability.
• Part B of this form should be completed with the details of the compensation claim.
• Part C of this form should be completed only where another person applies for funding on behalf of a person with a disability.

On completion, please return the form to: