FOI 24/25-1473 DOCUMENT 1

Practice Guide

For Internal Use Only

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Access and Eligibility Reassessment (ER)

Practice Guide - NDIS Amendment Act 2024

The content of this document is OFFICIAL.

This guide assists the Scheme Eligibility Branch to assess new applicants’ eligibility and determine if existing participants remain eligible for the National Disability Insurance Scheme (NDIS).

This guide is designed to be used with the Access and Eligibility Reassessment (ER) Decision Tree to make legislatively correct access decisions for all eligibility reassessments and any initial access requests received on or after 3 October 2024. If you are making an access decision for a request received before 3 October 2024, refer to Access and Eligibility Reassessment Practice Guide NDIS Act 2013.

1. Recent updates

2. Checklist

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Checklist

Note: All eligibility reassessments are assessed under NDIA Amendment Act 2024

If you are assessing:

• Based on NDIS Act 2013 — Go to Access Guide NDIS Act 2013
• Based on NDIS Amendment Act 2024 — Continue to Section 3. Are you making an Access or ER decision?

You are working through:

• Access and ER Decision Tree

3. Are you making an Access or ER decision?

For Access decisions, go to Section 4. Access — Age Requirements

For ER decisions, go to Section 8. ER — Residence Requirements

4. Access — Age Requirements

Does the applicant meet the age requirements?

Legislation

Section 22 Age requirements

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A person meets the age requirements if the person was aged under 65 when the access request in relation to the person was made.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant was aged under 65 when their access request was received as valid (that is, complete)

5. Access – Residence Requirements

5.1 Does the applicant meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person:

(a) resides in Australia; and

(b) is one of the following:

(i) an Australian citizen;

(ii) the holder of a permanent visa;

(iii) a special category visa holder who is a protected SCV holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to:

(a) the nature of the accommodation used by the person in Australia; and

(b) the nature and extent of the family relationships the person has in Australia; and

(c) the nature and extent of the person’s employment, business or financial ties with Australia; and

(d) the nature and extent of the person’s assets located in Australia; and

(e) the frequency and duration of the person’s travel outside Australia; and

(f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

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When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• lives in Australia for most of the year; and
• is an Australian Citizen; or
• is the holder of a permanent visa; or
• is the holder of a protected Special Category Visa (SCV)

6. Access – Streamlined Decisions

6.1 List A

List A conditions that are likely to meet the disability requirements.

• Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

6.2 0-25 Hearing Impairments

An applicant meets the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and

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• have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

Applicants that have a List A condition who are under 7

Applicants that have a List A condition who are over 7

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Applicants that DON’T have a List A condition who are over 7

Applicants that DON’T have a List A condition who are under 7

6.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

• Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you need early intervention?

For applicants under the age of 7

6.4 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

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(a) the person:

(iii) is a child who has developmental delay; and

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability; and

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, selfcare or self-management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.; and

(d) the CEO is satisfied any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) cognitive development;

(iv) motor development; and

(c) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

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For further information, refer to Our Guidelines - What about children younger than 6 with developmental delay?

6.5 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more conditions that are likely to result in a permanent impairment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

• has substantially reduced functional capacity to perform one or more activities;
• is affected in their capacity for social or economic participation; and
• is likely to require support under the NDIS for their lifetime.
• Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to Our Guidelines - Is your impairment likely to be permanent?

For applicants who meet the 0-25 Hearing Loss, List D or Developmental Delay criteria

For applicants who DON’T meet the 0-25 Hearing Loss, List D or Developmental Delay criteria

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7 Access - Early Intervention Requirements

For children under the age of 7 they are first assessed against the early intervention criteria. If they do not meet, then assess them against the disability requirements.

Before you commence the assessment, you must ensure the applicant meets both the age requirements and residency requirements.

7.1 Does the applicant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
• the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and
• the impairment is, or is likely to be, permanent.
• Note: When an applicant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?

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• Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
• Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success?
• Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only?
• Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes?
• If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable?
• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Our Guidelines - Do you need early intervention?

7.2 Does the applicant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

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(1) A person meets the early intervention requirements if:

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the applicant’s permanent impairment/s will reduce their need for disability-related supports in the future.

• Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the applicant needs less disability supports in the future?
• Does the evidence note which specific supports the applicant will no longer require should early intervention be undertaken?
• Does the evidence indicate that early intervention is likely to result in greater independence for the applicant?
• If the applicant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports?
• Is the recommended support of a functional nature, or capacity building in nature?
• In answering the above questions, does the evidence contain sufficient information addressing:
• How the applicant’s impairment is likely to impact them over time?
• What supports the applicant will require if they don’t receive intervention?
• What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

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7.3 Does the applicant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the applicant by:
• addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life
• preventing their functional capacity from getting worse
• improving their functional capacity
• supporting their informal supports to build their skills to help the applicant.

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• Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the applicant’s permanent impairment on their functional capacity?
• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the applicant’s functional capacity from declining?
• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the applicant’s functional capacity?
• Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports?
• In answering the above questions, does the evidence contain sufficient information addressing:
• How the applicant’s impairment is likely to impact them over time?
• What supports the applicant will require if they don’t receive intervention?
• What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

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7.4 Does the applicant meet section 25(1)(d)?

Legislation

Section 25 Early intervention requirements

(d) … any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports required are NDIS supports.

• Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Whether or not funding is available through other general systems is not the test of whether it is most appropriately funded or provided through the NDIS. For example, the fact that the health system does not adequately fund what is essentially clinical treatment (or some other form of support that is more appropriately funded through the health system) does not make it the responsibility of the NDIS.

For further information, refer to Our Guidelines - Is your early intervention most appropriately funded by the NDIS?

For applicants who do not have a List A impairment

For applicants who have a List A impairment

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8 Access – Disability Requirements

8.1 Does the applicant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has a disability (a reduction or loss in their ability to do things); and
• their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
• the impairment is intellectual, cognitive, neurological, sensory, or physical in nature.
• Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate both that the applicant has an impairment, and that the impairment is resulting in a disability?

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• Does the evidence demonstrate that the applicant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment?
• Does the evidence demonstrate that the applicant has a loss or significant change in one of their body’s functions or structure, or in how they think and learn; however, there is no indication that this is causing a reduction or loss in their ability to do things?
• Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to Our Guidelines - Is your disability caused by an impairment?

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

8.2 Does the applicant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

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(1) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant has a:

• permanent impairment; or
• likely permanent impairment.
• Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
• Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
• Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success?
• Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only?
• Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes?
• If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?
• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Is your impairment likely to be permanent? | NDIS

If the person does NOT meet the Early Intervention criteria

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If the person does meet the Early Intervention criteria

8.3 Does the applicant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

(i) communication;

(ii) social interaction;

(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

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…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures.
• Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations.
• Learning: how they learn, understand and remember new things, and practise and use new skills.
• Mobility: how they move around home and the community and how they get in and out of bed or a chair.
• Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health.
• Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.
• Note: When an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment?
• Does the evidence demonstrate that the applicant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person?
• Does the evidence demonstrate that the applicant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person?
• Does the evidence indicate that the applicant is able to participate in each activity effectively by using commonly used items?

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• Does the evidence indicate that the applicant is able to participate in each activity effectively, albeit more slowly or in a different way?
• Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the applicant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the applicant cannot complete without support?
• Why the applicant requires support?
• How often the applicant requires support, and what that support looks like?

For further information, refer to Our Guidelines - Does your impairment substantially reduce your functional capacity?

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

8.4 Does the applicant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

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(1) A person meets the disability requirements if:

(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the applicant’s social or economic participation.

• Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way?
• Does the evidence demonstrate that the applicant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way?
• Does the evidence demonstrate that the applicant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

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8.5 Does the applicant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(e) The person is likely to require NDIS supports under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• will require NDIS supports under the National Disability Insurance Schemes s their lifetime; or
• is likely to require the support of the NDIS for their lifetime.
• Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is likely to require disability supports that are not clinical in nature, and that focus on their functional ability, for their lifetime?
• Does the evidence demonstrate that the applicant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions?
• Are there any recommendations for interventions that are likely to improve the applicant’s functional capacity, and reduce their future need for disability related supports?
• If the applicant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions?

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• Does the applicant’s need for support relate to a health condition, and is that support more appropriately funded by the health system?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

If the person does NOT meet the Early Intervention criteria

If the person does meet the Early Intervention criteria

9 ER – Residence Requirements

9.1 Does the participant continue to meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person:

(a) resides in Australia; and

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(b) is one of the following:

(i) an Australian citizen;

(ii) the holder of a permanent visa;

(iii) a special category visa holder who is a protected SCV holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to:

(a) the nature of the accommodation used by the person in Australia; and

(b) the nature and extent of the family relationships the person has in Australia; and

(c) the nature and extent of the person’s employment, business or financial ties with Australia; and

(d) the nature and extent of the person’s assets located in Australia; and

(e) the frequency and duration of the person’s travel outside Australia; and

(f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

• lives in Australia for most of the year; and
• is an Australian Citizen; or
• is the holder of a permanent visa; or
• is the holder of a protected Special Category Visa (SCV)

10 ER – Streamlined Decisions

10.1 List A

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List A conditions that are likely to meet the disability requirements.

• Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

For applicants under the age of 7

Applicants aged 7 and over

10.2 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

• Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you need early intervention?

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10.3 0-25 Hearing Impairments

An applicant meets the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and
• have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

Applicants who are under the age of 7

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Applicants who are over the age of 7

10.4 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(iii) is a child who has developmental delay; and

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability; and

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

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(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, selfcare or self-management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.; and

(d) the CEO is satisfied any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(d) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(e) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) cognitive development;

(iv) motor development; and

(f) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to Our Guidelines - What about children younger than 6 with developmental delay?

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• knowledge article KA – Complete an Eligibility Check
• knowledge article KA – Finalise an Eligibility Reassessment decision | | Applicants that do not meet the Developmental Delay criteria | Go to Section 10.3 - List B |

10.5 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more conditions that are likely to result in a permanent impairment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

• has substantially reduced functional capacity to perform one or more activities;
• is affected in their capacity for social or economic participation; and
• is likely to require support under the NDIS for their lifetime.
• Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to Our Guidelines - Is your impairment likely to be permanent?

For participants who are under the age of 7

For participants who are over the age of 7

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11 ER - Disability Requirements

11.1 Does the participant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the participant has a disability (a reduction or loss in their ability to do things); and
• their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
• the impairment is intellectual, cognitive, neurological, sensory, or physical in nature.
• Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate both that the participant has an impairment, and that the impairment is resulting in a disability?
• Does the evidence demonstrate that the participant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment?
• Does the evidence demonstrate that the participant has a loss or significant change in one of their body’s functions or structure, or in how they think and learn; however, there is no indication that this is causing a reduction or loss in their ability to do things?

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• Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to Our Guidelines - Is your disability caused by an impairment?

For participants under the age of 7

For participants over the age of 7

11.2 Does the participant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(2) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant has a:

• permanent impairment; or

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• likely permanent impairment.
• Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
• Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
• Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success?
• Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only?
• Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes?
• If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?
• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Is your impairment likely to be permanent? | NDIS

For participants under the age of 7

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| | If they do not meet this criterion, they automatically do not meet Section 25(1)(a).

Please follow the process in:
- knowledge article KA – Complete an Eligibility Check, or
- knowledge article KA – Finalise an Eligibility Reassessment decision |

For participants over the age of 7

11.3 Does the participant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(2) A person meets the disability requirements if:

(c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

(i) communication;

(ii) social interaction;

(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

When is this criterion considered met?

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This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures.
• Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations.
• Learning: how they learn, understand and remember new things, and practise and use new skills.
• Mobility: how they move around home and the community and how they get in and out of bed or a chair.
• Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health.
• Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.
• Note: When a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment?
• Does the evidence demonstrate that the participant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person?
• Does the evidence demonstrate that the participant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person?
• Does the evidence indicate that the participant is able to participate in each activity effectively by using commonly used items?
• Does the evidence indicate that the participant is able to participate in each activity effectively, albeit more slowly or in a different way?

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• Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the participant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the participant cannot complete without support?
• Why the participant requires support?
• How often the participant requires support, and what that support looks like?

For further information, refer to Our Guidelines - Does your impairment substantially reduce your functional capacity?

