DOCUMENT 22
IRT - Planning request internal note templates
This article provides guidance for a review officer, business support officer or participant support officer to use templates to accurately record activities for internal notes in PACE.
Recent updates
1 December 2025
Updates to initial call and clarification of review contact 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 for guidance on creating case activities.
Select the relevant Internal Notes name to use the template relating to the action completed on the Internal Review Case.
Note: For s100 – Completed – No change to statement of supports (confirmed decision) and s100 – Completed – Change to statement of supports – Implementation required with participant (set aside/vary decision) templates must be added into the Handover Notes for the Plan Implementation.
s100 – Withdrawn as review created in error or to follow alternate pathway
Note: This withdrawal template is for the purposes of participant requested withdrawals, including if they choose an alternate pathway.
Pre-Contact SMS Sent:
Contact with:
Email/Phone number:
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 (Proof of Identity) confirmed: <Yes/No> < Provide details of the 3-point security check – full name, address, DOB, email, organisation name, work email, work address, participant’s NDIS (National Disability Insurance Scheme) number, participant’s DOB>.
Withdrawal confirmed by:
Withdrawal explanation:
I have advised the impact of withdrawal on the review request (no decision will be made, no Administrative Review Tribunal (ART) rights to the < participant, authorised representative>, as well as relevant options discussed <list options for example linkage with community partner details, implementation of plan supports>.
Advised the National Disability Insurance Agency (NDIA) will not take any further action on the internal review request, and they will not receive a decision letter. The internal review request is withdrawn on <dd/mm/yyyy>. Advised withdrawal letter will be issued.
s100 - Request review withdrawn due to early resolution
Pre-Contact SMS Sent:
Contact with:
Email/Phone number:
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> < Provide details of the 3-point security check – full name, address, DOB, email, organisation name, work email, work address, participant’s NDIS number, participant’s DOB>.
Withdrawal confirmed by:
Reason for withdrawal: < Participant/plan nominee/child representative/guardian/decision maker> indicated they have made the decision to withdraw the internal review request because of <a scheduled reassessment due in/early resolution> <Note the reason for the withdrawal and participant’s understanding of the early resolution>.
Outcome: Advised the NDIA will not take any further action on their request for internal review, and they will not receive a decision letter. They will therefore not be able to appeal to the ART to change their plan. They will however still be able to ask the NDIA for a participant initiated plan reassessment at any time. Confirmed having received this information,
Next steps informed:
As per this conversation/contact the internal review is withdrawn on <dd/mm/yyyy>.
Advised withdrawal letter will be sent out via the preferred communication method by <postal address/email address abcd@xyx.com>.
s100 - Unauthorised review request
A review request for an s100 review of a reviewable decision was lodged on <dd/mm/yyyy> by an unauthorised person. <Record the detail of the unauthorised representative, relevant information>.
The Reviews Branch has withdrawn the s100 and will take no further action on this request. It was not deemed a valid request as no consent was noted on the record from the participant.
I confirm I have checked this participant record and the party that submitted the review request does not have authority to act on behalf of the participant.
If an internal review is required, please advise the requestor they will need to re-submit the s100 with the required consent.
If the participant provides consent for the review in the future, the date of the request should reflect the date a valid request was made.
The Internal Review Unauthorised Request Letter has been sent to
s100 – Initial call and clarification of review contact
Date: <dd/mm/yyyy>
Pre-Contact SMS Sent:
Contact with:
Phone number:
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> < Provide details of the 3-point security check – full name, address, DOB, email, organisation name, work email, work address, participant’s NDIS number, participant’s DOB>.
Review requests as confirmed:
<Request/s>
For example:
Core support for 15 hours per day to assist with daily living
30 hours of Therapy per week
Funding for Assistance dog.
<Brief notes/any key points from phone conversation/ information relates to review request>.
Confirm relevant current evidence on file. All evidence provided for the internal review:<Yes/No>. <If No, provide details of what further information is to be provided>.
I have explained in addition to the above specific requested supports, we will consider the total statement of participant support and determine this is correct and if any adjustments are required to be made. This means funding could increase or decrease based on the outcome of the review. If I find an error in funded supports I will arrange contact before making my decision.
Further evidence requested by IRO: <Yes/No>
Document Listing (If required): <Insert evidence used for most recent decisions and all newly provided evidence using the naming convention: Participant surname, Participant first name, NDIS number, Topic/Document Name/Document and Report Date.>
Agreed timeframe: Occupational Therapy report/Functional capacity assessment, Letter from specialist to be provided by <dd/mm/yyyy>.
Preferred Plan Duration discussed: <24 month/12-month plan end date same as scheduled reassessment>.
Preferred Plan Management: Participant wants the new plan to be <Agency/Plan/Self-managed>.
Preferred Funding Periods: Participant has a preference of <1/3/6/12 month> funding periods.
Plan implementation meeting offer outcome: <accepted/declined>
Preferred Method of Contact for Internal Review Outcome: <Confirmed as per
current information on system by phone/email/mail>
Next steps informed:
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 - Unable to contact
Date: <dd/mm/yyyy>
Pre-Contact SMS Sent:
Contact with:
Phone number:
If contact was via phone, add the following sentence
s100 - Outcome decision - Reassess a plan (s48)
Date: <dd/mm/yyyy>
Decision Outcome:
A s100 review was completed on dd/mm/yyyy in relation to the previous decision made to not <conduct a plan reassessment / not to vary the plan>.
A decision was made based on the evidence available at the time of review.
All documents relevant to the decision, including the decision letter are uploaded to PACE.
