IRT - Access and revocation request internal note templates

DOCUMENT 4 FOI 25/26-1995

IRT - Access and revocation request internal note templates

This article provides guidance for an internal review officer to use templates accurately to record activities in PACE.

Recent updates

15 December 2025

Updates to:

• s100 – Initial contact template
• s100 – Request Withdrawn template

Templates

Recording activities within PACE is essential for information gathering, record keeping and a nationally consistent service delivery approach. Refer to article [Log an activity or internal note](https://example.com) for guidance on creating case activities.

All references to applicant in this document also refers to former participants (for revocations), authorised representatives, nominees and child representatives.

Recording Internal Notes in PACE is mandatory. It is essential for information gathering, record keeping and a nationally consistent service delivery approach.

s100 – Initial Contact

Record initial s100 contact with the applicant

Date: <dd/mm/yyyy>.

Pre-Contact SMS Sent: <Yes on dd/mm/yyyy to applicant’s name/authorised representative>.

Contact with: <relationship – applicant’s name/authorised representative>.

Phone no: .

Consent confirmed: <Yes/No> <who gave consent, how – over the phone/in writing, to whom the consent is being given, for what purpose, for how long the consent is provided>.

POI Confirmed: <Yes/No> <3 point security check – full name, address, DOB, email, organisation name, work email, work address, applicant’s NDIS no., applicant’s DOB.>.

Valid request for s100: Confirmation of consent and authority of the applicant <relationship – nominee/child representative/guardian> established <prior to

initial contact and verified by IRO/during initial contact as required by IRO>.

<Confirm the disabilities/impairments to be reviewed informed by what was assessed in the original decision>

.

.

All evidence provided for the internal review: <Yes/No>. <If No, provide details of what information is to be provided>.

Further evidence requested by IRO: <Yes/No>.

Document Listing: <Optional inclusion: Insert evidence used for most recent decisions and all newly provided evidence using the naming convention: Applicant surname, Applicant first name, NDIS number, Topic/Document Name/Document and Report Date.>

Agreed timeframe: <Provide details about what information to be provided, how information is to be provided> by agreed timeframe of <dd/mm/yyyy>.

IRO acknowledged <applicant’s> concerns/review request and explained the review process and access criteria.

.

Preferred Method of Contact for Internal Review Outcome: <Confirmed as per current information on PACE as phone/email/mail> <Internal review decision agreed to be communicated by phone/email/mail>.

Action: .

If no response is received by the due date, a decision will be made based on the evidence available.

Details provided to assist with gathering further evidence: Details provided include <provide relevant details about Support Coordinator/Local Area Coordinator or Early Childhood Partner>.

Once the internal review decision is made the outcome will be communicated by <phone/email/mail>.

s100 – Initial Contact (within 14 days of the Acknowledgement Letter)

Date: <dd/mm/yyyy>.

Pre-Contact SMS Sent: <Yes on dd/mm/yyyy to applicant’s name/authorised representative>.

Contact with: <relationship – applicant’s name/authorised representative>.

Phone no: .

Consent confirmed: <Yes/No> <who gave consent, how – over the phone/in writing, to whom the consent is being given, for what purpose, for how long the consent is provided>.

POI Confirmed: <Yes/No> <3 point security check – full name, address, DOB, email,

organisation name, work email, work address, applicant’s NDIS no., applicant’s DOB.>.

Valid request for s100: Confirmation of consent and authority of the applicant <relationship – nominee/child representative/guardian> established <prior to initial contact and verified by IRO/during initial contact as required by IRO>.

<IRO confirmed that no further information would be provided within the 14-day acknowledgement timeframe and <applicant’s name/authorised representative> provided consent for the review to progress and for a decision to be made.>

<IRO advised the additional information is required to be submitted by .

IRO explained a Further Information Request letter would be <posted/emailed>. IRO further explained if the additional information was not provided by that date, and if no contact was made by <applicant’s name/authorised representative>, the Internal Review would proceed, and a decision would be made using the available information.>

IRO acknowledged <applicant’s> concerns/review request and explained the review process and access criteria.

.

Action:

s100 – Unable to Contact

Date: <dd/mm/yyyy>

Pre-Contact SMS Sent: <Yes on dd/mm/yyyy to applicant’s name/authorised representative>

Contact with: <relationship – applicant’s name/authorised representative>

Phone no:

Contact attempt was made regarding an Internal Review via <email/phone/SMS> to <applicant’s name/authorised representative> on <insert phone number/email address>.

If contact was via phone, add the following sentence OR .

s100 – Unauthorised Request

An internal review request was lodged on <dd/mm/yyyy> by an unauthorised person. <Record the detail of the unauthorised representative, relevant information>. The Internal Review Branch has withdrawn the internal review and will take no further action on this request. It was an invalid request without record of consent from the applicant. I confirm I have checked this file and the party that submitted the review request does not have authority to act on behalf of the applicant.

If an internal review is required, please advise the requestor that they will need to re-submit the request with the required consent. Refer to Internal Review guidelines and Our Guideline - Your privacy and information (external) for who is authorised to request an internal review .

If the applicant provides consent for the review in the future and within time, the date of

the request should reflect the date a valid request was made.

The Internal Review Unauthorised Request Letter has been sent to on <dd/mm/yyyy>.

<IRO/BSO Logon>

s100 – Internal review requested

s100 form submitted on: <dd/mm/yyyy>.

Submitted by: .

Review Type: <Access not met/Access revoked>.

IRT Intake completed by:

Date received by Agency: <dd/mm/yyyy>

Authorised Representative: <Authorised representative that consented to review/no consent>

Acknowledgement letter sent: <dd/mm/yyyy>

Core issues associated with review request:

Risk:

Reason for risk:

Type of s100:

s100 – Request for Further Information

Request for further information from or .

Formal request for information issued via email/post on <dd/mm/yyyy>.

Further evidence to be provided by mail/email. Email/return postal address details provided. Due date: <dd/mm/yyyy>.

Consent has been provided to contact third parties regarding the information: <Y/N, details of third party, and note you have recorded their consent on PACE>.

Due date based on method of provision and

.

s100 – Request Withdrawn

s100 of or decision withdrawn on <dd/mm/yyyy>.

Withdrawn by: <name of Applicant/Authorised representative>

Reason for withdrawal: . I have advised the impact of withdrawal on the review request (no decision will be made, no ART rights) to the applicant, as well as options for new access application in the future.

If applicable, add following paragraph about POI

Any required POI check had been completed via <insert method for example. 3-point

security check – full name, address, DOB, email, organisation name, work email, work address, applicant’s NDIS no., applicant’s DOB.>.

s100 – Confirmed (Access not met) – Age Requirements

Review of Access not met/Revocation decision – completed by .

Original Access not met/Revocation decision made – <dd/mm/yyyy>.

As a delegate of the CEO, I am not satisfied meets the access criteria to become a participant of the NDIS.

The criteria for access to the NDIS is set out in section 22 of the National Disability Insurance Scheme Act 2013. This states a person must be aged between 0 and 64 when an access request is made. The NDIA is unable to waive this legislative requirement.

As the age requirements are not satisfied by information and evidence provided for the internal review, further assessment of eligibility in relation to the Disability, Residency and Early Intervention requirements (set out in sections 23, 24 and 25 of the National Disability Insurance Scheme Act 2013) has not been considered as part of this internal review.

s100 – Confirmed (Access not met) – Residency Requirements

Review of Access not met/Revocation decision – completed by <IRO name and Logon ID

Original Access not met/Revocation decision made – <dd/mm/yyyy>.

As a delegate of the CEO, I am not satisfied meets the access criteria to become a participant of the NDIS.

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

As the age requirements are not satisfied by information and evidence provided for the internal review, further assessment - of eligibility in relation to the Disability, Residency and Early intervention requirements (set out in sections 23, 24 and 25 of the National Disability Insurance Scheme Act 2013) has not been considered as part of this internal review.

s100 – Confirmed (Access not met) – Disability and Early Intervention

Review of Access not met/Revocation decision – completed by .

Original Access not met/Revocation decision made – <dd/mm/yyyy>.

As a delegate of the CEO, I am not satisfied meets the access criteria to

become a participant of the NDIS.

s100 – Set Aside (Access met)

Review of Access not met/Revocation decision – completed by .

Original Access not met/Revocation decision made – <dd/mm/yyyy>.

Recent contact made with <applicant’s name> and <they provided additional documents/no-additional documents provided>.

As a delegate of the CEO, I am satisfied meets the <s24 disability criteria/ s25 early intervention criteria/s24 disability and s25 early intervention criteria> to become a participant of the NDIS. The applicant has met for the following impairment <category/categories>:

<Instruction: Remove any impairment categories that are not required>

• Physical
• Intellectual
• Cognitive
• Sensory
• Neurological
• One or more impairments to which a psychosocial disability is attributable
• Developmental Delay

Section 22 and 23 Met Justification:

Age and residency criteria are met for as verified through <Centrelink mainframe with consent by on /documents attached to PACE by on /Document Verification System with consent by on <dd/mm/yyyy>.