For participants under the age of 7

For participants over the age of 7

11.4 Does the participant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

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(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the participant’s social or economic participation.

• Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way?
• Does the evidence demonstrate that the participant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way?
• Does the evidence demonstrate that the participant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

For participants under the age of 7

For participants over the age of 7

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11.5 Does the participant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(e) The person is likely to require NDIS supports under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

• will require NDIS supports for their lifetime; or
• is likely to require NDIS supports for their lifetime.
• Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant is likely to require disability supports that are not clinical in nature, and that focus on their functional ability, for their lifetime?
• Does the evidence demonstrate that the participant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions?
• Are there any recommendations for interventions that are likely to improve the participant’s functional capacity, and reduce their future need for disability related supports?
• If the participant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions?
• Does the participant’s need for support relate to a health condition, and is that support more appropriately funded by the health system?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

For participants under the age of 7

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For participants over the age of 7

12 ER – Early Intervention Requirements

12.1 Does the participant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

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(1) A person meets the early intervention requirements if:

(a) the person:

(i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the participant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and

• the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and

• the impairment is, or is likely to be, permanent.

• Note: Where a participant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

• What to consider

• Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?

• Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?

• Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success?

• Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only?

• Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes?

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• If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable?
• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Our Guidelines - Do you need early intervention?

For participants under the age of 7

For participants over the age of 7

12.2 Does the participant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(2) A person meets the early intervention requirements if:

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

When is this criterion considered met?

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This criterion is considered met if evidence on the record shows that early intervention supports for the participant’s permanent impairment/s will reduce their need for disability-related supports in the future.

• Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the participant needs less disability supports in the future? • Does the evidence note which specific supports the participant will no longer require should early intervention be undertaken? • Does the evidence indicate that early intervention is likely to result in greater independence for the participant? • If the participant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports? • Is the recommended support of a functional nature, or capacity building in nature?

In answering the above questions, does the evidence contain sufficient information addressing:

• How the participant’s impairment is likely to impact them over time? • What supports the participant will require if they don’t receive intervention? • What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

For participants under the age of 7

For participants over the age of 7

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12.3 Does the participant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the participant by: • addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life • preventing their functional capacity from getting worse • improving their functional capacity

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• supporting their informal supports to build their skills to help the participant. • Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the participant’s permanent impairment on their functional capacity? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the participant’s functional capacity from declining? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the participant’s functional capacity? • Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports? • In answering the above questions, does the evidence contain sufficient information addressing: • How the participant’s impairment is likely to impact them over time? • What supports the participant will require if they don’t receive intervention? • What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

For participants under the age of 7

For participants over the age of 7

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12.4 Does the participant meet Section 25(1)(d)?

Legislation

Section 25 Early intervention requirements

(d) … any early intervention supports that would be likely to benefit the person as mentioned in paragraphs (b) and (c) would be NDIS supports for the person.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports required are NDIS supports.

• Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Whether or not funding is available through other general systems is not the test of whether it is most appropriately funded or provided through the NDIS. For example, the fact that the health system does not adequately fund what is essentially clinical treatment (or some other form of support that is more appropriately funded through the health system) does not make it the responsibility of the NDIS.

For further information, refer to Our Guidelines – Is your early intervention most appropriately funded by the NDIS?

For participants under the age of 7

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For participants over the age of 7

13 Related procedures or resources

• National Disability Insurance Scheme (Becoming a Participant) Rules 2016 • NDIS Amendment Act 2024 • Our Guidelines - Applying to the NDIS

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ndis Practice Guide For Internal Use Only

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• KA — Make an access decision • KA — Complete an Eligibility Check • KA — Finalise an Eligibility Reassessment decision • Access and ER Decision Tree

14 Feedback

If you would like to provide feedback about this guidance material, please discuss with your team leader who can send a request to redacted: s47E(d) - certain operations of agencies

15 Version control

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FOI 24/25-1473 DOCUMENT 2

ndis Practice Guide For Internal Use Only

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Access and Eligibility Reassessment (ER) Practice Guide

The content of this document is OFFICIAL.

This guide assists the National Access Team (NAT) to assess new applicants’ eligibility and determine if existing participants remain eligible for the National Disability Insurance Scheme (NDIS).

This guide is designed to be used with the Access and Eligibility Reassessment (ER) Decision Tree to make legislatively correct access decisions.

1. Recent updates

What’s changed

2. Checklist

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3. Are you making an Access or ER decision?

For Access decisions, go to Section 4. Access — Age Requirements

For ER decisions, go to Section 9. ER - Residence Requirements

4. Access — Age Requirements

4.1 Does the applicant meet the age requirements?

Legislation

Section 22 Age requirements

A person meets the age requirements if the person was aged under 65 when the access request in relation to the person was made.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant was aged under 65 when their access request was received as valid (that is, complete); or • the applicant is non-defined and their data was received by the NDIA prior to their 65th birthday.

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5. Access – Residence Requirements

5.1 Does the applicant meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person:

(a) resides in Australia; and

(b) is one of the following:

(i) an Australian citizen;

(ii) the holder of a permanent visa;

(iii) a special category visa holder who is a protected SCV holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to:

(a) the nature of the accommodation used by the person in Australia; and

(b) the nature and extent of the family relationships the person has in Australia; and

(c) the nature and extent of the person’s employment, business or financial ties with Australia; and

(d) the nature and extent of the person’s assets located in Australia; and

(e) the frequency and duration of the person’s travel outside Australia; and

(f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant:

• lives in Australia for most of the year; and • is an Australian Citizen; or • is the holder of a permanent visa; or • is the holder of a protected Special Category Visa (SCV)

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6. Access – Streamlined Decisions

6.1 List A

Where an applicant has been diagnosed with a condition on List A they will meet the disability requirements without further assessment (unless there are an document integrity issues pending investigation).

Note: A person does not need to have a condition on List A to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

Applicants under the age of 7

Applicants aged 7 and over

6.2 List B

Where an applicant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more impairments that is, or is likely to be, permanent without further assessment.

For applicants diagnosed with a condition on List B, you will only need to assess whether the applicant:

• has substantially reduced functional capacity to perform one or more activities; • is affected in their capacity for social or economic participation; and

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• is likely to require support under the NDIS for their lifetime.

Note: A person does not need to have a condition on List B to become a participant in the NDIS.

For further information, refer to Our Guidelines - Is your impairment likely to be permanent?

For applicants under the age of 7

For applicants aged 7 and over

6.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will meet the early intervention requirements without further assessment.

Note: A child does not need to have a List D condition to become a participant of the NDIS.

For further information, refer to Our Guidelines - Do you need early intervention?

For applicants under the age of 7

6.4 0-25 Hearing Impairments

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An applicant meets the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and • have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

For applicant aged under 7

For applicants aged 7 and over

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7. Access – Disability Requirements

7.1 Does the applicant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the applicant has a disability (a reduction or loss in their ability to do things); and • their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, or physical in nature.

Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate both that the applicant has an impairment, and that the impairment is resulting in a disability? • Does the evidence demonstrate that the applicant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment? • Does the evidence demonstrate that the applicant has a loss or significant change in one of their body’s functions or structure, or in how they think and learn; however, there is no indication that this is causing a reduction or loss in their ability to do things?

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Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to Our Guidelines - Is your disability caused by an impairment?

Applicants under the age of 7

Applicants aged 7 or over

7.2 Does the applicant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the applicant has a:

• permanent impairment; or • likely permanent impairment.

Note: Where an applicant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

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What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable? • What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Is your impairment likely to be permanent? | NDIS

Applicants under the age of 7

Applicants aged 7 and over

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7.3 Does the applicant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

(i) communication;

(ii) social interaction;

(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures. • Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations.

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• Learning: how they learn, understand and remember new things, and practise and use new skills. • Mobility: how they move around home and the community and how they get in and out of bed or a chair. • Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health. • Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

Note: When an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment? • Does the evidence demonstrate that the applicant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person? • Does the evidence demonstrate that the applicant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person? • Does the evidence indicate that the applicant is able to participate in each activity effectively by using commonly used items? • Does the evidence indicate that the applicant is able to participate in each activity effectively, albeit more slowly or in a different way? • Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the applicant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the applicant cannot complete without support? • Why the applicant requires support?

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• How often the applicant requires support, and what that support looks like?

For further information, refer to Our Guidelines - Does your impairment substantially reduce your functional capacity?

Applicants under the age of 7

Applicants aged 7 and over

7.4 Does the applicant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the applicant’s social or economic participation.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

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• Does the evidence demonstrate that the applicant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way? • Does the evidence demonstrate that the applicant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way? • Does the evidence demonstrate that the applicant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

Applicants under the age of 7

Applicants aged 7 and over

7.5 Does the applicant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(e) The person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

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This criterion is considered met if evidence on the record shows the applicant:

• will require the support of the NDIS for their lifetime; or • is likely to require the support of the NDIS for their lifetime.

Note: Where an applicant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant is likely to require disability supports that are not clinical in nature, and that focus on their functional ability, for their lifetime? • Does the evidence demonstrate that the applicant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions? • Are there any recommendations for interventions that are likely to improve the applicant’s functional capacity, and reduce their future need for disability related supports? • If the applicant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions? • Does the applicant’s need for support relate to a health condition, and is that support more appropriately funded by the health system?

For further information, refer to Our Guidelines - Does your impairment affect your social, work or study life?

Applicants under the age of 7

Applicants aged 7 and over

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8. Access - Early Intervention Requirements

For children under the age of 7 they are first assessed against the early intervention criteria. If they do not meet, then assess them against the disability requirements.

For applicants aged 7 or above, only assess their eligibility for early intervention supports if they have not met the disability requirements.

Before you commence the assessment, you must ensure the applicant meets both the age requirements and residency requirements.

8.1 Developmental Delay

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(iii) is a child with who has developmental delay

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

(i) self-care;

(ii) receptive and expressive language;

(iii) cognitive development;

(iv) motor development; and

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(c) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to Our Guidelines - What about children younger than 6 with developmental delay?

8.2 Does the applicant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

(i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or

(ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

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• the applicant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and • the impairment is, or is likely to be, permanent.

Note: When an applicant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the applicant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the applicant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the applicant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable? • What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Our Guidelines - Do you need early intervention?

Applicants aged under 7

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Applicants aged 7 and over

8.3 Does the applicant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the applicant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the applicant needs less disability supports in the future?

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• Does the evidence note which specific supports the applicant will no longer require should early intervention be undertaken? • Does the evidence indicate that early intervention is likely to result in greater independence for the applicant? • If the applicant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports? • Is the recommended support of a functional nature, or capacity building in nature? • In answering the above questions, does the evidence contain sufficient information addressing: • How the applicant’s impairment is likely to impact them over time? • What supports the applicant will require if they don’t receive intervention? • What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

For applicants aged under 7

For applicants aged 7 and over

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8.4 Does the applicant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

(i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or

(ii) preventing the deterioration of such functional capacity; or

(iii) improving such functional capacity; or

(iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

…

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the applicant by: • addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life • preventing their functional capacity from getting worse • improving their functional capacity • supporting their informal supports to build their skills to help the applicant.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the applicant’s permanent impairment on their functional capacity? • Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the applicant’s functional capacity from declining?

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• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the applicant’s functional capacity? • Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports?

In answering the above questions, does the evidence contain sufficient information addressing:

• How the applicant’s impairment is likely to impact them over time? • What supports the applicant will require if they don’t receive intervention? • What supports the applicant currently requires, and what supports (if any) the applicant is likely to require after intervention?

For further information, refer to Our Guidelines - How will early intervention help you?

For applicants aged under 7

For applicants aged 7 and over

8.5 Does the applicant meet Section 25(3)?

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Legislation

Section 25 Early intervention requirements

(3) … the person does not meet the early intervention requirements if the CEO is satisfied that early intervention support for the person is not most appropriately funded or provided through the National Disability Insurance Scheme, and is more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or through systems of service delivery or support services offered:

(a) as part of a universal service obligation; or

(b) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows early intervention supports are most appropriately funded by the NDIS.

Note: If an applicant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Whether or not funding is available through other general systems is not the test of whether it is most appropriately funded or provided through the NDIS. For example, the fact that the health system does not adequately fund what is essentially clinical treatment (or some other form of support that is more appropriately funded through the health system) does not make it the responsibility of the NDIS.