A copy of the decision letter has been emailed/posted to participant/nominee/child representative at <insert email address/address> on dd/mm/yyyy. <If email is their preferred method of communication, include the following sentence:> Notification SMS Sent for s100 outcome email sent: <Yes on dd/mm/yyyy to nominee/child rep/guardian/participant>.
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 letter. More details about ART are included in the letter.
Plan implementation support information was provided to the participant and they <accepted/declined> a plan implementation meeting.
Confirmed all internal notes and communications completed? <Yes/No>
s100 – Completed Outcome - Statement of supports/Plan variation (s47A)
Date: <dd/mm/yyyy>
Decision Outcome <Set aside/Vary/Confirm>
An s100 review of <statement of support/variation s47a> was completed on: dd/mm/yyyy
Supports reviewed were:
-
<List support 1>
-
<List support 2, if applicable>
-
<List support 3, if applicable>
-
<If s47A plan variation was also included in your s100 decision, include the support request here and state in brackets at the end of the sentence (s47A request), if applicable>.
A decision was made based on the evidence available at the time of review.
All documents relevant to the decision, including the decision letter are uploaded to PACE.
A copy of the decision letter <and plan (if set aside/vary decision)> has been emailed/posted to participant/nominee/child representative at <insert email address/address> on dd/mm/yyyy. <If email is their preferred method of communication, include the following sentence:>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 letter.
More details about ART are included in the letter.
Plan implementation support information was provided to the participant and they <accepted/declined> a plan implementation meeting.
(If decision was to set-aside/vary also include the following):
Plan Duration:
Plan Management:
Was the PCST used as part of the plan build? <Yes/No/>
Has the PCST been attached to the record? <Yes/No/>
Removal/changes to supports:
Additional Delegate notes for plan implementer:
Please accept this as notification the participant’s record is also being returned for implementation of the plan.
Confirmed all internal notes and communications completed? <Yes/No>
(If decision was to confirm also include the following):
There has been no change to the participant’s statement of supports, the date the plan will be reassessed by or plan management method. For further information refer to the s100 Outcome of Decision letter. The participant may require additional support to access mainstream or community services
Plan implementation support information was provided to the participant and they <accepted/declined> a plan implementation meeting.
Confirmed all internal notes and communications completed? <Yes/No>
s100 - Request to complete a plan reassessment (s48)
Date: <dd/mm/yyyy>
<Insert the following sentence if the request requires priority action: This request is identified for priority action due to potential risk or escalation and has been endorsed
by <insert logon of Team Leader/Assistant Director> who will provide a handover to
Risk: <insert, low, medium, high, extreme>
Risk Reason:
Confirmed all internal notes and communications completed? <Yes/No>
s100 - Internal review home and living advice required
Date: <dd/mm/yyyy>
Home and living advice required following s100 Decision
Risk Rating: (Low, Medium, High, Extreme).
Risk Reason: (for example, homelessness in 2 weeks, no funding in current plan).
The Reviews Branch have endorsed an internal review where home and living supports have been impacted, advice is required prior to plan approval.
Internal Review Home and Living Team - please advise if a change to the SIL or LASA calculation is required.
Decision made: (for example, s100 decision to set aside the original decision).
Review Request for: (please list reason, for example, changes to SCCP etc.).Please
refer to s100 work item XXX and Inbound Documents named XXX for further information.
Please update this Interaction Record and/or contact Reviews Branch Delegate to discuss advice.
s100 - Explanation of decision
Date: <dd/mm/yyyy>
Pre-Contact SMS Sent:
Contact with:
Phone number:
Explanation of Decision:
Review request:
Decision made: <confirm/set-aside>
Explanation:
Would you like today’s explanation of decision in writing? <yes/no>
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.
s100 – Higher Decision Delegate Approval Level 4
Plan submitted for approval on: <dd/mm/yyyy>
Review type:
Plan completed by:
NDIS number:
CASE ID number:
Outline of s100 request:
Supports proposed to be set-aside/varied as part of this Internal Review Request:
-
<List support 1 category and volume/frequency>
-
<List support 2, if applicable>
-
<Plan management type, if applicable>
-
<Plan variation decision under Section 47A, if applicable>
Supports proposed to be confirmed as part of this Internal Review Request:
-
<List support 1 category and volume/frequency>
-
<List support 2, if applicable>
-
<Plan management type, if applicable>
- <Plan variation decision under Section 47A, if applicable>
Plan duration:
Inflation percentage:
I confirm the participant’s plan management decision has been taken into consideration and they have chosen to
I have considered supports which are reasonable and necessary and these supports are funded under s34 of the NDIS Act. I have detailed in justifications my reasoning as to why supports are reasonable and necessary and included a list of materials referred to as part of the s100 decision.
s100 – Review Officer home and living assessment specialist disability accommodation
SDA Price for Approval (lowest of below as per - Implement SDA quote): $0.00
RO HaL SDA Decision:
PACE Case: <#XXXXXXXX>
Decision Date: <dd/mm/yyyy>
SDA Type:
Location:
Design Category:
Building Type:
Maximum Price (2024/25):
SDA PACE Enrolled Dwelling:
Asset Provider:
Address:
SDA Type:
Location:
Design Category: Building Type:
Maximum Price (2024/25):
s100 - Legacy specialist disability accommodation
SDA Quote has been processed and approved in PACE by IRO HaL
As per Our Guideline - Specialist Disability Accommodation page,13, where a participant is residing in SDA prior to accessing the NDIS, they are eligible for SDA funding. However, where a participant moves from their accommodation setting, they are still eligible but will require an SDA re- assessment.
Legacy Enrolled Dwelling:
Legacy ID: Asset Provider:
Address:
SDA Type:
Location:
Design Category:
Building Type:
Max Price: