Disability Services recourse request form

This form is to be completed by an organisation requesting the department reconsider the amount of service or funding reduced in their Agreement and/or the amount of funding recouped due to NDIS arrangements.

This request must be submitted along with supporting evidence within 20 business days of notification being given.

To be eligible for recourse, you will need to be able to evidence that there was a true and reasonable basis for the service provision and use of funding. Recourse is only available for situations where

  • the information held by the department was not reflective of the service delivery arrangement; or
  • the application of a daily pro-rata reduction of funding was not reflective of service delivery which has occurred.

The department will acknowledge receipt of your application by return email within 2 business days and if all information is available for consideration, we will notify you of our decision within 10 business days.

An asterisk (This field is required) indicates a required field.

Organisational details
Does your request relate to:This field is required

So that we reference the correct record/s, please let us know:

If you are asking us to consider a claim about a recoupment please let us know:

If you are asking us to consider a claim about the reduced annual service delivery or funding amount:

To assist the department to consider your request and provide you with a decision, please assist by attaching a copy of any relevant documentation to this request:

Examples of evidence include:

  • An outline of the model of service delivery
  • Details of your program / service i.e. creative design learning program
  • Roster for the quarter
  • Expenditure details relating to this request
  • The service users individual support plan
  • Advice to the department of changes to service delivery arrangement

By submitting this request I acknowledge:

  • additional information may be required to evidence my application; and
  • that I have the authority to sign on behalf of my organisation