For further information, refer to Our Guidelines - Is your early intervention most appropriately funded by the NDIS?

For applicants aged under 7

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For applicants aged 7 and over

9. ER – Residence Requirements

9.1 Does the participant continue to meet the residence requirements?

Legislation

Section 23 Residence requirements

(1) A person meets the residence requirements if the person:

(a) resides in Australia; and

(b) is one of the following:

(i) an Australian citizen;

(ii) the holder of a permanent visa;

(iii) a special category visa holder who is a protected SCV holder.

(2) In deciding whether or not a person resides in Australia, regard must be had to:

(a) the nature of the accommodation used by the person in Australia; and

(b) the nature and extent of the family relationships the person has in Australia; and

(c) the nature and extent of the person’s employment, business or financial ties with Australia; and

(d) the nature and extent of the person’s assets located in Australia; and

(e) the frequency and duration of the person’s travel outside Australia; and

(f) any other matter relevant to determining whether the person intends to remain permanently in Australia.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

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• lives in Australia for most of the year; and • is an Australian Citizen; or • is the holder of a permanent visa; or • is the holder of a protected Special Category Visa (SCV)

10. ER - Streamlined Decisions

10.1 List A

Where a participant has been diagnosed with a condition on List A they will continue to meet the disability requirements without further assessment (unless there are an document integrity issues pending investigation).

Note: A person does not need to have a condition on List A to continue to be eligible for the NDIS.

For further information, refer to Our Guidelines - Do you meet the disability requirements?

For participants under the age of 7

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For participants aged 7 and over

10.2 List B

Where a participant has been diagnosed with a condition on List B, they will be considered to have a disability attributable to one or more impairments that is, or is likely to be, permanent without further assessment.

For participants diagnosed with a condition on List B, you will only need to assess whether the participant:

• has an impairment that results in substantially reduced functional capacity to perform one or more activities; • has an impairment which affect their capacity for social or economic participation; and • is likely to require support under the NDIS for their lifetime.

Note: A person does not need to have a condition on List B to continue to be eligible for the NDIS.

For further information, refer to Our Guidelines – Is your impairment likely to be permanent?

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For participants under the age of 7

For participants aged 7 and over

10.3 List D

Where a child under the age of 7 has been diagnosed with a condition on List D, they will continue to meet the early intervention requirements without further assessment.

Note: A child does not need to have a condition on List D to continue to be eligible for the NDIS.

For further information, refer to Our Guidelines – Do you need early intervention?

For participants under the age of 7

10.4 0-25 Hearing Impairments

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A participant continues to meet the early intervention requirements without further assessment if they:

• are aged between birth and 25 years of age; and • have confirmed results from a specialist audiological assessment (including electrophysiological testing when required) consistent with auditory neuropathy or hearing loss ≥ 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent.

What to consider

This streamlined access approach for early intervention acknowledges a rich body of evidence that recognises that early intervention supports up to and including the age of 25 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

This same body of evidence suggests that brain development and language capability have been achieved by the age of 26. Therefore, adults aged 26 years and over are not immediately accepted to be likely to benefit from the same early intervention approach because there is no requirement to support the development of the auditory pathways. Adults aged 26 years and over with hearing impairment will therefore be assessed normally, on a case-by-case basis, having regard to the availability of all relevant evidence.

For further information, refer to Our Guidelines - What about people aged between 0 and 25 with a hearing impairment?

For participants under the age of 7

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For applicants aged 7 and over

11. ER - Disability Requirements

11.1 Does the participant meet Section 24(1)(a)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or the person has one or more impairments to which a psychosocial disability is attributable

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the participant has a disability (a reduction or loss in their ability to do things); and • their disability is caused by an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and • the impairment is intellectual, cognitive, neurological, sensory, or physical in nature.

Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

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What to consider

• Does the evidence demonstrate both that the participant has an impairment, and that the impairment is resulting in a disability? • Does the evidence demonstrate that the participant is reduced in their ability to do things, however this reduction cannot be reasonably attributed to an impairment? • Does the evidence demonstrate that the participant has a loss or significant change in one of their body’s functions or structure, or in how they think and learn; however, there is no indication that this is causing a reduction or loss in their ability to do things?

Note: A diagnosis is not required to meet this criterion: if the evidence shows the person has a disability caused by a relevant impairment, then they will meet 24(1)(a) – this is because we assess based on the impairment/functional impact.

For further information, refer to Our Guidelines - Is your disability caused by an impairment?

For participants under the age of 7

For participants aged 7 and over

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11.2 Does the participant meet Section 24(1)(b)?

Legislation

Section 24 Disability requirements

(2) A person meets the disability requirements if:

(b) The impairment or impairments are, or are likely to be, permanent

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant has a:

• permanent impairment; or • likely permanent impairment.

Note: Where a participant has been diagnosed with a List A or List B condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment? • Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored? • Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success? • Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only? • Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes? • If there are evidence-based treatments not undertaken, why were they considered and deemed unsuitable?

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• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to Is your impairment likely to be permanent? | NDIS

For participants under the age of 7

For participants aged 7 and over

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11.3 Does the participant meet Section 24(1)(c)?

Legislation

Section 24 Disability requirements

(2) A person meets the disability requirements if:

(c) The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities: The impairment or impairments result in substantially reduced functional capacity to undertake one or more of the following activities:

(i) communication;

(ii) social interaction;

(iii) learning

(iv) mobility

(v) self-care

(vi) self-management

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, results in substantially reduced functional capacity in one or more of the following activities:

• Communication: how they speak, write or use sign language and gestures. • Social interaction: how they make and keep friends, interact with the community, and cope with feelings and emotions in social situations. • Learning: how they learn, understand and remember new things, and practise and use new skills. • Mobility: how they move around home and the community and how they get in and out of bed or a chair. • Self-care: how they partake in personal care, hygiene, grooming, eating and drinking, and health. • Self-management (if older than 6): how they organise their life, make decision, solve problems and manage money.

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Note: When a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant is unable to participate effectively or completely (i.e., across the whole or majority of tasks) in one or more activities, without formally prescribed equipment? • Does the evidence demonstrate that the participant is unable to participant effectively or completely in one or more activities, and usually requires the assistance of another person? • Does the evidence demonstrate that the participant would be unsafe to complete one or more tasks required to participate in an activity without formally prescribed equipment or assistance from another person? • Does the evidence indicate that the participant is able to participate in each activity effectively by using commonly used items? • Does the evidence indicate that the participant is able to participate in each activity effectively, albeit more slowly or in a different way? • Would completing tasks more slowly or in a modified way, or using commonly used items, relieve the participant’s need for personal assistance?

In answering the above questions, does the evidence contain sufficient information addressing:

• What specific tasks the participant cannot complete without support? • Why the participant requires support? • How often the participant requires support, and what that support looks like?

For further information, refer to Our Guidelines - Does your impairment substantially reduce your functional capacity?

For participants under the age of 7

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For participants aged 7 and over

11.4 Does the participant meet Section 24(1)(d)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

(d) The impairment or impairments affect the person’s capacity for social or economic participation.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the permanent impairment, or permanent impairments combined, affects the participant’s social or economic participation.

Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant’s social participation (e.g., their capacity to play sport, go to the movies, see friends, etc.) is affected by their permanent impairment/s - in any way?

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• Does the evidence demonstrate that the participant’s economic participation (e.g., their capacity to travel, to find or maintain voluntary or paid work, etc.) is affected by their permanent impairment - in any way?
• Does the evidence demonstrate that the participant’s social and economic participation is not impacted in any way, and that they can fully engage without any assistance?

For further information, refer to [Our Guidelines - Does your impairment affect your social, work or study life?]

For participants under the age of 7

For participants aged 7 and over

11.5 Does the participant meet Section 24(1)(e)?

Legislation

Section 24 Disability requirements

(1) A person meets the disability requirements if:

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(e) The person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the participant:

• will require the support of the NDIS for their lifetime; or
• is likely to require the support of the NDIS for their lifetime.

Note: Where a participant has been diagnosed with a List A condition, they will meet this criterion without further assessment.

What to consider

• Does the evidence demonstrate that the participant is likely to require disability supports that are not clinical in nature, and that focus on their functional ability, for their lifetime?
• Does the evidence demonstrate that the participant will likely be substantially reduced in their functional capacity (in a relevant activity) for their lifetime, despite any interventions?
• Are there any recommendations for interventions that are likely to improve the participant’s functional capacity, and reduce their future need for disability related supports?
• If the participant is a child or young adult, does the evidence indicate that significant functional improvements can be expected - either as they develop, or through interventions?
• Does the participant’s need for support relate to a health condition, and is that support more appropriately funded by the health system?

For further information, refer to [Our Guidelines - Does your impairment affect your social, work or study life?]

For participants under the age of 7

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For participants aged 7 and over

12. ER – Early Intervention Requirements

12.1 Developmental Delay

Legislation

Section 25 Early intervention requirements

(2) A person meets the early intervention requirements if:

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(a) the person:

• (iii) is a child with who has developmental delay

Section 9 Definitions

Developmental delay means a delay in the development of a child under 6 years of age that:

(a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; and

(b) results in substantial reduction in functional capacity in one or more of the following areas of major life activity:

• (i) self-care;
• (ii) receptive and expressive language;
• (iii) cognitive development;
• (iv) motor development; and

(c) results in the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services that are of extended duration and are individually planned and coordinated.

When is this criterion considered met?

This criterion is considered met if evidence on the record shows the child is younger than 6 on the day we determine they have developmental delay.

For further information, refer to [Our Guidelines - What about children younger than 6 with developmental delay?]

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12.2 Does the participant meet Section 25(1)(a)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(a) the person:

• (i) has one or more identified intellectual, cognitive, neurological, sensory or physical impairments that are, or are likely to be, permanent; or
• (ii) has one or more identified impairments to which a psychosocial disability is attributable and that are, or are likely to be, permanent

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows:

• the participant has an impairment (a loss or significant change in their body’s functions or structure, or how they think and learn); and
• the impairment is intellectual, cognitive, neurological, sensory, or physical in nature; and
• the impairment is, or is likely to be, permanent.

Note: Where a participant is diagnosed with a condition on List B or List D, they meet this criterion without further assessment.

• What to consider
• Does the evidence demonstrate that the participant has completed all available and appropriate treatment options, and that there are no recommended treatment options likely to remedy the impairment?
• Does the evidence contain recommendations for treatments which have not been demonstrated to have been explored?
• Does the evidence indicate that the participant requires further treatment, and that this treatment has some prospect of success?

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• Does the evidence demonstrate that the participant requires ongoing treatment, but that it is for maintenance purposes only?
• Does the evidence demonstrate that the impairment is degenerative in nature, and that treatment will not improve the impairment?

In answering the above questions, does the evidence contain sufficient information addressing:

• What treatments have been undertaken and what were the outcomes?
• If there are evidence-based treatments not undertaken, why were they considered and deemed not suitable?
• What further/ongoing treatments have been recommended and what are the expected outcomes of these treatments?

For further information, refer to [Our Guidelines - Do you need early intervention?]

For participants under the age of 7

For participants aged 7 and over

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12.3 Does the participant meet Section 25(1)(b)?

Legislation

Section 25 Early intervention requirements

(2) A person meets the early intervention requirements if:

(b) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by reducing the person’s future needs for supports in relation to disability

…

When is this criterion considered met?

This criterion is considered met if evidence on the record shows that early intervention supports for the participant’s permanent impairment/s will reduce their need for disability-related supports in the future.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and indicate that this intervention will mean the participant needs less disability supports in the future?
• Does the evidence note which specific supports the participant will no longer require should early intervention be undertaken?
• Does the evidence indicate that early intervention is likely to result in greater independence for the participant?
• If the participant has accessed intervention before, is the outcome noted? Did previous intervention reduce their need for disability related supports?
• Is the recommended support of a functional nature, or capacity building in nature?
• In answering the above questions, does the evidence contain sufficient information addressing:
• How the participant’s impairment is likely to impact them over time?
• What supports the participant will require if they don’t receive intervention?
• What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

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For further information, refer to [Our Guidelines - How will early intervention help you?]

