DOCUMENT 3 FOI 25/26-1995

IRT – Access and revocation practice guide

This article provides guidance for business support officers (BSO) and internal review officers (IRO) to support decision making practices and is to be used alongside NDIS Act 2013 (external), NDIS (Becoming a Participant) Rules 2016 (external), and Our Guidelines (external).

Recent updates

1 December 2025 Updates to:

• Language, formatting and hyperlinks
• Gathering further information example templates
• Early Intervention not met decision letter example wording
• Appendix B – Legislation Amendments

Procedural fairness or natural justice

When completing an Access or Revocation Internal Review, procedural fairness is applied throughout the review process so the correct decision is made according to the law.

The IRO must follow the principles during the internal review process:

• Bias Rule: The decision maker must be impartial and approach the review with an open mind. If there is a conflict of interest, the IRO will advise their line manager for reassignment to another IRO.
• Evidence, facts and findings: An IRO’s decision is made on the available evidence.
• IROs may also request additional evidence.

Checking for integrity issues

When completing an internal review, IROs may encounter fraudulent documents or information.

If an IRO suspects fraudulent information has been provided, or there is a conflict of

interest, the IRO must contact their line manager and follow steps outlined in article IRT – Complete an access or revocation internal review case.

Examples of integrity issues

Identity or identity documents

For guidance about integrity issues relating to a person’s identity or their identity documents, refer to article Escalate an integrity issue about identity.

NDIS Application consent

• Applicant does not have capacity to provide consent, and they do not have a legally authorised representative.
• Applicant signed the NDIS application form; however, the evidence indicates they do not have capacity to provide consent.
• Cut and pasted signatures in signature blocks within documents.
• Applications where communication has primarily been through a third party.

Treating professional information

• Unable to confirm a treating professional’s qualifications and registration in Australian Health Practitioner Regulation Authority (external) (AHPRA).
• Error in the treating professional’s title.
• Contact information for the treating professional is the same as the applicant. For example, phone number, email address.
• Contact information for the treating professional is personal, rather than business.
• A treating professional should not be using personal email addresses (for example: Gmail or Hotmail) due to privacy and security concerns.
• Address for treating professional is not a legitimate address. For example, address appears as another business when you search online through open-source information. Another way to check, is by using their Australian Business Number (ABN) and searching on Australian Business Register (external) (ABR).

Signs evidence of disability may be fraudulent

• No difference in handwriting between the applicant and treating professional section.
• Evidence of disability is all self-reported.

• Documents are unprofessional. For example, a change of language style within the document, lack of appropriate detail, spelling errors, inappropriate use of grammar.
• Name of another applicant appears in the document and/or misspelled names.
• Signs of text being removed, added, or changed within document. For example, white out used to remove important information.
• Inconsistent fonts, sizes, misalignment of text or paragraphs in documents.
• Poor character quality due to repeated scanning and photocopying. For example, document is hard to read.
• Partial documents from a treating professional.
• Documents can be edited.

Signs of altered documents

• Signs of text being removed, added, or changed within document. For example, white out used to remove important information.
• Inconsistent fonts, sizes, misalignment of text or paragraphs in documents.
• Poor character quality due to repeated scanning and photocopying. For example, document is hard to read.
• Partial documents from a treating professional.
• Documents can be edited.
• Changes in pronouns throughout document.

Signs of a conflict of interest

• Provider that gave evidence of disability may benefit from the applicant becoming a participant.
• Interactions indicate excessive and repeated contact from provider, and provider may benefit from the applicant becoming a participant.
• Treating professional may be related to the applicant. For example, the treating professional has a similar name.
• Applicant has made more than two applications to access the NDIS and changed the primary disability each time.

Verifying age and residency

When completing an access or revocation internal review, at times, an applicant may not provide consent to verify age and residency through Centrelink, may not have a Centrelink customer reference number, or Centrelink information may be incorrect or out of date. In this circumstance, an IRO must confirm age and residency through documentary evidence. Documents are typically verified as part of the original access request pathway by our Partner teams. Any documentation that we request will need to be provided to these teams to complete verification. IROs may complete a referral to the Access Integrity Management team outlined within the article IRT – Complete an access or revocation internal review case.

The age and/or residency criteria must be satisfied for an IRO to assess the other eligibility criteria (disability and early intervention). This should be considered when verifying age and/or residency and when requesting further information. This also informs our decision correspondence.

Verifying age

To be eligible for the NDIS, an applicant must be younger than 65 on the day they apply.

When checking an applicant’s age, their date of birth must match one of the following documents:

• Full birth certificate (an extract is not acceptable)
• My First Health Record (‘Blue Book’ in some states) signed by a doctor or midwife (only for a newborn under 3 months of age)
• Passport biodata page (the page that has their photograph on it) from a current passport or a passport that expired within the last 2 years (but was not cancelled)
• Proof of age card issued by state licensing authorities
• Driver’s license
• Adoption papers
• ImmiCard.

Verifying residency

To meet the residency requirements, an applicant must be an Australian citizen or permanent resident and live in Australia.

When checking an applicant’s residence status, it must match one of the following:

• Full Australian birth certificate (an extract is not acceptable) (See below for additional documents required if the applicant was born on or after 20 August 1986.).
• Australian passport biodata (the page that has their photograph on it) from a current passport or a passport that expired in the last two years (but was not cancelled).
• Australian citizenship or naturalisation certificate.
• Overseas passport or travel document which includes a valid Australian Permanent Residency Visa or Protected Special Category Visa.

If the applicant was born in Australia on or after 20 August 1986, check that the citizenship status matches one of the following documents:

• Australian passport issued on or after 1 January 2000 in the applicant’s name, valid for at least 2 years
• Australian citizenship certificate
• full Australian birth certificate (an extract is not acceptable).

If these are not available, proof of one parent’s Australian citizenship is required and must match one of the following documents:

• full Australian birth certificate from one parent* (an extract is not acceptable), showing the parent was born in Australia before 20 August 1986 or
• Australian passport from one parent* before the applicant’s birth, valid for at least 2 years and issued on or after 20 August 1986 or
• Australian citizenship certificate from one parent*, showing they were an Australian citizen before the applicant’s birth.

Note: If the parent was born on or after 20 August 1986, the applicant will also need to provide proof that one of their grandparents was an Australian citizen before this date. If

the applicant can only provide partial evidence, such as their own birth certificate without any other documents listed above, discuss their circumstances with your line manager to consider the most appropriate alternatives.

If the evidence does not match the above requirements and the applicant has provided a passport, visa grant notification or Immi Card, you may be able to verify visa status in the Visa Entitlement Verification Online system (external) (VEVO). Complete the check and save the VEVO result to the Internal Review Case. Refer to the resources IRT – Setting up VEVO login details (DOCX 64KB) and IRT – Complete a VEVO check (DOCX 62KB).

Note: New Zealand citizens who enter Australia on a New Zealand passport are granted a Special Category Visa (TY-444) (Temporary Visa). A Special Category Visa holder is protected if they:

• were in Australia on 26 February 2001 or
• were in Australia for at least 12 months in the 2 years before 26 February 2001 and returned to Australia after that day.