Section 24 <Met/Not Met> Justification:

Based on the information provided meets/does not meet the disability criteria as set out in s24 of the NDIS Act 2013 based on the following:

<Provide a brief statement as to why the criterion was met or not met, and what piece of evidence supports your statement of claim under the appropriate headings below:>

24 1a – Impairment

24 1b – Permanence

24 1c – Substantial reduction in functioning

24 1d – Participation

24 1e – Requires lifetime NDIS supports>

<Attached evidence from <name, date and discipline of health professional> indicates has . This is on List A and no further assessment is required.>

Section 25 <Met/Not Met> Justification:

Based on the information provided meets/does not meet the early intervention criteria as set out in s25 of the NDIS Act 2013 based on the following:

<Provide a brief statement as to why the criterion was met or not met, and what piece of evidence supports your statement of claim under the appropriate headings below:

25 1a – Impairment

25 1b – Reducing future need for support

25 1c – Benefiting the person

25 1d – Early intervention supports that would likely benefit the person are NDIS supports>

<Provide a brief statement as to why the criterion was met and what piece of evidence supports your statement of claim under the appropriate headings below:

25 1a – Delay attributable to Impairment

<Under the age of 6 at the time of assessment>

<Substantial reduction in <self-care, receptive or expressive language, cognitive

development or motor development>

25 1b – Reducing future need for support

25 1c – Benefiting the person

25 1d – Early intervention supports that would likely benefit the person are NDIS supports>

<Based on the information provided, meets the Early Intervention criteria as set out in s25 of the NDIS Act 2013 based on the following:

This child under 7 years old has a condition listed on List D and no further information is required.>

Set Aside Completion Tasks

<Instruction: Include this information at the end of the section 24/25 justification for all set aside decisions>

Note: has only met access for . They do not meet access for .

The following pre-planning tasks have been completed or confirmed based on available evidence/information at time of Internal Review decision: Streaming correct.

Primary disability correct.

s100 – Communicate Confirm Decision (phone and email/mail)

Pre-Contact SMS Sent: <Yes on dd/mm/yyyy to applicant’s name/authorised representative>.

Successful phone contact made with on .

POI Confirmed: <Yes/No> <3 point security check – full name, address, DOB, email, organisation name, work email, work address, applicant’s NDIS no., applicant’s DOB.>

Decision outcome:

<Insert IRO communication regarding the decision outcome, the evidence supporting it, a brief explanation, and ART rights>.

<Insert applicant’s response to the decision outcome>.

Action undertaken:

Internal review outcome to be finalised with the basis of the decision letter sent via <email/mail> to .

If applicable add information about agency risk, otherwise delete

.

Refer to the outcome decision letter for further information.

If applicable add information about SMS notification sent for email outcome

Notification SMS Sent for s100 outcome email sent: <Yes on dd/mm/yyyy to applicant’s name/authorised representative>

s100 – Communicate Confirm Decision (email/mail)

Decision outcome provided via <email/post>.

Decision outcome, ART rights, Local Area Coordinator/other community supports provided within correspondence.

Refer to the decision letter for further information.

s100 – Communicate Set-aside Decision

Pre-Contact SMS Sent: <Yes on dd/mm/yyyy to applicant’s name/authorised representative>.

Successful phone contact made with on .

POI Confirmed: <Yes/No> <3 point security check – full name, address, DOB, email, organisation name, work email, work address, applicant’s NDIS no., applicant’s DOB.>

Decision outcome:

IRO provided outcome of the internal review to as a set aside decision with the evidence meeting the <disability criteria/early intervention criteria/disability and early intervention criteria>. IRO advised that has met for their . If applicable add information about the Impairments categories information

IRO advised these impairment categories will be listed on the participant’s Impairments categories information.

IRO advised they would receive contact from an NDIS representative to arrange a planning appointment.

.

Action undertaken:

s100 letter has be sent via <email to /mail to applicant’s address>.

If applicable add information about SMS notification sent for email outcome

Notification SMS Sent for s100 outcome email sent: <Yes on dd/mm/yyyy to applicant’s name/authorised representative>

Refer to the outcome decision letter titled s100 internal review request <dd/mm/yyyy> for further information.

s100 – Outcome Recorded, Internal Review Closed

Original Access not met/Revocation decision made: <dd/mm/yyyy>

Internal review decision made: <dd/mm/yyyy>.

Any relevant information or documents have been uploaded to PACE.

I confirm all materials relevant to the decision, including the decision letter, are attached to the participant file on PACE.

s100 – Explanation of Decision

Date: <dd/mm/yyyy>

Pre-Contact SMS Sent: <Yes on dd/mm/yyyy to applicant’s name/authorised representative>.

Contact with: <relationship – <applicant’s name/authorised representative>.

Phone no:

POI Confirmed: <Yes/No> <3 point security check – full name, address, DOB, email, organisation name, work email, work address, applicant’s NDIS no., applicant’s DOB.>.

: Phone/Email contact made to discuss the request for Explanation of decision, no answer, <no message was left/a voicemail message was left with Review Officer’s name>.

Explanation of Decision:

Review request: (list the requests)

Decision made: (confirm/set-aside)

Explanation:

Would you like today’s explanation of decision in writing? Y/N?

If not satisfied with the decision they may also apply to the Administrative Review Tribunal (ART) for a further external review within 28 days of receiving the s100 outcome letter.

More details about ART are included in the letter.