For participants under the age of 7

For participants aged 7 and over

12.4 Does the participant meet Section 25(1)(c)?

Legislation

Section 25 Early intervention requirements

(1) A person meets the early intervention requirements if:

(c) the CEO is satisfied that provision of early intervention supports for the person is likely to benefit the person by:

• (i) mitigating or alleviating the impact of the person’s impairment upon the functional capacity of the person to undertake communication, social interaction, learning, mobility, self‑care or self‑management; or
• (ii) preventing the deterioration of such functional capacity; or
• (iii) improving such functional capacity; or

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• (iv) strengthening the sustainability of informal supports available to the person, including through building the capacity of the person’s carer.

…

When is this criterion considered met?

• This criterion is considered met if evidence on the record shows early intervention supports will help the participant by:
• addressing the impact of their impairment on their ability to move around, communicate, socialise, learning, look after themselves, or organise their life
• preventing their functional capacity from getting worse
• improving their functional capacity
• supporting their informal supports to build their skills to help the participant.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will mitigate or alleviate the impact of the participant’s permanent impairment on their functional capacity?
• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will prevent the participant’s functional capacity from declining?
• Does the evidence contain specific recommendations for early intervention, and detail how this intervention will improve the participant’s functional capacity?
• Does the evidence indicate that intervention is likely to strengthen the sustainability of informal supports available to the person, and result in a decreased need for formal disability related supports?

In answering the above questions, does the evidence contain sufficient information addressing:

• How the participant’s impairment is likely to impact them over time?
• What supports the participant will require if they don’t receive intervention?
• What supports the participant currently requires, and what supports (if any) the participant is likely to require after intervention?

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For further information, refer to [Our Guidelines - How will early intervention help you?]

For participants under the age of 7

For participants aged 7 and over

12.5 Does the participant meet Section 25(3)?

Legislation

Section 25 Early intervention requirements

(3) … the person does not meet the early intervention requirements if the CEO is satisfied that early intervention support for the person is not most appropriately funded or provided through the National Disability Insurance Scheme, and is more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or through systems of service delivery or support services offered:

(a) as part of a universal service obligation; or

(b) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.

When is this criterion considered met?

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This criterion is considered met if evidence on the record shows early intervention supports are most appropriately funded by the NDIS.

Note: Where a participant has been diagnosed with a condition on List D, they meet this criterion without further assessment.

What to consider

Whether or not funding is available through other general systems is not the test of whether it is most appropriately funded or provided through the NDIS. For example, the fact that the health system does not adequately fund what is essentially clinical treatment (or some other form of support that is more appropriately funded through the health system) does not make it the responsibility of the NDIS.

For further information, refer to [Our Guidelines - Is your early intervention most appropriately funded by the NDIS?]

For participants under the age of 7

For participants aged 7 and over

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13. Related procedures or resources

• National Disability Insurance Scheme Act 2013
• National Disability Insurance Scheme (Becoming a Participant) Rules 2016
• Our Guidelines - Applying to the NDIS
• SOP – Progress NDIS Application in the System
• SOP - Finalise Access Met Decision
• SOP - Finalise Access Not Met Decision
• Access and ER Decision Tree

14. Feedback

If you would like to provide feedback about this guidance material, please discuss with your team leader who can send a request to redacted: s47E(d) - certain operations of agencies

15. Version control

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Applicant - record disability conditions and impairments

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4

2 Before you start …………………………………………………………………………………………………….. 5

3 Reported condition ……………………………………………………………………………………………….. 6

4 Impairment evidence …………………………………………………………………………………….––––– 7

4.1 Gather evidence ………………………………………………………………………………………………….. 7

5 Record a disability in an access request case…………………………………………………………

6 Next steps …………………………………………………………………………………………………..———— 9

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This article provides guidance for a local area coordinator, early childhood partner, business support officer, liaison officer (HLO/JLO), participant support officer or access delegate to:

• learn about a reported condition
• understand and gather impairment evidence
• record conditions and impairments in an access request case.

Recent updates – 3

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1 Recent updates

3 October 2024

Linked article title updated from How to complete the access request case form to Complete form in the access request case.

Recent updates – 4

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2 Before you start

You have:

• read and understood Our Guideline - Applying to the NDIS (external) including sections Do you meet the disability requirements? Is your disability caused by an impairment?
• read the articles What evidence of disability is required? Understand disability requirements.

Before you start – 5

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3 Reported condition

When a person with a disability applies to the NDIS, they will provide their impairment evidence. This is a reported condition. The person may have more than one impairment when they apply.

Reported condition – 6

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4 Impairment evidence

You need a person’s impairment evidence to decide if they’re eligible to become an NDIS participant. This could include evidence of:

• treatment history
• any recommended supports or early interventions
• how an impairment affects their day-to-day life.

A treating health professional, who is most relevant to an applicant’s disability should provide the impairment evidence. It should also include the applicant’s functional capacity evidence.

For early intervention, an early childhood partner can provide developmental delay evidence. For more information, refer to article What evidence of disability is required?

4.1 Gather evidence

When you gather evidence, make sure you get their name, contact details and relationship to the applicant. This will allow for easy follow up.

1. Record details of who has provided evidence on the applicant’s behalf. Use article Log an activity or internal note.
2. Include references for any information or specific documents you have sourced.

To add evidence or documents to a case, use guidance Add and link evidence to a case.

Impairment evidence – 7

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5 Record a disability in an access request case

To enter disabilities, you need to be in the Disabilities step of the Access Request case form.

1. To add a disability, select New.
2. At Select reported condition, start to enter the condition name. The system will suggest possible disabilities based on what you enter. Select the appropriate disability. This will auto-fill the ICD Disability and ICD Disability Code fields.
3. You must select one Primary Disability using the checkbox. You can only have one primary disability. Do not future date the primary disability.

Note: To identify the primary disability, look at the reported disability condition with the greatest impact on a person’s daily life.

4. You must specify a Start Date for the disability. This may be either from birth or when onset of the disability occurred. Do not enter an end date.
5. At Evidence, select the type of disability evidence from the options shown.
6. Select Save.
7. Repeat the steps above to add additional disabilities. Remember you may only select the Primary Disability checkbox once.
8. At Was your primary disability caused by an accident or event? Select Yes or No based on the information provided.
9. If you select Yes, you’ll need to provide the date, and details of any compensation. For more information on providing compensation details, refer to article Check for compensation when recording disabilities.
10. Select Next.

Record a disability in an access request case – 8

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6 Next steps

1. To complete the access request form, continue to use guidance in article Complete form in the access request case.
2. Use the Evidence tab to upload any documentary evidence of the person’s disability. Refer to articles Record treating professional details and Upload requested evidence for a new applicant.

Next steps – 9

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4

2 Before you start …………………………………………………………………………………………………….. 5

3 Who can act on behalf of an NDIS applicant?…………………………………………………………

4 Applicant representative role and responsibility……………………………………………………..

5 Applicant representative evidence …………………………………………………………………………. 8

6 Next steps …………………………………………………………………………………………………..———— 9

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This article provides guidance for all NDIA staff and partners to understand:

• who can act on behalf of an NDIS applicant
• the role and responsibility of an applicant’s representative
• what evidence an applicant needs to provide to have someone act on their behalf.

For participant consent in non-applying situations, use article [Check consent, nominee, child representative, or self-representation authorities].

Recent updates – 3

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1 Recent updates

3 October 2024

Linked article title updated from ‘How to complete the access request case form’ to ‘Complete form in the access request case.’

Guidance updated to improve accessibility and consistency with related articles.

Recent updates – 4

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2 Before you start

You have read and understood:

• Who can help you apply? in Our Guideline – Applying to the NDIS (external).
• article Understand consent requirements
• article Complete form in the access request case

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3 Who can act on behalf of an NDIS applicant?

If an applicant wants someone to act on their behalf to apply for the NDIS, you need their consent. An applicant can choose who they want to act on their behalf. This could include a:

• family member, friend, or carer
• support worker or service provider
• residential aged care facility staff member
• treating health professional or hospital staff.

The person making the application must be the applicant, their authorised representative, or a representative who has consent to act on their behalf.

If an applicant is younger than 18, parental responsibility applies. This is usually the applicant’s parents or legal guardian or someone else who has parental responsibility.

For an adult applicant, the representative can be a:

• person the applicant has given consent to act as their representative
• guardian
• person with power of attorney who can make personal and health decisions for the applicant
• person with an active advance care health directive.

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4 Applicant representative role and responsibility

When an applicant gives consent for another person or organisation to act on their behalf, they can decide:

• who is the authorised person
• in what capacity they can act
• for how long the person or organisation can act on their behalf (ongoing or a set timeframe).

For example, the applicant wants someone to help them apply for the NDIS. This means that the selected person or organisation only has permission to act on their behalf while applying for the NDIS.

Applicant representative role and responsibility – 7

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5 Applicant representative evidence

If an applicant consents for a representative to act on their behalf, you must get proof that the applicant gave consent freely.

Evidence can be:

• consent for a third party to act on your behalf
• documentation to show the applicant’s legal guardian
• documentation to show the applicant’s current power of attorney and power type.

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6 Next steps

To record consent, continue to follow guidance in article [Complete form in the access request case].

Next steps – 9

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Applicant consent to collect information

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4

2 Before you start …………………………………………………………………………………………………….. 5

3 Understand consent to collect information ……………………………………………………………..

4 Check consent to collect information ……………………………………………………………………..

5 Record applicant consent to collect information …………………………………………………….

6 Next steps …………………………………………………………………………………………………..———— 9

Table of Contents – 2

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This article provides guidance for a local area coordinator, early childhood partner and all NDIA staff (planner delegate, payments officer, internal review delegate, complaints officer, participant support officer, access delegate, technical advisors, National Contact Centre, liaison officers (HLO/JLO), complex support needs (CSN) planner, national reassessment delegate) to:

• understand consent to collect information
• check if applicant has given this consent
• record ‘collect information’ consent.

This article is for NDIS applicants. For participant consent guidance, go to article [Understand the process for consent, nominee, child representative or self-representation].

Recent updates – 3

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1 Recent updates

December 2023

• Article name change from – What consent do we need to collect information?
• Content strengthened to explain difference between consent to collect and consent to share.
• Article scope – consent for NDIS applicants.
• Guidance re-direction to participant consent guidance
• PACE guidance to check and record consent to collect information.

Recent updates – 4

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2 Before you start

You have read and understood:

• Our Guideline – Privacy and information, including section Do we need your consent to ask other people for your information?
• Our Guideline – Applying to the NDIS, including section Who can help you apply?
• article, Understand consent requirements.

Before you start – 5

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3 Understand consent to collect information

This consent is when the applicant or their representative, agrees for you to collect their information from another person or organisation. This consent does not include permission to share their information. A person’s consent to share information is a separate agreement. Refer to Next steps in this article.

For example, an applicant may give you consent to talk to their health professional about their disability.

Understand consent to collect information – 6

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4 Check consent to collect information

Check applicant account

When the applicant gives their consent, you record this information. To check if you have collect information consent:

1. From Person Account, select Details tab.
2. Scroll to Consents, check if these consent permissions are selected:
   • Consent Collect Info from Auth Rep
   • Consent Collect Info from Third Party

Check application documents

To also check any completed electronic consent forms or the access request form:

1. From the Person Account, select Documents tab.
2. Scroll in File Name to find the relevant document.
3. If the relevant document is there, select check box to open, select Download.
4. Review the documents to check for consent.

Check consent to collect information – 7

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5 Record applicant consent to collect information

You must obtain and record consent to collect information in PACE.

1. From Person Account, select Cases tab.
2. Check for an existing Create Person Account or Update Person Account case with a new status, select to open.
3. If no existing case, select New to set up a case. Go to articles Create a person account or Update a person account.
4. Progress case to the What would you like to update? step.
5. Select Consents then select Next.
6. At question – Collect personal information from an organisation authorised representative – match to applicant’s selection in the application or consent form with either:
   • Yes, then record Authorised representative organisation contact details
   • No, then select Next.
7. At question – Contact health professional organisations, service provider organisations and schools where relevant, to collect information about you – match to applicant’s selection in the application or consent form with either:
   • Yes, then select Add to record Health professional organisation, service provider organisation or schools contact details
   • No, then select Next.
8. At question – Do you consent to NDIA collecting, using and disclosing your personal and sensitive information for the above purposes, including to verify your identity with the document issuer or official record holder via third party systems, and in accordance with our Privacy Policy
   • This is a separate agreement. Go to article Consent to use document verification. For other agreements, go to Next steps in this article.
9. Confirm information is correct.
10. To change, select Previous. If correct, select Submit.
11. To upload consent evidence, go to article Add documents to a case.