There are two ways to obtain documentary evidence the applicant has a protected Special Category Visa. Both options need to show a visa class/subclass TY-444 and have a grant date of 26 February 2001 or before.

1. VEVO Check online (the Applicant must have a valid passport or ImmiCard to obtain a VEVO check.
2. Receive an IMMI Grant Notification.

Weighing evidence of disability

When completing an internal review, IROs will see a range of different types of evidence from varying health professionals and providers and are to refer to, Our Guidelines, How do we weigh evidence of disability? (external). When weighing the relevance and importance of the evidence of disability provided, the two main considerations an IRO needs to make are:

• How old is the evidence
• Who is providing the evidence.

Identifying if key information is required

When completing an access or revocation internal review, IROs need to consider key indicators as part of their desktop review to determine whether further information is required.

Examples of key indicators are, but not limited to:

• An applicant relies on prescribed aides and devices for most tasks most of the time (other than a common item).
• An applicant has a List B (external) impairment.
• Applicant demonstrates a reliance or noted deterioration requiring the support/intervention of other people for most tasks most of the time.
• Applicant is unable to perform tasks or actions needed to participate in an activity.
• Sections of the access criteria are met (for example, an applicant has a substantial reduction in functional capacity, but permanency of impairment is unclear).
• A new or recent diagnosis has been provided.
• The applicant has a degenerative condition.

IROs need to identify whether these key indicators exist for an applicant and if this may lead to a confirmed or set-aside decision. This will determine the appropriate pathway for the internal review. During the review, information or evidence provided may change the path of the review.

There are two primary examples as to how to progress an internal review:

• Option 1 - original decision is likely to be confirmed
• Option 2 – original decision is likely to be set-aside with additional evidence.

Note: During initial contact, information can be gathered to determine next steps, including whether seeking additional information is required.

Option 1

If an internal review has no key indicators, the outcome is likely to be confirmed even if the applicant provides further evidence.

Before progressing, an IRO must make sure:

• Information and evidence provided for the internal review clearly indicates the original decision was correct.
• The impairment is not a List A (external), List B (external), or List D (external) impairment.
• Sections of the access criteria are not met (for example, a recent assessment will not meet the access criteria for permanence). In this situation IROs may need to request non-mandatory technical advice. IROs should discuss the case before progressing.
• The evidence-based treatments and therapies have not been trialled or ruled out by treating practitioners as to reasons why treatment cannot be undertaken.
• Other than a new assessment of impairment or rapid deterioration in functional capacity, the applicant is unlikely to meet the access requirements.
• The applicant has indicated they do not intend to provide further information or evidence in support of their review.

While an IRO does not need to request further information, they must make sure the applicant is provided the opportunity to supply further information. If the applicant wishes to provide further evidence, refer to article IRT - Requests for further information.

Option 2

If an internal review has key indicators and the original decision may be set-aside with additional evidence, the IRO should seek additional evidence. Refer to article IRT - Requests for further information.

IROs should follow the gathering further information steps to make sure they have provided adequate opportunity for new information to be considered.

An IRO may speak to an applicant directly to gather supplementary functional information and/or seek consent to contact an applicant’s health professional (where appropriate) to confirm information.

If an IRO is considering a set-aside outcome, a proposal must be submitted via the Access - Proposed Set Aside Decisions MS Teams form (external).

For APS5 delegates, all proposed set-aside outcomes must be reviewed and supported by an APS6/TL, irrespective of any additional information provided by the applicant or any TAPIB advice that has been sought.

For APS 6 delegates, only proposed set-aside outcomes where there is no new information since the original decision are required to be reviewed and supported by an EL1/TL.

Note: whilst an APS6 delegate does not require a proposed set-aside outcome to be reviewed and supported by an EL1/TL where additional information has provided by the applicant or TAPIB input has been sought, the proposed set-aside outcome must still be submitted via the MS teams form so that the branch can capture relevant data regarding set-aside outcomes.

For further guidance and instructions on submitting a proposed set-aside outcome refer to the article IRT – Complete an Access or Revocation Internal Review Case.

Seeking Technical Advice & Practice Improvement Branch (TAPIB) Advice considerations

TAPIB advice is required for all mandatory requests as per TAPIB instructions.

IROs may also need to seek non-mandatory advice if evidence indicates an applicant has a substantially reduced functional capacity but permanency of an impairment is not clear. It is recommended IRO’s discuss with their line manager.

To submit a referral for technical advice, refer to the article Create a technical advice case.

Gathering further information

Further information request letter example templates

The following are example templates to assist IROs to prepare the letter and complete the free text field when further information is needed. These cover the most common requests.

Section 22 and Section 23 – requests regarding age and residency

Evidence is required that confirms <you/applicant’s name> meet the <age/residency/age and residency> requirements. Please provide formal documentation, which confirms <your/applicant’s name> <date of birth/citizenship/visa status>. This can be demonstrated via a <birth certificate/passport/visa documentation> and provided to your Partner in the Community, . You can also provide consent for the NDIA to access your age and residency information from your Centrelink record.

Section 24(1)(b) and Section 25(1)(a) – permanency of an impairment

Please provide information from your treating health professional about your treatment history. This should include a timeline of all past and current treatments to remedy or cure your impairment that you have undertaken. The frequency, duration, level of engagement of treatments and their outcomes or expected outcomes, as well as any appropriate treatment options you may have not yet explored. If certain treatments are deemed unsuitable, reasons must be provided. Treatments may include medications, therapies, surgeries, or rehabilitation. Where possible, obtain this from the most relevant treating professional. You may also include any existing reports or assessments that have been completed.

Section 24(1)(c) – functional impact of a permanent impairment

Please provide information from your treating heath professional about the everyday tasks you cannot complete without a high level of support, due to your impairments. This may include information about what a typical day/week looks like, and evidence about the types of disability-specific supports you need (e.g. physical assistance, assistive technology or equipment prescribed by a doctor or medical/allied health professional), including how often and for how long. This should cover relevant areas related to your impairment such as mobility, communication, socialising, learning, self-care, and self-management (if older than 6). You may also include any existing reports or assessments that have been completed.

Section 25(1)(b) and/or Section 25(1)(c) – early intervention capacity building and/or reducing future need for support.

Please provide information from your treating health professional about recommended capacity-building supports and those already implemented. This should include frequency, duration and outcomes or expected outcomes, as well as how early intervention supports are likely to reduce your future support needs in relation to disability. You may also attach any relevant reports or assessments. All information should be provided by the professional most familiar with your impairment.

Section 25(d) – early intervention supports that would likely benefit the person are NDIS supports

Please provide information from your treating health professional that confirms the supports you require are not most appropriately funded by other government services such as mainstream health or education.

Please provide information from your treating health professional that confirms the supports you require are deemed to be NDIS Supports.

Section 25(1)(a) – Developmental delay

Please provide information from your child’s treating health professional about their functional capacity in self-care, language, cognitive, and motor development as compared to children of the same age. This may also include any recommended early intervention supports, the expected frequency, duration and outcomes of any recommended supports, and any risk of future disability where assessment is difficult due to age. You may also attach any relevant reports or assessments that have been completed.