No consent to collect information

You can’t collect information from others without consent. This may make it harder to decide if a person is eligible for the NDIS. Go to Next steps - 1 in this article.

For a person to give consent, go to consent forms on the NDIS website.

Record applicant consent to collect information – 8

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6 Next steps

1. For more guidance about consent, go to article Understand consent requirements.
2. To check other consent types, go to articles:
   • Consent to share information
   • Consent to use Centrelink information
   • Consent to use document verification service

Next steps – 9

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Applicant consent to share information

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Understand consent to share information ……………………………………………………………… 6 3.1 No consent to share information ……………………………………………………………………………. 6 4 Check applicant consent to share information ……………………………………………………….. 7 4.1 Check applicant account ………………………………………………………………………………………. 7 4.2 Check application documents ……………………………………………………………………… 7 5 Record applicant consent to share information ……………………………………………………… 8 6 Next steps …………………………………………………………………………………………………………….. 9

Table of Contents – 2

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This article provides guidance for a local area coordinator, early childhood partner and all NDIA staff (planner delegate, payments officer, internal review delegate, complaints officer, participant support officer, access delegate, technical advisors, National Contact Centre, liaison officers (HLO/JLO), complex support needs (CSN) planner, national reassessment delegate) to:

• understand consent to share information
• check if applicant has given this consent
• record ‘share information’ consent.

This article is for recording consent to share information in the Access request case. To record consent at other times, go to article Record consent to share information or for a third party to act.

Recent updates – 3

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1 Recent updates

12 February 2024 Guidance updated to clarify that Share information about you with identified third party organisations to help with developing and implementing your plan can apply to both organisations and individuals.

Recent updates – 4

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2 Before you start

You have read and understood:

• Our Guideline – Privacy and information, including section Do we need your consent to ask other people for your information?
• Our Guideline – Applying to the NDIS, including section Who can help you apply?
• article Understand consent requirements.

Before you start – 5

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3 Understand consent to share information

This is when the applicant or their representative, agrees for us to share their information with another person or organisation during the applying process. For example, an applicant may give you consent to talk to their family about their disability and how the NDIS can support them.

It doesn’t include permission to collect their information. A person’s consent to collect information is a separate agreement. Refer to article Applicant consent to collect information

3.1 No consent to share information

You can’t share information with others without consent. This may make it harder to decide if a person is eligible for the NDIS. Go to article Understand consent requirements.

A person can give consent verbally or can use the consent form on the NDIS website.

Understand consent to share information – 6

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4 Check applicant consent to share information

4.1 Check applicant account

When the applicant gives their consent, we record this information. To check if you have consent to share an applicant’s information as part of the applying process:

1. From Person Account, select Details tab.
2. Scroll to Consents, check if this consent permission is selected:
   • Consent Provide Info to Third Party

4.2 Check application documents

To check any completed electronic consent forms or the access request form:

1. From the Person Account, select Documents tab.
2. Scroll in File Name to find relevant document.
3. If relevant document is there, select check box to open, select Download.
4. Review the documents to check for consent.

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5 Record applicant consent to share information

During the applying process, you must obtain and record consent to share an applicant’s information in PACE

1. From Person Account, select Cases tab.
2. Check for an existing Create Person Account or Update Person Account case with a New status, select to open.
3. If no existing case, select New to set up a case. Go to articles Create a person account or Update a person account.
4. Progress case to the What would you like to update? step.
5. Select Consents then select Next.
6. At question Share information about you with identified third party organisations to help with developing and implementing your plan match to applicant’s selection in the application or consent form with either:
   • Yes: then select Add to record Third Party Organisation Contact Details then select Next
   • No: then select Next.Note: This question applies to both third party individuals and third party organisations. Answer Yes and record the person’s contact details here if the third party is an individual
7. At question Do you consent to the NDIA collecting, using and disclosing your personal and sensitive information for the above purposes, including to verify your identity with the document issuer or official record holder via third party systems, and in accordance with our Privacy Policy?
   • This is a separate agreement. Go to article Consent to use document verification. For other agreements, go to Next steps in this article.
8. Check the details and select Submit if correct, or select Previous to make any changes. Confirm information is correct
9. To upload consent evidence, go to article Add documents to a case.

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6 Next steps

1. For more guidance about consent, go to article Understand consent requirements.
2. To check other consent types, go to articles:
   • Applicant consent to collect information
   • Consent to use Centrelink information
   • Consent to use document verification service

Next steps – 9

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SGP KP Publishing – Check access request is complete

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Accept an access request case ……………………………………………………………………… 6 4 Complete initial checks ……………………………………………………………………………………. 7 4.1 Check there’s no internal review or ART review in progress ……………………………………… 7 4.1.1 Contact applicant – internal review or new access request ………………………………………………….. 7 4.2 Check if remote, YPIRAC or terminal illness ……………………………………………………………. 7 4.2.1 Update subject to terminal illness ……………………………………………………………………………………. 8 4.2.2 Update prioritisation reason to Motor Neurone Disease ………………………………………………………. 8 4.3 Check for eligibility evidence not linked to the case ………………………………………………….. 8 4.4 Check for Access Integrity Management referral (AIM) tasks …………………………………….. 8 4.5 Check if access request case completed by NCC ……………………………………………………. 9 4.6 Verify consent to apply ……………………………………………………………………………………. 9 4.7 Verify identity ………………………………………………………………………………………………………. 9 4.7.1 Check DVS consent …………………………………………………………………………………………………….. 10 4.7.2 Check documents have Verification Status of Verified DVS …………………………………………. 10 4.7.3 Check non-DVS identity documents ……………………………………………………………………………….. 10 4.7.4 Check if identity is verified ……………………………………………………………………………………. 11 4.8 Verify age and residence …………………………………………………………………………………….. 11 4.9 Check evidence of disability ………………………………………………………………………………… 11 5 Check for a streaming case ……………………………………………………………………… 13 5.1 Create and assign a streaming case …………………………………………………………………….. 13 6 Complete the checklist ……………………………………………………………………………………. 14 6.1 Confirm correspondence …………………………………………………………………………………….. 14 7 Next steps …………………………………………………………………………………………………………… 16

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This article provides guidance for an access delegate (officer) to:

• accept an access request case
• complete initial checks
• check for a streaming case
• complete the checklist.

Note: if you’re not from scheme eligibility, go to article Complete checklist in the access request case.

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1 Recent updates

9 December 2024 Updated to help you understand how and when to manually send system generated letters to statutory guardians if the participant has a statutory guardian.

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2 Before you start

You have read Our Guideline – Applying (external), including section How do we decide if you’re eligible? (external)

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3 Accept an access request case

1. At the Home page, select Omni-Channel at the bottom left of the screen.
2. A Status message will appear. Select Available from the drop-down list.
3. Select the tick box next to the access request case. The Access Request case will open.
4. Set Omni-Channel status to Offline. This will make sure you’re only allocated one case at a time to complete.

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4 Complete initial checks

4.1 Check there’s no internal review or ART review in progress

1. From the Person Account, select the Cases tab.
2. Under Open Cases, check if there’s an Internal Review case or Administrative Review Tribunal (ART) review. If:
   • No, go to section Check if remote, YPIRAC or terminal illness in this article
   • Internal Review case, go to next step
   • ART review, complete the AO Support Webform to contact your team leader to decide next steps.
3. Check if the review is for an access decision or revocation decision. If:
   • access decision, go to section Contact applicant – internal review or new access request in this article
   • revocation decision, go to next step.
4. Check when revocation decision was made. If:
   • on or after 3 October, go to section Contact applicant – internal review or new access request in this article
   • before 3 October, go to section Check if remote, YPIRAC or terminal illness in this article.

4.1.1 Contact applicant – internal review or new access request

1. Contact the applicant or their authorised representative to let them know you’ve received their NDIS application. Let them know they can’t apply again as they have an internal review in progress for a previous <access not met / revocation> decision. They can either continue with their internal review and withdraw their NDIS application, or withdraw the internal review and continue with the new access request. Ask them what they want to do.
2. After contacting the person (successfully or not), log an activity to record this using article Log an activity or internal note.
3. If they decide to continue with the:
   • Internal review, go to article When to withdraw an access application
   • Access request, go to article IRT – Withdraw an internal review. Then go to section Check if remote, YPIRAC or terminal illness in this article.

4.2 Check if remote, YPIRAC or terminal illness

The access request case must be completed by an access delegate in the Priority Health Access Team or Specialised Access Team if the applicant:

• lives in a remote or very remote location (MMM6 and MMM7)
• is a younger person in residential aged care (YPIRAC)
• is living with a terminal illness
• is living with Motor Neurone Disease or Kennedy’s Disease.

If you aren’t in these teams, you need to change the case owner of the access request case.

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1. Check if one of the above situations applies. If the applicant:
   • lives in a remote or redacted: s47F - personal privacy very remote location (MMM6 and MMM7), change Case Owner to Danika redacted: s47F - personal privacy
   • is a younger redacted: s47F - personal privacy person in residence aged care (YPIRAC), change Case Owner to Sam redacted: s47F - personal privacy
   • is living with a terminal illness (including glioblastoma and metastatic cancer), go to section Update subject to terminal illness in this article
   • is living with Motor Neurone disease or Kennedy’s disease, go to section Update prioritisation reason to Motor Neurone Disease in this article.

4.2.1 Update subject to terminal illness

1. From the Access Request case, select the Details tab.
2. Scroll down to System information.
3. At Subject, select Edit Subject (pencil icon).
4. Enter Terminal Illness.
5. Select Save.
6. Change Case Owner to Access Request Routing Queue.

4.2.2 Update prioritisation reason to Motor Neurone Disease

1. From the Access Request case, select the Details tab.
2. Scroll down to Prioritisation.
3. Select Edit (pencil icon) next to Prioritisation Reason.
4. At Prioritisation Reason, select Disability.
5. At Priority Description, select Motor Neurone Disease.
6. Select Save.
7. Change Case Owner to Access Request Routing Queue.

4.3 Check for eligibility evidence not linked to the case

1. Check for eligibility evidence not linked to the access request case that needs to be considered. This includes evidence in SAP CRM, Enquiries inbox and enquiry cases.
2. Check the Account Timeline for any cases, tasks or log activities relevant to the case. For further guidance, go to article View the Person Account Timeline.
3. If required, add and link any eligibility evidence to the access request case. Go to article Add and link evidence to a case.

4.4 Check for Access Integrity Management referral (AIM) tasks

If there is an application or evidence document that may not be genuine or real, this is an integrity issue.

1. From the Person Account, check the Account Timeline for any AIM referral tasks. If:
   • No, go to section Check if access request case completed by NCC in this article.

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• Yes, open the task and review Comments for instructions under Task Information. Then go to section Check if access request case completed by NCC in this article.

Note: there may also be alerts in the person account relating to integrity concerns.

4.5 Check if access request case completed by NCC

In exceptional circumstances, the National Contact Centre (NCC) will complete the access request case. To learn more, go to Applying for the NDIS Telephone Access Request (TAR) Team Leader KA.

1. Check if there’s an internal note with the subject NCC TL TAR (National Contact Centre Team Leader Telephone Access Request). If:
   • No, NCC didn’t complete the access request case. Go to section Check access request is complete.
   • Yes, NCC completed the access request case. If the access request is incomplete, don’t refer to the NDIS partner to complete. You’ll need to request the information. To check this, go to section Check access request is complete.

Note: for how to find internal notes, go to article View the Person Account Timeline.

4.6 Verify consent to apply

1. Check if there’s an internal note that records who provided consent to apply. For how to find internal notes, go to article View the Person Account Timeline.
2. Use article Applicant consent to apply to consider if the person has consent to apply on behalf of the applicant. If:
   • the applicant or their authorised representative provided consent, go to section Verify identity in this article.
   • the person doesn’t have consent or there’s no internal note, go to next step.
3. Go to sections Verify identity, Verify age and residence and Check evidence of disability in this article to check if anything else is incomplete. Then go to article Return incomplete access request case.