Substantially Reduced Functional Capacity (SRFC)

Access or Revocation Internal Review (s100) decisions are made based on the NDIS Act, Becoming a Participant Rules, and relevant Guidelines.

This involves considerations against the age access criteria (s22), residence (s23), disability (s24), and early intervention criteria (s25).

As part of the considerations for disability requirements (s24), an IRO is required to assess whether an applicant has SRFC in one or more relevant activities in mobility, self-care, learning, self-management, communication or social interaction (section 24(1)(c) of the NDIS Act 2013). These activities are defined in Our Guidelines - Applying to the NDIS (external).

An IRO will assess SRFC for an applicant by reviewing the available evidence of the applicant’s current functional capacity or impairments against the relevant activities.

Our Guidelines - Applying to the NDIS (external) describes when an impairment is likely to result in a SRFC to perform one or more activities.

Substantially Reduced Functional Activity examples across the six key life activities is found in Appendix A.

Completing the access or revocation decision letter

A letter and basis of decision (in the same document) will need to be completed to inform the Applicant of the outcome. Letter and basis of decision templates are available on the Internal Review Branch Hub.

The following sections are example wording to complete the Access or Revocation successful and unsuccessful decision letter and/or the basis of decision at the end of the letter for Access criteria. Depending on the circumstances and evidence, the wording can be modified in the below examples.

Note: If age and/or residency criteria are not met, further assessments for other eligibility criteria is not required. The IRO can delete all reference to other criteria on the access or revocation decision letters.

Age not met (s22)

The criteria for access to the NDIS is set out in section 22 of the National Disability Insurance Scheme Act 2013, which states a person must be aged under 65 when an access request was made.

The NDIA is unable to waive this legislative requirement.

As <you/applicant’s name> were not younger than 65 on the day <you/applicant’s name> made your NDIS application, <you/applicant’s name> do not meet the age requirements.

Further assessment of <you/applicant’s name> eligibility in relation to the residency, disability, and early intervention requirements (set out in sections 23, 24 and 25 of the National Disability Insurance Scheme Act 2013) will not be considered as part of this internal review.

Residence not met (s23)

The criteria to access the NDIS is set out in section 23 of the National Disability Insurance Scheme Act 2013, which states a person must meet the residence requirements to meet the access criteria. The NDIA is unable to waive this legislative requirement.

As <you/applicant’s name> <reason for not meeting for example <are not the holder of a permanent visa/are not Australian citizen>, you do not meet the residency requirements.

As <you/applicant’s name> do not meet the residence requirements, further assessment of your eligibility in relation to the disability and early intervention requirements (set out in sections 24 and 25 of the National Disability Insurance Scheme Act 2013) will not be considered as part of this internal review.

Disability not met

Does not meet section 24(1)(a): impairment attributable to disability

For the purposes of becoming a participant of the NDIS, (as outlined in the Our Guidelines - Applying to the NDIS (external) when we consider your disability we think about whether any reduction or loss in your ability to do things, across all life domains, is because of an impairment. The term ‘impairment’ is a loss of or damage to your body’s functions. We look at:

• your body’s functions
• your body structure
• how you think and learn

<Include one of the following options:

Option 1 - applicant does not have evidence of impairment and disability:

Evidence provided does not demonstrate <your/applicant’s name> <condition/name diagnoses> <result/s> in an impairment or disability attributable to an impairment. As such, <they/name of condition> will not be assessed further in this review.

Option 2 – applicant has no evidence of disability:

Evidence provided does not indicate <your/applicant’s name> <condition/s> of results in a reduction or loss in <your/applicant’s name> ability to do things, and as such, I have concluded <it/they> <has/have> not resulted in disability consistent with NDIS requirements. As such, <they/name of condition> will not be assessed further in this review.

Option 3 – applicant has no evidence of impairment:

As <diagnosis/diagnoses> <is/are> not a loss or significant change to <your/applicant’s name> body’s functions, structure, or how <you/applicant’s name> <think/s> and <learn/s>, I have concluded <this/these conditions> cannot be considered <an impairment/s> consistent with NDIS requirements. As such, <they/name of condition> will not be assessed further in this review.>

Does not meet section 24 (1)(b): permanency

Importantly, even when a condition or diagnosis is permanent, the NDIA must assess the permanency of the associated and resulting impairment(s). For example, reduced capacity for mobility, socialising and so on. In line with Our Guidelines - Applying to the NDIS (external), a person may not be eligible if their impairment is temporary, still being treated, or if there are remaining treatment options. Generally, the NDIA will consider a person’s impairment is likely to be permanent after all available and appropriate treatment options have been pursued or ruled out and the impairment is considered enduring. This means that we need to know whether your impairments are enduring so that you require NDIS supports on an ongoing basis.

To effectively assess the functional impact of an applicant’s impairment, the NDIA must have sufficient evidence that demonstrates that the impairment has been optimally treated.

When the NDIA looks at what treatments are available, we think about whether the treatment is suitable for an applicant’s personal situation. We consider the availability and appropriateness of the treatment and whether there are any other known and available treatments that could be suitable. Treatment should be understood in a broadest sense and may include changes to your diet and lifestyle.

In making this determination, I have consulted the following legislation and guidelines:

• Section 5.4 of the National Disability Insurance Scheme (Becoming a Participant) Rules 2016 (external), which states, an impairment is or is likely to be permanent only if there are no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment.
• Section 5.6 of the National Disability Insurance Scheme (Becoming a Participant) Rules 2016 (external), which states, an impairment may require

medical treatment and review before a determination can be made about whether the impairment is permanent or likely to be permanent. The impairment is, or is likely to be, permanent only if the impairment does not require further medical treatment or review in order for its permanency or likely permanency to be demonstrated (even though the impairment may continue to be treated and reviewed after this has been demonstrated).

• Section 5.7 of the National Disability Insurance Scheme (Becoming a Participant) Rules 2016) (external), which states if an impairment is of a degenerative nature, the impairment is, or is likely to be, permanent if medical or other treatment would not, or would be unlikely to, improve the condition.
• Our Guidelines - Applying to the NDIS (external) states if a person is still undergoing or have recently had treatment, we’ll need to wait until the outcome of the treatment is known before, we can determine your impairment is likely to be permanent.

<Include one of the following options:

Option 1 – applicant has been assessed at 24 (1)(a) as not having an impairment or disability attributable to an impairment:

As outlined in criterion (a) of Section 24 – Disability Requirements, I am unable to conclude from the evidence provided that <your/applicant’s name> <condition/name diagnoses> <result/s> in an impairment or disability attributable to an impairment. Therefore, the requirements of criterion (b) have not been satisfied, as criterion (b) relies on first meeting the requirements of criterion (a).

Option 2 – applicant is undergoing treatment or has treatment available:

It is acknowledged <you/applicant’s name> <have/has> experienced long-standing symptoms and difficulties as a result of <your/their> diagnosed condition/s. However, information provided by indicates <you/applicant’s name> are currently <undergoing <type of treatment. For example “Group based Dialectical Behaviour Therapy (DBT)”> <or/and> <recommended by to engage with >.

As the evidence indicates that <you/applicant’s name> <have/has> not completed all available and recommended treatments, the likely permanency of <your/applicant’s name> impairment/s cannot be determined at this time. Without specialist evidence

confirming that all available treatment options have been explored, completed, and that <your/applicant’s name> <impairment/s have/has> been optimally treated and stabilised, your <impairment/s> cannot meet this criterion.

Option 3 – applicant has received some treatment:

The evidence states <your/applicant’s name> <have/has> received some appropriate and recommended treatments for <your/their impairment/s>. However, there is not enough information to confirm that there are no further known and available appropriate evidence-based treatments that are likely to remedy <your/applicant’s name> <impairment/s>.

Without specialist evidence confirming that all available treatment options have been explored, completed, and that <your/applicant’s name> <impairment/s> <have/has> been optimally treated and stabilised, <your/applicant’s name impairment/s> cannot meet this criterion.

Option 4 – applicant has not provided treatment history:

The evidence provided does not address any previously completed treatment, current treatment, or future treatment, which may have been recommended to <you/applicant’s name>. Therefore, it cannot be concluded all available and appropriate treatments options which may remedy <your/applicant’s name> <disability type/s/condition> have been explored.

Option 5 – treatment history is not thorough:

The evidence received does not include a detailed treatment history for <your/applicant’s name> <impairment/s>. Detailed evidence of <your/applicant’s name> treatment history should include a timeline of treatments undertaken, types and frequency of treatments, the duration and outcome of treatments, including a report from <your/applicant’s name> <Treating Practitioner/Specialist> about the outcomes.

The evidence does not conclude that all recommended treatment options have been explored and completed. Therefore, based on the provided evidence, the permanency of <your/applicant’s name impairment/s> cannot be determined at this time.

Option 6 – future applications would benefit from further information:

Future applications would benefit from a thorough treatment history for <your/applicant’s name> <impairment/s> indicating the outcomes of all medical treatment, <surgical intervention (if applicable)>, specialist reviews, and specialist prognosis. The evidence would need to show that all readily available and evidence-based treatments that would be likely to remedy <your/applicant’s name> <impairment/s> have been completed, become unavailable, or no longer deemed medically viable by the relevant treating professionals/specialists.>

Does not meet section 24(1)(c): substantially reduced functional capacity

Option 1 – applicant has been assessed at 24 (1)(a) as not having an impairment or disability attributable to an impairment:

As outlined in criterion (a) of Section 24 – Disability Requirements, I am unable to conclude from the evidence provided that <your/applicant’s name> <condition/name diagnoses> <result/s> in an impairment or disability attributable to an impairment. Therefore, the requirements of criterion (c) have not been satisfied, as criterion (c) relies on first meeting the requirements of the preceding criterions.

Option 2 - not met due to impairments not being considered permanent

As explained in Our Guidelines - Applying to the NDIS (external), the NDIA only considers an applicant’s permanent impairments when assessing their functional capacity or ability to undertake activities.

As noted in Section 24(1)(b) <your/applicant’s name impairment/s> cannot be considered permanent therefore, this criterion has not been met.

We acknowledge that <you/applicant’s name> <live/s> with limitations that affect <your/their> functional capacity, that <you/they> have had to adjust the way <you/they> do things and occasionally rely on others for assistance. However, to meet this criterion, the evidence must demonstrate that an applicant usually needs disability-specific support to participate or complete activities in one or more of the six key activities assessed (communication, socialising, learning, mobility, self-care, and self-management (if older than 6)).

As described in Our Guidelines - Applying to the NDIS (external), your impairment substantially reduces your functional capacity if you usually need high levels of disability-specific supports to participate in or complete key activities. These disability-specific supports include:

• a high level of support from other people, such as physical assistance, guidance, supervision or prompting
• assistive technology, equipment or home modifications that are prescribed by your doctor, allied health professional or other medical professional.

Information provided indicates that <your/applicant’s name> <impairment/s have/has> resulted in difficulties with completing certain tasks. We acknowledge that <you/applicant’s name> <experience/s> challenges which prevent <you/them> from fully participating in some tasks and the seriousness and significance of <your/their> impairment is not disputed.

However, I have been unable to conclude from the existing evidence, that <you/applicant’s name> usually <require/s> a high level of support from other people, assistive technology, or equipment and home modifications to complete the activities assessed and to ensure <your/their> safety and independence in the community.

In making this determination, I have referred to section 5.8 of the National Disability Insurance Scheme (Becoming a Participant) Rules 2016 (external), which states an impairment results in a substantial reduction in functional capacity if:

• The person is unable to participate effectively or completely in the activity, or to perform tasks or actions required to undertake or participate effectively or completely in the activity, without assistive technology, equipment (other than commonly used items such as glasses) or home modifications or
• The person usually requires assistance from other people to participate in the activity or to perform tasks or actions required to undertake or participate in the activity or
• The person is unable to participate in the activity or to perform tasks or actions required to undertake or participate in the activity, even with assistive technology, equipment, home modifications or assistance from another person.

Option 3 - not met as reduced capacity is only limited to activities required to be completed in a slower or modified manner:

I understand <your/applicant’s name> <impairment/s have/has> resulted in difficulties with a number of tasks, and <you/they> may need to complete these tasks in a slower or different manner.

For example, <refer to applicant’s individual functional evidence for relevant tasks. For example. “When mobilising in the community, you need to take rest breaks before you are able to mobilise further. When getting dressed you do so in a seated manner”>.

While it is noted that <you/applicant’s name> <do/does> have a reduced functional capacity, it cannot be said that <you/they> have a substantially reduced functional capacity as <you/they> do not require a high level of support from other people, assistive technology, or home modifications.

Option 4 - not met as the assistive items stated to be required are commonly used items:

I understand <your/applicant’s name> <require/s and benefit/s> from equipment such as <insert item for example <a walking stick, shower chair and bathroom grab rails>. Reliance on such <an item/items> is not considered substantially reduced functional capacity as the <item/items> required <is/are> considered to be a <‘commonly used item’/‘commonly used items’> rather than specialist equipment or technology that is specifically designed to increase the functional capacity and participation of people with disability.

Option 5 – not met as reduced capacity only occurs during acute episodes:

Evidence provided indicates <your/applicant’s name> <impairment/s> <is/are> fluctuating and <you/they> experience greater difficulty with daily tasks during certain periods. For example, .

We consider an applicant’s ability over time, taking into account their ups and downs.

From the evidence provided, I cannot determine that, on an average day,

<you/applicant’s name> <require/s> a high level of support from other people, assistive technology, or home modifications.

Option 6 - not met as no evidence provided for reduced functional capacity:

I understand <your/applicant’s name> <impairment/s> <have/has> resulted in difficulties with a number of tasks, however, based on the information provided, there is no evidence to indicate <you/they> have reduced functional capacity or ability to participate in activities in one of the following: communication, social interaction, learning, mobility, self-care or self-management.

Option 7 - future applications may benefit from further information:

Future applications may benefit from a thorough functional assessment detailing the impacts of your permanent impairments on your day-to-day living. The information would need to include what tasks you are unable to do, what type of support you require to complete tasks, and the frequency of supports required.>

Option 8 - for children:

To help us decide if a child’s ability is substantially reduced, we compare their abilities with other children of the same age. Sometimes when a child’s impairment doesn’t substantially reduce their ability right now, but might in the future, we will look at the early intervention requirements. Similarly, if a child’s impairment currently substantially reduces their ability, but may not after receiving supports, we will look at the early intervention requirements. We have considered Early Intervention as most appropriate for <Child’s name>.

Option 9 – for hearing impairments:

We’ll generally decide you have a substantially reduced functional capacity if your hearing loss is at least 65 decibels in your better ear. This is based on a pure tone average of 500Hz, 1000Hz, 2000Hz and 4000Hz.

We may also decide you have a substantially reduced functional capacity if your hearing loss is less than 65 decibels in your better ear. We may decide this if either:

• you also have another permanent impairment, such as a vision or cognitive impairment
• you give us evidence your speech detection and speech discrimination outcomes are significantly poorer than expected

The evidence provided does not demonstrate that you meet the above criteria.

Does not meet section 24(1)(d): social and economic participation

Option 1 – applicant has been assessed at 24 (1)(a) as not having an impairment or disability attributable to an impairment:

As outlined in criterion (a) of Section 24 – Disability Requirements, I am unable to conclude from the evidence provided that <your/applicant’s name> <condition/name diagnoses> <result/s> in an impairment or disability attributable to an impairment, which in turn affects <your/their> capacity for social or economic participation.

Therefore, the requirements of criterion (d) have not been satisfied, subsequent to the preceding criterion not being met.

Option 2 – does not reduce capacity for social and economic participation:

The evidence provided does not currently demonstrate that <your/applicant’s name> impairment has impacted <your/applicant’s name> capacity for social and economic participation.

Option 3 – not met due to impairments not being considered permanent:

As explained in Our Guidelines - Applying to the NDIS (external), we only consider an applicant’s permanent impairments when assessing their ability to participate socially and economically.

As noted in Section 24(1)(b) <your/applicant’s name> <impairment/s> <is/are> not considered to be permanent therefore this criterion has not been met.>

Does not meet section 24(1)(e): lifetime NDIS supports:

To meet this criterion, an applicant must be likely to need NDIS support for their lifetime. When we decide if an applicant likely needs NDIS supports for their lifetime, we consider:

• a person’s life circumstances
• the nature of a person’s long-term support needs
• whether a person’s needs are best met by the NDIS, or by other government and community services

Option 1 – required supports are not NDIS supports:

NDIS supports (external) are the services, items, and equipment that can be funded by the NDIS. We cannot fund supports that are not NDIS supports. For example, while the NDIS is responsible for supports related to a person’s ongoing functional impairment, the NDIS is not responsible for the diagnosis and clinical treatment of health conditions, including chronic health conditions. From the information provided, the supports <you/applicant’s name> require are not NDIS supports; therefore, this criterion is not met.

Option 2 – no identified impairment or disability attributable to an impairment, or no permanent impairment, or no substantially reduced functional capacity

It is clear the challenges <you/applicant’s name> <face/s> <are/is> unique and significant and <you/applicant’s name> would benefit from support. However, without meeting all of the criteria outlined within Section 24(1)(a)(b)(c) and (d), it cannot be said that <you/applicant’s name> will require the support of the NDIS for <your/their> lifetime, and thus <you/applicant’s name> support needs are not best met through the NDIS.>

<Note: include one of the following three options depending on the applicant’s circumstances (remove the number when inserting into the letter template

• Local Area Coordinators are available to assist people that are not eligible for the NDIS to link with mainstream services. The Local Area Coordinator for <your/applicant’s name> region is < Local Area Coordinator Details> who are

located at

Option 3 - no developmental delay

When we decide if a child has developmental delay, we use the definition in Section 9 of the NDIS Act 2013 (external).

We need to know that the child is under the age of 6 and that the delay:

• is due to mental or physical impairments (external)
• substantially reduces the child’s functional capacity (external) compared with other children the same age
• means the child needs specialist services (external) from more than one professional working as a team to support the child and for longer than 12 months.

<option: does not meet age – As <child’s name> was already 6 years of age at the time of the original access decision, it cannot be said that they have has a developmental delay, and therefore cannot meet this criterion>

<option: does not indicate a substantial delay: As the evidence provided does not outline <child’s name> has a substantial reduction in functioning in either self-care, receptive and expressive language, cognitive development, or motor development, it cannot be said that they meet the definition of a developmental delay under Section 9 of the NDIS Act 2013 (external). As such, this criterion cannot be met.

<option: does not require multidisciplinary support: As the evidence does not indicate that <child’s name> needs specialist services from more than one professional working as a team to provide support for longer than 12 months, it cannot be said that they have a developmental delay as per Section 9 of the NDIS Act 2013 (external). As such, this criterion cannot be met>.

Does not meet Section 25(1)(b): reduces future support needs

Option 1 - longstanding impairment

To meet this criterion, Our Guidelines - Applying to the NDIS (external) explain that early

intervention (early access to supports) must be likely to reduce a person’s future disability support needs.

Due to the long-standing nature of <your/applicant’s name> <impairment/s>, I am not satisfied the supports required are ‘early intervention’ in nature. From the evidence provided, <early intervention supports are not likely to reduce your/applicant’s name future needs for support in relation to disability/there is no information available to determine that early intervention supports are likely to reduce your/applicant’s name future support needs in relation to disability>.

Option 2 - no evidence of EI supports being required

To meet this criterion, Our Guidelines - Applying to the NDIS (external) explain that early intervention (early access to supports) must be likely to reduce a person’s future disability support needs.

From the evidence received, there is no information to determine that early intervention supports are likely to reduce <your/applicant’s name> future support needs in relation to disability.

Does not meet Section 25(1)(c): Benefiting the person, which may be shown in one of four ways

1. Lessening the impairment’s impact on the functional capacity for communication, social interaction, learning, mobility, self-care or self-management or
2. Preventing the deterioration of functional capacity or
3. Improving functional capacity or
4. Strengthening informal supports, including building the carer’s capacity

Evidence provided does not indicate early intervention supports are likely to benefit you by achieving one or more of the outcomes listed above. There is no indication in the evidence provided as to what benefits may or may not be experienced from receiving support.

Does not met Section 25(1)(d): Benefiting the person – the early intervention supports that would likely benefit the person are NDIS supports

To meet this criterion, the support a person requires must be most appropriately funded or provided by the NDIS.

A person won’t be eligible if we decide the support required is more appropriately funded or provided:

• by other general systems of service delivery or support services, such as a workers compensation scheme
• under a universal service obligation that other government services must provide to all Australians, such as schools and public hospitals
• as a reasonable adjustment under discrimination law, such as making places or venues accessible for you.

The evidence provided does not indicate that early intervention supports are most appropriately funded by the NDIS. Early intervention for <your/applicant’s name> <impairment/s is/are> most appropriately provided through the Health System or other government services. Clinical treatment is the responsibility of the Health System and not the NDIS.