Note: if NCC completed the access request case, don’t return the access request. Go to article Request further evidence for incomplete access request.

4.7 Verify identity

1. Check the correct identity documents have been provided for the applicant, and their authorised representative (if they have one). Go to article Understand how to verify identity documents. If:

   • all required identity documents are provided, go to step 4.
   • all required documents are not provided, go to next step.

   Note: identity documents with a Verification Status of Verified DVS don’t need to be uploaded. All other documents must be uploaded.

2. Check if there’s an internal note that explains a genuine reason why identity documents were not provided. If there is:

   • an internal note, contact your team leader to decide next steps

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• no internal note, go to next step.

3. Go to sections Verify age and residence and Check evidence of disability in this article to check if anything else is incomplete. Then go to article Return incomplete access request case.

   Note: if NCC completed the access request case, don’t return the access request. Go to article Request further evidence for incomplete access request.

4. Check if document verification service (DVS) was used to verify any of the documents. Go to article Understand the Document Verification Service for a list of documents that can be verified by DVS. If:

   • Yes, go to section Check DVS consent in this article
   • No, go to section Check non-DVS identity documents in this article.

4.7.1 Check DVS consent

1. Check consent is recorded, or other identity documents are provided. Go to article Consent to use document verification service. If:

   • Yes, go to section Check documents have Verification Status of Verified DVS in this article
   • No, go to next step.

2. Go to sections Verify age and residence and Check evidence of disability in this article to check if anything else is incomplete. Then go to article Return incomplete access request case.

   Note: if NCC completed the access request case, don’t return the access request. Go to article Request further evidence for incomplete access request.

4.7.2 Check documents have Verification Status of Verified DVS

1. Check all identity documents that can be verified with DVS have a Verification Status of Verified DVS, or other identity documents have been provided. To learn more, go to article Understand the Document Verification Service. If:
   • Yes, go to next step
   • No, try to verify (with consent). Go to section Using the Document Verification Service in article Understand the Document Verification Service. Then go to next step.
2. Check if there are any non-DVS identity documents. If:
   • Yes, go to section Check non-DVS identity documents in this article
   • No, go to section Check if identity is verified in this article.

4.7.3 Check non-DVS identity documents

1. Check for any integrity concerns. If yes, go to article Escalate an integrity issue about identity.

   Note: this includes when the document has a Verification Outcome of Pass. The exception is if an AIM Referral Task confirms AIM verified the documents.

2. Once you have checked the documents, under Verification Type, select Unverifiable Document (eyeball). If there are:

   • no integrity concerns, under Verification Outcome, select Pass. Go to section Check if identity is verified in this article

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• integrity concerns, under Verification Outcome, select Fail. Contact your team leader to decide next steps. This may include a referral to AIM.

4.7.4 Check if identity is verified

1. If identity is:

   • verified or there’s an internal note to explain why not, go to section Verify age and residence in this article.
   • not verified and there’s no internal note to explain why, the access request is not complete. Go to next step.

2. Go to sections Verify age and residence and Check evidence of disability in this article to check if anything else is incomplete. Then go to article Return incomplete access request case.

   Note: if NCC completed the access request case, don’t return the access request. Go to article Request further evidence for incomplete access request.

4.8 Verify age and residence

1. Go to article Consent to use Centrelink information to check if the person has given consent to check age and residence in Centrelink. For child applicants, we also need consent to check the child representative’s Centrelink. If:

   • Yes, go to article Verify age and residence with Centrelink information. Then go to step 4.
   • No, go to next step.

2. Check if there are documents to verify age and residence. Go to article Understand age and residence evidence. If:

   • Yes, go to step 4.
   • No, go to next step.

3. Go to section Check evidence of disability in this article to check if anything else is incomplete. Then go to article Return incomplete access request case.

   Note: if NCC completed the access request case, don’t return the access request. Go to article Request further evidence for incomplete access request.

4. Check if Account Name, Date of Birth, Address and Residence Information matches Centrelink (with consent) or documents. If age and residence is:

   • Verified, go to section Check evidence of disability in this article
   • Not verified, go to article Request further evidence for incomplete access request.

4.9 Check evidence of disability

1. Check evidence of disability has been provided. If:
   • Yes, go to next step.
   • No, go to article Return incomplete access request case. Note: if NCC completed the access request case, don’t return the access request. Go to article Request further evidence for incomplete access request.

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2. Check if child younger than 6 with developmental delay:

   • Yes, go to next step.
   • No, go to section Check for a streaming case in this article.

3. If an early childhood partner provides an evidence of developmental delay (EODD) form, check either:

   • the correct version (version Aug 24) of the EODD form was used
   • if the old version of the form was used, it was signed before 16 September and uploaded before 14 October.

   If:

   • Yes, go to section Check for a streaming case in this article.
   • No, go to next step.

4. Check if the child is turning 6 within 90 days. If:

   • Yes, contact your team leader for endorsement to continue. If endorsed, add an internal note with the endorsement details. Then go to section Check for a streaming case in this article
   • No, go article Return incomplete access request case.

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5 Check for a streaming case

1. From the Person Account screen, select Cases.
2. Check there’s a Streaming case with Status of Pending Outcome. If:
   • Yes, go to section Complete the checklist in this article
   • No, go to section Create and assign a streaming case in this article.

5.1 Create and assign a streaming case

1. Use article Complete a streaming case (Streaming and Restreaming) to create a streaming case. You don’t need to complete the case.

2. Record an internal note using article Log an activity or internal note. Use the following template:

   Access request case completed without a streaming case. Streaming case created and assigned to the <my NDIS contact / Access Request Hold Queue> Action required: Complete the streaming case

3. Change the Case Owner of the Streaming case. If access request case completed by:

   • NCC, change Case Owner to Access Request Hold Queue
   • anyone else, change Case Owner to the my NDIS contact.

4. Complete the AO Support Webform to notify your team leader.

5. Go to section Complete the checklist in this article.

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6 Complete the checklist

1. From the Access Request case, select the Checklist tab.

2. At Valid ARF Date, record the date the application was complete.

   An application is complete when an access request case is completed and:

   • has consent to apply from the applicant or their authorised representative
   • age and residence has been verified
   • evidence of disability has been provided
   • identity has been verified or an internal note confirming why identity documents have not been provided
   • the date that this information was received by the NDIA is the valid date.

3. At Select the legislation version that will be used for the access decision, select the relevant option. If Valid ARF Date is:

   • on or after 3 October, select National Disability Insurance Scheme Amendment (getting the NDIS Back on Track No.1). Note: this is the latest version of the National Disability Insurance Scheme Act 2013 which incorporates amendments as per the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No.1) Bill 2024
   • before 3 October, select National Disability Insurance Scheme 2013. Note: you need to select the legislation version the access delegate needs to use to make an access decision. The pre-legislation changes version of the legislation needs to be used if the access request was made before 3 October 2024.

4. Check if there needs to be a priority decision. Go to section When do we make priority eligibility decisions (external) in Our Guideline – Applying to the NDIS (external) to decide.

5. At Is this a Priority Access Application, select Yes or No. If:

   • No, go to step 9
   • Yes, continue to next step.

6. At Priority Category, select the relevant category.

7. At Priority Description, select the relevant priority description.

8. At Priority Justification, copy and paste the reason from section When do we make priority eligibility decisions (external) in Our Guideline – Applying to the NDIS (external).

9. Complete the following tick boxes if evidence has been verified:

   • Have you verified the applicant’s POI?
   • Have you verified the applicant’s Age Evidence?
   • Have you verified the applicant’s Residency Evidence?
   • Have you verified the applicant’s Disability Evidence?

10. Select Submit.

6.1 Confirm correspondence

An application ready to be assessed letter confirming the access application has been submitted for a decision will automatically be created when the checklist is completed.

1. At ARF Correspondence, fields will be prefilled with the valid ARF date, NDIS number and NDIA staff member first and last name initial. Select Next.

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2. At Do you want to preview the document before sending it?, select Yes.
3. Complete Select a Recipient for preview to preview the letter.
4. Select Next.
5. If correct, select Next. If incorrect, select Previous to update the fields that populate the letter.
6. Select Submit Correspondence.
7. Select Next.
8. A Confirmation will display that the checklist has been completed. Select Done.
9. The Access Request case status will move to Pending Outcome. The Case Owner will change to Access Request Hold Queue.

Note: if the participant has a statutory guardian and the relationship is established with the organisation account, you’ll need to manually send the auto-created application ready to be assessed letter to the statutory guardian. To do this, go to article Send a letter to a statutory guardian or trustee.

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7 Next steps

1. Don’t close the access request case. The case must remain open until an access decision is made when it will close automatically.
2. Once the checklist has been completed, an Access Decision case is automatically created.
3. An access delegate will use article Complete pre-assessment for an access decision.

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Check decision – Legislative timeframes

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start ………………………………………………………………………………………………….. 5 3 Application legislative timeframes ……………………………………………………………………… 6 4 Next steps ………………………………………………………………………………………………….. 7

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This article provides guidance for an access delegate to:

• understand application decision timeframes
• check if application is outside the legislative timeframe
• record when application is outside the legislative timeframe.

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1 Recent updates

December 2023 Guidance improvement with knowledge update and PACE alignment, includes:

• both service level agreements (SLA) for 21 and 14 days
• how to check if SLA is overdue for the access decision.

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2 Before you start

You have:

• read and understood Our Guideline - Applying to the NDIS, including section How do we decide if you’re eligible?
• utilised article Make an access decision.

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3 Application legislative timeframes

Understand access decision timeframes

When a person applies to become a NDIS participant, you have 21 days to make a decision on the application. You must decide which of the following applies:

• the application is access met
• the application is access not met
• we need more information to make a decision.

For more information, refer to the How do we decide if you’re eligible? section in Our Guideline - Applying to the NDIS.

If you need more information, the applicant will need to provide additional evidence. When this evidence is submitted, you have 14 more days to decide from the three options above.

For more information, refer to Our Guideline - Applying to the NDIS, in section What if we need more information to decide if you’re eligible?

Check legislative timeframes

1. From Details tab in Access Decision case. It must be the access decision case.
2. At case dashboard, check the Priority status is Overdue. The status can also be found in Case Information.
3. At Case Activity tab, scroll to Case Milestones.
4. A ticked Violation check box confirms application is outside the legislative timeframes:
   • If yes – record an internal note, go to Record application is outside the legislative timeframe in this article.
   • If no – go to Next Steps in this article.

Record application is outside the legislative timeframe

If the decision for an application takes longer than the legislative timeframe, you must record this in an internal note as internal communication in PACE.

1. Utilise article Log an activity or internal note.

2. Record with Outside legislative timeframe (template):

   Legislative Timeframe Not Met An access decision was not made in the legislative timeframe of <choose applicable – 14 / 21> days. Under s21(3) the applicant is taken to not meet the access requirements, and under s100, an internal review of the decision was commenced. As a delegate of the CEO, I have reviewed and overturned the decision to avoid further delays for the applicant. The access request will now be re-considered.

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4 Next steps

1. After recording the internal note, resume the application assessment. Continue to follow the guidance in article Make an access decision.

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Check eligibility – age and residence requirements

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start ………………………………………………………………………………………………….. 5 3 Make a decision on age requirements ……………………………………………………………………. 6 4 Make a decision on residence requirements ………………………………………………………….. 7

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This article provides guidance for an access delegate, local area coordinator, early childhood partner and review officer to understand how to:

• make a decision on age requirements
• make a decision on residence requirements.

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1 Recent updates

3 October 2024 Article title changed from Check evidence for a decision – Age and residence requirements to Check eligibility – age and residence requirements.

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2 Before you start

You have read and understood Our Guideline – Applying to the NDIS (external).

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3 Make a decision on age requirements

When assessing an application for a person to become a participant of the NDIS, you must first assess they meet the age requirements.

To learn more, refer to Do you meet the age requirements? (external) In Our Guideline – Applying to the NDIS.

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4 Make a decision on residence requirements

The next step when assessing an application for a person to become a participant of the NDIS, you must assess they meet the residence requirements.

To verify a person’s residence details, if Centrelink consent has been given check the person’s Centrelink record to confirm residence status. If consent has not been given, review the residence documentation provided to support the person’s application.