This determination is in line with Our Guidelines - Applying to the NDIS (external).

Further information on when early intervention supports are more appropriately funded by the NDIS or by other services can be found here:

• Our Guideline Mainstream and community supports (external)
• Schedule 1 of the NDIS (Supports for Participant) Rules (external)

Mainstream Early Intervention – Psychosocial Interventions

The information does not indicate that early intervention supports are most appropriately funded by the NDIS. Early intervention for <your/applicant’s name> psychosocial impairment is most appropriately provided through the Health System. Treatment of mental illness including acute inpatient, ambulatory, rehabilitation/recovery, early intervention and clinical support for child and adolescent developmental needs is the responsibility of the Health System and not the NDIS.

Developmental Delay – The NDIS is not the most appropriate system

To meet this criterion, the support a child requires must be most appropriately funded or provided by the NDIS.

A child won’t be eligible if we decide the support required is more appropriately funded or provided:

• by other general systems of service delivery or support services, such as a workers compensation scheme
• under a universal service obligation that other government services must provide to all Australians, such as schools and public hospitals
• as a reasonable adjustment under discrimination law, such as making places or venues accessible for you.

For example, children usually won’t be eligible if they only need the following supports. These are more appropriately provided by other government and community services:

• medical services, and treatments for health conditions
• inclusion supports to help young children join early childhood learning and care settings
• school readiness programs to help children prepare for school
• newborn follow-up, such as child and maternal health services.

It has been considered <child’s name> would benefit from intervention during this period in their life. However, as outlined above in Section 25(1)(a), as <child’s name> does not meet the definition of developmental delay under Section 9 of the NDIS Act 2013 (external) and Our Guidelines - Applying to the NDIS (external), it cannot be said that they have a developmental delay, and therefore the NDIS is not the most appropriate agency to fund supports.

This determination is in line with Our Guidelines - Applying to the NDIS (external).

Further information on when early intervention supports are more appropriately funded by the NDIS or by other services can be found at:

• Our Guideline and Mainstream and community supports (external)

• Schedule 1 of the NDIS (Supports for Participant) Rules (external)

Appendices

Appendix A – Examples of SRFC under the Six Key Life Activities

The following reference to Rules refer to the National Disability Insurance Scheme (Becoming a Participant) Rules 2016.

Mobility

Rule 5.8(a) reliance on prescribed aides and devices

SRFC may look like but is not limited to:

• The use of a prescribed wheelchair or mobility scooter (for either short or longer distances)
• Prescription of an AFO (Ankle Foot Orthosis) or KFO (Knee Foot Orthosis)
• Prescribed build up shoes related to a disability such as Post-Polio Syndrome
• Prescription or use of callipers
• Reliance upon Prosthetics required for amputated lower limbs/congenital missing limbs (missing toes, forefoot without the prescription of aides may not meet SRFC)
• Hoists or slings

Note: An IRO would assess prescribed aids based on the recommendations and prescriptions of health professionals. If a person chooses not to wear a prescribed aide as they feel it is uncomfortable or does not fit, this should not disqualify them.

Rule 5.8(b) reliance on the support/intervention of others

SRFC may look like a combination of these indicators but is not limited to:

• Assistance needed to stand and walk around the community or propel a wheelchair
• Frequent falls and unable to get up off the floor without assistance

• Using a number of common items such as 4-wheel walkers, frame and walking sticks, single point sticks, quad cane Canadian crutches, forearm crutches, belt strap as well as standby support of another person.

Rule 5.8(c) unable to participate in the activity

SRFC may look like but is not limited to:

• Hoist or slings transfers to a motorised wheelchair with reliance on another person for 24/7 mobility support.

Psychosocial Disability

It would be unusual to see a SRFC in mobility attributable to a psychosocial condition without any coexisting disabilities present. An example of reduced capacity for mobility resulting from a psychosocial impairment alone would be a conversion disorder (also known as functional neurological disorder) where psychosocial impairment shows as physical symptoms.

Further information can be found in the [Guide - Psychosocial Disability](https://example.com).

Examples of what evidence may not meet the requirements of SRFC for Mobility include:

• Build up shoes used for leg length discrepancies or stand-alone foot or back conditions
• Orthopaedic inserts
• Charcot Restraint Orthotic Walker (CROW) boots, even when these are formally prescribed, they are viewed as temporary aides
• Four-wheel walkers or frame and walking sticks, single point sticks, quad cane, Canadian crutches, forearm crutches used independently for short and/or long distances. These items can be purchased from chemists and mobility shops and do not require a formal prescription from a suitably qualified health professional

• Mobility scooter or wheelchair self-purchased or borrowed that has not been formally prescribed
• Not being able to complete isolated tasks such as sweep and mop, scrub shower recesses, mow lawns, complete household cleaning tasks, carry groceries, and lift small items such as a cooking pot. Regarding household tasks, the functional evidence obtained should be weighed to see if the applicant experiences substantially reduced functional capacity in the broader sense of the functional domain rather than in isolated tasks
• Not being able to catch public transport

Self-Care

Rule 5.8(a) reliance on prescribed aides and devices

SRFC may look like but is not limited to:

• Slings Hoist transfers for bathroom access
• Use of prosthetics for self-care tasks. The requirement of prosthetics for upper limb amputations/congenital missing limbs would result in SRFC in Self-care. An additional discussion may be needed with your Line Manager or TAPIB about missing fingers
• Percutaneous Endoscopic Gastrostomy (PEG) flexible feeding tube that cannot be managed independently
• Stoma or colostomy bags that cannot be managed independently
• Catheters that cannot be managed independently.

Rule 5.8(b) reliance on the support or intervention of others

SRFC may look like a combination of these indicators but is not limited to:

Note: there is an overlap between self-management and self-care for people living with intellectual, psychosocial and cognitive impairments. If the evidence supports limited insight into caring for one’s own self-care needs and the need for stand by assist for the majority of self-care tasks, then it meets the SRFC criteria.

• Evidence is needed for prescribed items such as stand by assistance or hands on support. There may be a need for a support person to lay out hygiene equipment (for example toothbrush, soap, face washer) and then talk the person through using each item.
• Evidence of fine motor difficulties is considered for SRFC in self- care. A condition that affect the fingers/upper limbs may affect the person’s ability to complete fine motor self-care activities. Examples and further information of the supports needed for upper limb/fine motor difficulties are available in the SRFC phone guide for question examples.

Rule 5.8(c) unable to participate in the activity

SRFC may look like but is not limited to:

The reliance on another person for 24/7 self-care support including overnight supervision or live in support of the person.

Psychosocial Disability

SRFC may look like but is not limited to:

• The person does not wash or change clothing without significant intervention
• The person soils clothing or bedding and does not acknowledge need to wash/change soiled items
• The person may have a lack of insight and requires intervention to manage health care needs.

Examples of what evidence may not meet the requirements of SRFC for Self-Care

The below items are considered general items that are available in the community and are reasonable adjustments to living environments:

• Commodes

• Over-toilet seats
• Webster packs to track medication
• Shower chairs
• Slip-resistant mats
• Bath-boards
• Modified cutlery
• Personal safety alarms
• Long handled brushes and pick up sticks
• Accessible tap handles
• Simple modifications to kitchen environment
• Sitting down to prepare meals
• Making use of microwave meals or simple recipes
• Not being able to wash hair or cut toenails
• The independent use a catheter, stoma, colostomy bag or peg tube.

With regard to a psychosocial impairment, these examples alone are not considered to meet SRFC

• Needs periodic assistance to check compliance with medications.
• Shows limited interest in self-care and sometimes fails to wash and change clothes regularly.

Learning

Rule 5.8(a) reliance on prescribed aides and devices

A prescribed aide or device for learning would not meet SRFC. Specialised aides and devices are usually provided by the education sector.

Rule 5.8(b) reliance on the support/intervention of others

SRFC may look like a combination of these indicators but is not limited to:

• Evidence the person gets lost easily if they leave the house by themselves
• An inability to implement road safety or maintain stranger danger awareness
• Inability to learn a new bus route by themselves
• They are part of an Australian Disability Enterprise (ADE)
• Unable to learn simple recipes or the process involved with other household tasks, such as, how to use a washing machine or dishwasher
• Step by step instruction from another person is always required to learn a new task
• A significant length of time is required to practice a new task before becoming independent or transferring the newly learned skill to a different environment
• They may be an adult living at home who is unable to live independently
• There may be guardianship or trustee orders in place or legal Authorised Representative acting on their behalf
• Carers or support person plays a key role in all learning tasks required for community access. There may be an overlap with self- management
• Verbal prompting may be required for all learning including a new morning routine, how to meet up with a new friend, how to travel to a new place.

Rule 5.8 (c) unable to participate in the activity

SRFC may look like but is not limited to:

There may be evidence of an inability to learn new tasks, remember information or practice a new skill. Formal guardianship orders may be in place. There may also be overlap with other key life areas such as self-management, mobility (for example, unable to learn to catch public transport), and social interaction.

Psychosocial Disability

SRFC may look like but is not limited to:

• Unable to learn a new bus route to get from home to work without assistance (not a substantial reduction, if it is age appropriate for assistance to be required).
• Unable to learn simple tasks such as how to make a sandwich or a very basic meal.

Examples of what evidence may not meet the requirements of SRFC for learning. Please note these also apply to the area of psychosocial disability.

• Requiring an aide in school or TAFE. This support is provided through the education setting. NDIS does not provide support to teach reading, writing and arithmetic
• Needing electronic phone reminders to attend TAFE, school or university
• Attendance issues relating to school TAFE or university
• Lack of organisation or preparation skills to hand in school, TAFE or University assignments
• The need for education adjustments within the school, TAFE or university setting

Self-Management

Rule 5.8(a) reliance on prescribed aides and devices

SRFC may look like but is not limited to:

The combination of standby support or physical prompting to use common items such as simple memory supports, such as, diaries, calendars, alarms and reminders, Webster packs for medication, direct debit arrangements, lists to remember tasks, personal safety alarms. Usually, common items used in isolation would not meet the SRFC requirements. Consider the below and discuss with your Line Manager or TAPIB advisor where needed.

Rule 5.8 (b) reliance on the support/intervention of others

SRFC may look like a combination of these indicators but is not limited to

• The person consistently has trouble-managing money and requires others to help
• There may be a history of risk of financial and/or physical exploitation
• Community Treatment Orders (CTO) may be in place
• Medication non-compliance or poor insight into taking medication may be evident
• There may be evidence of poor insight to manage health care needs appropriately
• There may be evidence of guardianship orders, informal/formal care arrangements
• Public trustee may be involved with management of finances
• The person may be living in supported accommodation (formal / informal) or a supported independent living (SIL) environment
• Strong evidence of hoarding and squalor leading to tenancy or health risks
• Inability to live at home safely by themselves. Carers are required to monitor regular and safe use of kitchen appliances
• Inability to solve a problem if they were out in the community by themselves. For example, how to calculate change accurately, what to do if they miss the bus
• Limited insight into the value of money
• A history of or risk of homelessness
• There may be a dual diagnosis of a psychosocial disability and an intellectual disability
• The person may not be able to plan their day by themselves or organise their time
• The person may require the support of a carer to make all decisions regarding finances, health or housing

Rule 5.8(c) unable to participate in the activity

There may be evidence of an inability to self-manage one’s own life. Formal guardianship orders may be in place. Informal supported decision-making supports may be in place. The person may be residing in supported accommodation or be an inpatient requiring support with all self- management. There may also be overlap with other key life areas such as learning.

Psychosocial Disability

SRFC may look like but is not limited to:

• Repeat homelessness as unable to manage a tenancy and make decisions
• Unable to manage finances
• Hoarding has become a health and safety concern. No insight to manage the household.

Examples of what evidence may not meet the requirements of SRFC for learning. Please note these also apply to the area of psychosocial disability.

• The person may make poor financial decisions (has been known on occasion to spend entire weekly income on new clothes leaving nothing for bills and food) but this is not always the case
• Lack of motivation to clean the house or inability to complete household chores
• Simple aides and supports used independently without support from another person
• Simple memory supports- diaries, calendars, alarms and reminders used independently
• Medications - Webster packs, pharmacist supports
• Direct debit arrangements
• Lists to remember tasks
• Personal safety alarms.

Communication

Rule 5.8(a) reliance on prescribed aides and devices

SRFC may look like but is not limited to:

• Adaptive computer equipment such as screen readers for example, “JAWS”, magnifiers.
• Augmentative and Alternative Communication (ACC) Devices for example, Proloquo2go, or text to speech software programs, picture exchange system such as PECS or boardmaker or Compic Pictographs.

Rule 5.8(b) reliance on the support/intervention of others

SRFC may look like a combination of these indicators but is not limited to:

• The person is unable to express basic needs and wants without the support of another person
• The person is unable to communicate with members of the community without the support of another person
• The person cannot follow the rules of a conversation
• Frequent communication breakdowns where the message is unable to be verbalised or understood resulting in a behavioural response outside the limits of reasonable community expectations
• Unable to follow a 2-step verbal instruction without repetition
• Unable to follow verbal instructions at work and require additional support from another person to understand
• Unable to follow the rules of a community sporting group and require both pictures and the support of another person in order to understand
• The person is “non-verbal” and is reliant on the support of another person to interpret gesture, signs or eye movements
• The person only has a few verbal words. For example, yes, no, toilet or more.

Rule 5.8(c) unable to participate in the activity

There may be evidence of an inability to communicate, or the person is “non-verbal”. Formal guardianship orders may be in place. Informal supported decision-making supports may be in place.

The person may be residing in supported accommodation or be an inpatient requiring support with all communication. There may also be overlap with other key life areas such as learning, self- management.

Psychosocial Disability

Examples of SRFC:

• Passive behaviour (involving mainly yes or no answers) with no or very limited conversation and no initiation of conversation. (Note that culture and language is contextual)
• Auditory hallucinations or thoughts interrupting communication attempts. The person may interrupt, shift topic, or have a separate conversation.
• Other cognitive or intellectual impairments that need the support of another person to manage behaviours.