To learn more, refer to Do you meet the residence requirements? (external) in Our Guideline – Applying the NDIS.

To learn more regarding evidence of age and residence, see article Understand age and residence evidence.

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Check eligibility - DIS – disability caused by an impairment

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Evidence an impairment is caused by a disability ………………………………………………….. 6 3.1 How to find evidence a disability is related to an impairment ……………………………………… 6 3.2 What to consider when making an eligibility decision ……………………………………………….. 6 4 Next steps …………………………………………………………………………………………………………….. 7

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This article provides guidance for all NDIA staff and partners to understand:

• how to find evidence showing disability is related to an impairment
• what to consider when making an eligibility decision for this requirement.

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1 Recent updates

3 October 2024

• Article title changed from Check evidence for a decision – disability caused by impairment to Check eligibility – DIS – disability caused by an impairment
• When we say DIS in a title, we mean disability requirements. We’ve added this to help you quickly identity which articles are for disability or early intervention requirements.

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2 Before you start

You have read:

• and understood Our Guideline – Applying to the NDIS (external) section Do you meet the disability requirements?
• article Understand disability requirements
• article What evidence of disability is required?

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3 Evidence an impairment is caused by a disability

3.1 How to find evidence a disability is related to an impairment

You need to review all available information about the person’s impairment and disability before making a decision. To do this, check their application and evidence in PACE.

3.2 What to consider when making an eligibility decision

To make an eligibility decision about this disability requirement, consider:

• the person’s impairment
• their disability
• our legislation and guidance
• if we have enough evidence to decide or need more.

The disability requirements are just one of the eligibility requirements. To be eligible for the NDIS, the applicant must also meet the age and residence requirements. Go to article Check eligibility – Age and residence requirements.

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4 Next steps

If you are an access delegate:

• to determine eligibility, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes.
• to check the timeframes to make a decision, follow guidance in article Check decision – Legislative timeframes.

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Check eligibility – DIS – likely permanence

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Evidence of likely permanence ………………………………………………………………………………. 6 3.1 Review evidence of likely permanence …………………………………………………………………… 6 4 Next steps …………………………………………………………………………………………………………….. 7

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This article provides guidance for all NDIA staff and partners to review evidence of likely permanence.

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1 Recent updates

3 October 2024

• Article title changed from Check evidence for a decision – Disability requirements – Likely permanence to Check eligibility – DIS – likely permanence.
• When we say DIS in a title, we mean disability requirements. We’ve added this to help you quickly identity which articles are for disability or early intervention requirements.

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2 Before you start

You have read:

• and understood Our Guideline – Applying to the NDIS (external) section Do you meet the disability requirements?
• article Understand disability requirements
• article What evidence of disability is required?

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3 Evidence of likely permanence

3.1 Review evidence of likely permanence

You need evidence an applicant will have the impairment for their lifetime to be eligible for the NDIS. To confirm their permanent impairment, we need evidence from their doctor or specialist.

The impairment may be episodic or vary in intensity. This means it will still be permanent due to the overall impact on their life and likelihood they’ll be impacted across their lifetime.

Even when their condition or diagnosis is permanent, we’ll also check if the impairment is permanent as well. For example, they may not be eligible if the impairment is temporary, still being treated or if there are known, available and appropriate evidence-based clinical, medical or other remaining treatments options that are likely to remedy the impairment.

We’ll generally consider if their impairment is likely to be permanent, after all available and appropriate treatment options have been pursued.

If an applicant gives us evidence they’re diagnosed with a List B (external) condition, we’ll usually decide if their disability from an impairment is likely to be permanent.

For more information, go to section Is your impairment likely to be permanent? In Our Guideline – Applying to the NDIS (external).

The disability requirements are just one of the eligibility requirements. To be eligible for the NDIS, the applicant must also meet age and residence requirements. Go to article Check eligibility – Age and residence requirements.

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4 Next steps

If you are an access delegate:

• to determine eligibility, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes.
• to check the timeframes to make a decision, follow guidance in article Check decision – Legislative timeframes.

Next steps – 7

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FOI 24/25-1473 DOCUMENT 12

Check eligibility – DIS – NDIS supports for life

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Exported on 2025-04-01 03:41:25

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Review evidence …………………………………………………………………………………………………… 6 4 Next steps …………………………………………………………………………………………………………….. 7

Table of Contents – 2

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This article provides guidance for an access delegate to review evidence to check if a person is likely to need NDIS supports for their lifetime.

Recent updates – 3

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1 Recent updates

3 October 2024 Updates to reflect legislation changes from 3 October 2024. Article title changed from Determine lifetime support eligibility to Check eligibility - DIS – NDIS supports for life. When we say DIS in a title, we mean disability requirements. We’ve added this to help you quickly identity which articles are for disability or early intervention requirements.

Recent updates – 4

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2 Before you start

You have read and understood:

• article Understand disability requirements
• article Understand early intervention requirements
• Our Guideline - Applying to the NDIS (external) section Will you likely need NDIS support for your lifetime?

Before you start – 5

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3 Review evidence

To be eligible for the NDIS, a person must likely need NDIS supports for their lifetime. To approve their application, you need to see evidence showing this. NDIS supports are the services, items and equipment that can be funded by the NDIS. NDIS supports are investments that help a participant build or maintain their functional capacity and independence, and help them work, study or take part in social life.

When we decide if an applicant will likely need NDIS supports for their lifetime, we consider:

• their life circumstances
• the nature of their long-term support needs
• whether their needs could be best met by the NDIS, or by other government and community services.

When you’re deciding if a person is eligible, you need to review:

• how old the evidence is
• who provided the evidence.

If a person provides more than one piece of evidence, you may need to consider one as more relevant than others. We call this weighing evidence.

For further information:

• read Our Guideline - Applying to the NDIS (external) section, How we weigh evidence of disability?
• refer to article What evidence of disability is required?.

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4 Next steps

To consider the other disability requirements, go to article Understand disability requirements.

If you are an access delegate:

• to make an access decision, continue to article Make an access decision – pre-legislation changes or Make an access decision – post legislation changes.
• to make an eligibility reassessment decision, continue to article Finalise eligibility reassessment decision.

Next steps – 7

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FOI 24/25-1473 DOCUMENT 13

Check eligibility – DIS – significant functional impact

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Exported on 2025-04-01 03:36:23

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Evidence of significant functional impact ………………………………………………………………. 6 3.1 Review evidence of the impairment that substantially reduces functional capacity ………. 6 4 Next steps …………………………………………………………………………………………………………….. 7

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to review evidence of the impairment that substantially reduces functional capacity

Recent updates – 3

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1 Recent updates

3 October 2024

• Article title changed from article - Check evidence for a decision - Significant functional impact to Check eligibility – DIS – significant functional impact.
• When we say DIS in a title, we mean disability requirements. We’ve added this to help you quickly identity which articles are for disability or early intervention requirements.

Recent updates – 4

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2 Before you start

You have:

• read Our Guideline – Applying to the NDIS (external) including the section Does your impairment substantially reduce your functional capacity?
• read articles Understand disability requirements, What evidence of disability is required? and Make an access decision.

Before you start – 5

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3 Evidence of significant functional impact

3.1 Review evidence of the impairment that substantially reduces functional capacity

We need to learn about the person’s impairment before we can make a decision about their eligibility.

To do this you need to check their application and evidence in PACE.

You need evidence the person’s impairment substantially reduces their functional capacity in one or more of the following areas:

• communication
• social interaction
• learning
• mobility
• self-care
• self-management (if older than 6).

A person’s needs might vary from time to time. This means they may go up and down each day or each month. A good example of this can be progressive multiple sclerosis. We consider a person’s ability over time and take into account how their ability fluctuates.

When a person’s impairment substantially reduces their functional capacity, they usually need disability-specific supports to join in or do these tasks and activities.

These disability-specific supports include:

• support from other people, such as physical assistance, guidance, supervision or prompting.
• assistive technology, equipment or home modifications prescribed by the person’s doctor, allied health professional or other medical professional.

To decide if a person is eligible, you need to determine their capacity and where they need more help. To decide if a support is reasonable and necessary, you need to consider what information you have available to identify if the person meets the NDIS funding criteria (external).

If a person has more than one permanent impairment, you will need to consider them together to see if their functional capacity is reduced substantially.

You need to consider:

• the person’s involvement in different areas of life, like at home, school, work and in the community
• how they carry out tasks and activities
• any other factors impacting their everyday life.

The disability requirements are just one of the eligibility requirements. To be eligible for the NDIS, the applicant must also meet the age and residence requirements. Go to article Check eligibility – Age and residence requirements.

Evidence of significant functional impact – 6

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4 Next steps

If you are an access delegate:

• to determine eligibility, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes.
• to check the timeframes to make a decision, follow guidance in article Check decision – Legislative timeframes.

Next steps – 7

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FOI 24/25-1473 DOCUMENT 14

Check eligibility – DIS – social and economic impact

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Exported on 2025-04-01 03:38:19

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Understanding evidence of social and economic impact of an impairment for disability requirements ………………………………………………………………………………………………… 6 3.1 What is evidence of a social and economic impact? …………………………………………. 6 4 When you need to ask for technical advice ……………………………………………………….. 7 5 Next steps ………………………………………………………………………………………………….. 8

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to:

• understand what evidence of social and economic impact is
• know when to ask for technical advice.

Recent updates – 3

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1 Recent updates

3 October 2024

• Article title changed from Check evidence for a decision – Disability requirements – social and economic impact to Check eligibility – DIS – social and economic impact
• When we say DIS in a title, we mean disability requirements. We’ve added this to help you quickly identity which articles are for disability or early intervention requirements.

Recent updates – 4

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2 Before you start

You have:

• read Our Guideline – Applying to the NDIS (external) including sections Does your impairment affect your social, work or study life? and Do you meet the disability requirements?
• read articles Understand disability requirements and What evidence of disability is required?

Before you start – 5

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3 Understanding evidence of social and economic impact of an impairment for disability requirements

3.1 What is evidence of a social and economic impact?

We need evidence of how an impairment affects a person’s ability to work, study or take part in social life.

This means evidence of the impact on how the applicant can find and keep a job, contribute to the community, or join social activities because of their permanent impairment.

For children with evidence of social or economic impact or both, go to article Understand early intervention requirements.

Understanding evidence of social and economic impact of an impairment for disability requirements – 6

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4 When you need to ask for technical advice

You must request advice from the Technical Advice and Practice Improvement Branch (TAPIB) if you are considering an access met decision for a person with a chronic health condition. Go to article Create a technical advice case.

To learn more, read Requesting TAPIB Advice on the NDIA Intranet.

The disability requirements are just one of the eligibility requirements. To be eligible for the NDIS, the applicant must also meet the age and residency requirements. Go to article Check eligibility – Age and residence requirements.

When you need to ask for technical advice – 7

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5 Next steps

If you are an access delegate:

• to determine eligibility, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes.
• to check the timeframes to make a decision, follow guidance in article Check decision – Legislative timeframes.

Next steps – 8

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FOI 24/25-1473 DOCUMENT 15

Check eligibility - EI - Developmental delay

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Exported on 2025-04-02 04:46:49

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 How to find developmental delay evidence ……………………………………………………….. 6 3.1 How to find developmental delay evidence ……………………………………………………………… 6 3.2 What to consider when checking eligibility ……………………………………………………….. 6 4 Next steps …………………………………………………………………………………………………………….. 7

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to understand how to find developmental delay evidence.

Recent updates – 3

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1 Recent updates

3 October 2024

• Updates to reflect legislation changes from 3 October 2024.
• Article title changed from Check evidence for a decision – developmental delay to Check eligibility – EI – Developmental delay.
• When we say EI in titles we mean early intervention requirements. We’ve added this to help you identify articles about early intervention or disability requirements.

Recent updates – 4

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2 Before you start

You have read and understood:

• Our Guideline - Applying to the NDIS (external), what about children younger than 6 with developmental delay?
• Our Guideline - Early childhood approach (external)
• article Understand early intervention requirements
• article Check eligibility – age and residence

Before you start – 5

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3 How to find developmental delay evidence

3.1 How to find developmental delay evidence

You need to review all available information about the child’s impairment and developmental delay before you make an access decision. To do this, check their application and linked evidence in PACE. To find linked evidence in PACE select the Documents tab. This will provide a list of the documents that have been linked as evidence. For example, the completed Form – Evidence of development delay.