Examples of what evidence may NOT meet the requirements of SRFC for communication. Please note these also apply to the area of psychosocial disability.

• A learning disorder which limits a persons’ ability to read and write
• Attending speech pathology for help with communication
• Help for remembering information at appointments
• Support and prompting to share feelings.

Case Studies in Communication – other key indicators

Apraxia of Speech

Apraxia of speech (often referred to as Childhood Apraxia of Speech ‘CAS’) is a motor speech disorder. This is a neurological impairment commonly diagnosed by a neurologist and/or speech pathologist. The TAPIB have advised IROs to consider Access Met – Early Intervention (section 24(1) (b), s251 (a) satisfied) and support the gathering of further information if required and completing a functional call with relevant authorised health professional and/or a ‘request further information’ letter.

Stroke/Cerebrovascular Accident (CVA), Traumatic Brain Injury (TBI) or Acquired brain Injury (ABI), Hypoxic brain Injury with communication impacts

Pathways in the brain are responsible for both understanding (receptive language) and speaking (expressive language). Any impacts on the brain can affect these areas responsible for communication. There will usually be a speech pathologist report, neurologist report or rehab specialist report. Further information should be sought using a functional capacity phone call or request for further information letter if there is evidence of one of these impairments related to brain injury and there is information another person is supporting most communication attempts.

Advice from your Line Manager or TAPIB advisor may be needed, if you notice any of these key indicators.

Vision and Hearing Impairments

Have reference to the Our Guidelines - Applying to the NDIS (external) when assessing visual and hearing impairments and obtain further information if the SRFC requirements are not met.

An application does not need to demonstrate the application from a Deaf or Hard of Hearing person would meet the List A or B requirements to meet the Section 24 Disability Requirements. For example, if a case shows the use of Cochlear implants and Auslan is the primary language, do not request further evidence in terms of audiograms or surgical reports if the functional evidence is demonstrating substantially reduced functional capacity.

The same is considered for visual impairments. An IRO can apply discretion around whether guide dogs, white cane, legally blind is mentioned in the evidence coupled with strong functional information rather than request evidence from an ophthalmologist. If in doubt, have a conversation with your line manager or receive further advice thought TAPIB.

Other key indicators to consider for vision and hearing impairments may include:

• Braille

• Hearing loss at a young age, now an adult and still reliant on aides
• Audiogram where the hearing limits do not reach the levels adequate for speech sound discrimination

Social interaction

Rule 5.8(a) reliance on prescribed aides and devices

SRFC may look like but is not limited to:

It is rare a person would be completely reliant upon a device for social interaction. There may be an overlap with a communication device, which the person uses when in social settings.

Rule 5.8(b) reliance on the support/intervention of others

SRFC may look like a combination of these indicators but is not limited to:

• History of inappropriate behaviours towards others
• History of violent aggression where the person consistently misinterprets the responses of others
• The person usually requires people to act as intermediary between them and others
• The person’s main social engagement is through facilitated and/or supported groups. For example, day programs, social clubs
• The person’s parents may still organise their outings as an adult
• The person’s friends are mainly other people living with a disability or are trusted support workers
• Evidence the person cannot make or keep friends
• The person might regularly lose friends easily
• The person may overshare to the point of vulnerability or offence
• The person may not be able to access their community effectively due to a lack of ability to behave within social norms

• There may be a history of being taken advantage of socially or a history of being socially vulnerable.

Rule 5.8(c) unable to participate in the activity

SRFC may look like but is not limited to:

There may be evidence of a complete inability to participate in the mainstream community appropriately. There may also be overlap with other key life areas such as learning, self-management.

Psychosocial Disability

Examples of SRFC in social interaction.

• The person may not be able to interact with members of the community due to social anxiety. They may require a support person to leave the house and interact with people at the bank, shop or post office
• An inability to make and keep any friends
• An inability to access any section of the community
• An inability to behave within limits which are acceptable within the community

Examples of what evidence may NOT meet the requirements of SRFC for communication. Please note these also apply to the area of psychosocial disability.

• Needs help to make contact with friends or socially withdraws when unwell
• Only has contact with friends via phone, email
• Socially isolated because friends and family live far away
• Socially isolated because they are a person from a culturally and linguistically diverse background (CALD)

Appendix B – Legislation Amendments

On 22 August 2024 the ‘Getting the NDIS back on track No.1’ Amendments Act 2024 passed through parliament with the purpose of amending the NDIS Act 2013. This Amendments Act applies only to internal review requests for decisions made after the 3 October 2024. This Amendment Act repealed and replaced the wording within the Disability criteria, Section 24(1)(e) to confirm that supports provided must be ‘NDIS Supports’. The Amendments Act also replaced the Early Intervention criteria s25(1)(3) with 25(1)(d) to note that a person must meet the criteria for requiring ‘NDIS Supports’ to be eligible for the NDIS. ‘NDIS Supports’ are outlined within Section 10 of the Act and enlivened through our National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (Miscellaneous Provisions) Transitional Rules 2024.

The Amendments Act also outlined that a person who is applying for the NDIS may be eligible for either the Disability criteria, Early Intervention criteria or both. The NDIS must confirm what eligibility criteria a participant has met for in writing.

From January 2025 the NDIS must provide impairment categories information as part of access met decision outcomes. When an IRO decides to set aside a previous ‘access not met’ decision, a letter with impairment categories information, specifying the category or categories of impairments that cover the impairment or impairments for which the participant has met the disability and/or early intervention requirements, is automatically included with the participant’s successful NDIS application letter.

The NDIS Act was previously amended on 1 July 2022, to provide more clarity around the eligibility criteria for people with episodic or fluctuating impairments. These amendments also update the language in respect of episodic or fluctuating impairments.

Terminology has changed from ‘psychiatric condition’ to ‘psychosocial disability’.

All impairments which are episodic or fluctuating in nature may be taken to be permanent, regardless of whether the impairment is attributable to a psychosocial or non-psychosocial disability. This clarification reflects recommendations from the Tune Review.

Currently, there are no changes to how Section 24(1)(c) substantially reduced functional capacity is assessed.

Please speak to your line manager if you have any questions in relation to Access or Revocation Internal Reviews impacted by these changes.

Appendix C – Guidance for using Templates along with free text for s100 outcome letters

1. Ensure information is objective, include facts based on evidence, and avoid personal opinions or feelings. We must make good, evidence-based decisions. Communicating the internal review decision clearly is critical as it improves the applicant/participant experience and understanding.
2. Reference all information the applicant/former participant/participant has provided in your decision. This includes any relevant documents or material relied on such as medical reports, comments, conversations, and emails.
3. Keep the text short, simple and in plain conversational English.
4. Avoid jargon, terminology or additional information that is non-specific or does not add value to the understanding of the internal review outcome.
5. Introduce all acronyms before using them. For example, ‘Occupational Therapy (OT)’.
6. Cross-check your decision against the statutory criteria to ensure you meet all necessary sections.
7. Provide the basis for how you reached your decision against each criteria in the legislation.
8. Provide relevant information on how and why the internal review decision was made.