3.2 What to consider when checking eligibility

When you review evidence to check if the child is eligible under this early intervention requirement, consider:

• the child is younger than 6
• the child’s impairment
• the child’s developmental delay
• the recommended early intervention supports
• if the early intervention supports recommended are NDIS support
• recommendation have been made by the right early childhood professional
• our legislation and guidance
• if we have enough evidence to decide or need more.

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4 Next steps

To consider the other early intervention requirements, go to article Understand early intervention requirements.

If you are an access delegate:

• to make an access decision, continue to either article Make an access decision – pre-legislation changes or Make an access decision – post legislation changes.
• to make an eligibility reassessment decision, continue to article Finalise eligibility reassessment decision.

Next steps – 7

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Check eligibility - EI - hearing loss 0-25 years of age

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Exported on 2025-04-02 04:48:52

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Check evidence …………………………………………………………………………………………………….. 6
4. Consider eligibility for hearing loss ……………………………………………………………………….. 7
5. Priority eligibility decision – child younger than 7 ………………………………………………….. 8
6. Next steps …………………………………………………………………………………………………………….. 9

Table of Contents – 2

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This article provides guidance for an access delegate and review officer to:

• check for an eligible hearing impairment for a person aged between 0 and 25
• consider NDIS eligibility under early intervention requirements
• make a priority eligibility decision for children younger than 7.

Recent updates – 3

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1 Recent updates

3 October 2024

Article title changed from Check evidence for a decision - Hearing Loss 0-25 years of age to Check eligibility – EI - hearing loss 0-25 years of age.

Recent updates – 4

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2 Before you start

You have

• read and understood Our Guideline - Applying to the NDIS (external) including sections: Do you need early intervention? What about people aged between 0 and 25 with a hearing impairment?
• read article Understand early intervention requirements
• followed guidance in article Make an access decision.

Before you start – 5

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3 Check evidence

1. From Access Decision case, select Decision tab to view Dashboard.
2. At Key Information, check Age to confirm the person is 25 or younger.
3. Scroll to Disability Evidence.
4. Select View link to open auditory, neuropathy or hearing loss evidence, which must:
   • be from a specialist audiological assessment
   • be a hearing loss at least 25 decibels in either ear at 2 or more adjacent frequencies
   • show the hearing loss is likely to be permanent.
5. Review their hearing loss level with the current eligible standards for early intervention. If required, request further information.

Check evidence – 6

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4 Consider eligibility for hearing loss

A person aged 0 to 25 with an eligible hearing impairment will meet early intervention requirements.

Consider eligibility for hearing loss – 7

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5 Priority eligibility decision – child younger than 7

If a child younger than 7 is identified by Hearing Australia or an Early Childhood Partner as newly diagnosed with a hearing impairment, a priority eligibility decision must be made within 2 business days once the evidence has been validated.

For more information about action to take in this circumstance refer to article Consider priority eligibility decision.

Priority eligibility decision – child younger than 7 – 8

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6 Next steps

• To determine eligibility, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes. The sub-criterion decisions will be made based on these evidence selections.
• For a person aged 26 or older with hearing loss, they may be eligible under disability or early intervention requirements. For further information read Our Guideline - Applying to the NDIS (external).

Next steps – 9

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Check eligibility – EI – Impairment is likely permanent

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Exported on 2025-03-31 22:16:08

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Evidence the impairment is likely to be permanent …………………………………………. 6 3.1 Review evidence of a permanent impairment ………………………………………………………….. 6
4. Next steps …………………………………………………………………………………………………………….. 7

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to:

• review evidence of a permanent impairment
• use this information to support the person to understand the eligibility requirements.

Recent updates – 3

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1 Recent updates

3 October 2024

• Article title changed from (EI) Check evidence for a decision – Impairment is likely to be permanent to Check eligibility – EI – Impairment is likely permanent.
• When we say EI in a title, we mean early intervention requirements. We’ve added this to help you identity which articles are for disability or early intervention requirements.

Recent updates – 4

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2 Before you start

You have:

• read and understood Our Guideline – Applying to the NDIS (external) section How will early intervention benefit you?
• read article Understand early intervention requirements.

Before you start – 5

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3 Evidence the impairment is likely to be permanent

3.1 Review evidence of a permanent impairment

Review the available evidence to consider if the person has one or more impairments that is permanent or is likely to be permanent.

You will need to review the available evidence that says they are likely to have the impairment for their lifetime.

They might have some periods in their life where there is a smaller impact on their daily life, because their impairment may be episodic or fluctuate in intensity. Their impairment can still be permanent due to the overall impact on their life, and the likelihood that they will be impacted across their lifetime.

Even when their condition or diagnosis is permanent, you need to check if the impairment is permanent too. For example, a person may not be eligible if their impairment is temporary, still being treated, or if there are known, available and appropriate evidence-based clinical, medical or other remaining treatments options that are likely to remedy the impairment.

Generally, you’ll consider whether an impairment is likely to be permanent after all available and appropriate treatment options have been pursued.

For more information, go to section Do you have an impairment that’s likely to be permanent? in Our Guideline – Applying to the NDIS (external).

Early intervention requirements are just one of the eligibility requirements. To be eligible for the NDIS under early intervention, the applicant must also meet the age and residence requirements. Go to article Check eligibility – Age and residence requirements.

Evidence the impairment is likely to be permanent – 6

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4 Next steps

If you are an access delegate:

• to determine eligibility, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes.
• to check the timeframes to make a decision, follow guidance in article Check decision – Legislative timeframes.

Next steps – 7

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Check eligibility – EI – likely to improve or reduce deterioration of functional capacity or strengthen informal supports

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Exported on 2025-04-01 03:09:06

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Review evidence of functional capacity or informal supports …………………………… 6
4. Next steps …………………………………………………………………………………………………………….. 7

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to understand how to:

• review evidence of functional capacity or informal supports
• use this information to support the person to understand the eligibility requirements.

Recent updates – 3

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1 Recent updates

3 October 2024

• Article title changed from ‘(EI) Check evidence for a decision – Likely to improve or reduce deterioration of functional capacity or strengthen informal supports’ to ‘Check eligibility – EI – likely to improve or reduce deterioration of functional capacity or strengthen informal supports’.
• When we say EI in a title, we mean early intervention requirements. We’ve added this to help you identity which articles are for disability or early intervention requirements.

Recent updates – 4

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2 Before you start

You have read:

• and understood Our Guideline - Applying to the NDIS (external), section, How will early intervention help you?
• article Understand early intervention requirements.

Before you start – 5

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3 Review evidence of functional capacity or informal supports

Review the available evidence to consider if early intervention supports are likely to help the person with at least one of the following:

• address the impact of their impairment on their ability to move around, communicate, socialise, learn, look after themselves and organise their lives
• prevent their functional capacity from getting worse
• improve their functional capacity
• support their informal supports, which includes building their skills to help them.

Before making an eligibility decision, you must find out about the person’s functional capacity and informal supports. You do this by checking their application and evidence.

To make an eligibility decision about this early intervention requirement, you must consider:

• how early intervention will help the person
• their functional capacity
• their informal supports
• our legislation and guidance
• if we have enough evidence to decide or need more.

Early intervention requirements are just one of the eligibility requirements. To be eligible for the NDIS under early intervention, the applicant must also meet the age and residence requirements. Refer to Check eligibility – Age and residence requirements.

Review evidence of functional capacity or informal supports – 6

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4 Next steps

If you are an access delegate:

• to determine eligibility, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes
• to check the timeframes to make a decision, follow guidance in article Check decision – Legislative timeframes.

Next steps – 7

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FOI 24/25-1473 DOCUMENT 19

Check eligibility – EI – likely to reduce future support needs

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Exported on 2025-04-01 03:06:44

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Review evidence to determine the likelihood that future supports may be reduced … 6
4. Next steps …………………………………………………………………………………………………………….. 7

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to understand to understand how to:

• review evidence to determine the likelihood that future supports may be reduced
• use this information to support the person to understand the eligibility requirements.

Recent updates – 3

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1 Recent updates

3 October 2024

• Article title changed from ‘(EI) Check evidence for a decision – Likely to reduce future support needs’ to ‘Check eligibility – EI – likely to reduce future support needs’.
• When we say EI in a title, we mean early intervention requirements. We’ve added this to help you identity which articles are for disability or early intervention requirements.

Recent updates – 4

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2 Before you start

You have:

• read and understood Our Guideline – Applying to the NDIS (external) in section, How will early intervention help you?
• read article Understand early intervention requirements.
• evidence early intervention is likely to reduce future support needs

Before you start – 5

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3 Review evidence to determine the likelihood that future supports may be reduced

Review the available evidence to consider if early intervention supports will mean the person is likely to need less NDIS supports in the future.

To determine if early intervention will help reduce the person’s need for future supports, you need to look at:

• how their impairment might change over time
• how long they have had their impairment
• if there’s been a significant change to their impairment
• if their needs are likely to change soon, such as if they are finishing school.

Early intervention requirements are just one of the eligibility requirements. To be eligible for the NDIS under early intervention, the person must also meet the age and residence requirements. Go to article Check eligibility – Age and residence requirements.

Review evidence to determine the likelihood that future supports may be reduced – 6

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4 Next steps

If you are an access delegate:

• to determine eligibility, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes
• to check the timeframes to make a decision, follow guidance in article Check decision – Legislative timeframes.

Next steps – 7

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FOI 24/25-1473 DOCUMENT 20

Check eligibility - EI - Supports will be NDIS supports

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Exported on 2025-04-01 03:13:45

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Review evidence …………………………………………………………………………………………………… 6
4. Next steps …………………………………………………………………………………………………………….. 7

Table of Contents – 2

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This article provides guidance for all NDIA staff and partners to review evidence to check if early intervention supports that are likely to benefit the person will be NDIS supports.

Recent updates – 3

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1 Recent updates

3 October 2024

• Updates to reflect legislation changes from 3 October 2024.
• Article title changed from (EI) check evidence for a decision – Support most appropriately funded by NDIS to Check eligibility - EI – Supports will be NDIS supports.
• When we say EI in a title, we mean early intervention requirements. We’ve added this to help you identity which articles are for disability or early intervention requirements.

Recent updates – 4

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2 Before you start

You have read and understood:

• Our Guideline - Applying to the NDIS (external) section, Will the support you need be NDIS supports?
• Article Understand early intervention requirements.

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3 Review evidence

To decide if early intervention supports that will benefit the person will be NDIS supports, you must consider:

• the recommended early intervention supports
• if an appropriate treating professional has made the recommendation
• what is provided by mainstream and community supports
• if the supports are the services, items and equipment that are NDIS supports
• our legislation and guidance
• if we have enough evidence to decide or need more.

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4 Next steps

To consider the other early intervention requirements, go to article Understand early intervention requirements.

If you are an access delegate:

• to make an access decision, continue to article Make an access decision – pre-legislation changes or Make an access decision – post legislation changes.
• to make an eligibility reassessment decision, continue to article Finalise eligibility reassessment decision.

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Check eligibility - List A condition

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Overview ………………………………………………………………………………………………………………. 6 4 Check for a List A condition ………………………………………………………………………………….. 7 4.1 How to find evidence of a List A Condition? …………………………………………………………….. 7 4.2 If the person has a List A condition ………………………………………………………………………… 7 4.3 If the person doesn’t have a List A condition ……………………………………………………………. 7 5 Next steps …………………………………………………………………………………………………………….. 8

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This article provides guidance for all NDIA staff and partners to check for a List A condition.

Recent updates – 3

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1 Recent updates

3 October 2024 Updates made to improve the knowledge article and merge information from the archived article Evidence Guide – List A conditions. Article name changed from ‘Check evidence for a decision – List A condition’ to ‘Check eligibility – List A condition.’

Recent updates – 4

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2 Before you start

You have:  read Our Guideline – Applying to the NDIS (external)  read article Understand disability requirements  read article Understand early intervention requirements  considered the age and residence requirements using article Check eligibility – Age and residence requirements.

Before you start – 5

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3 Overview

To be eligible for the NDIS, the person must meet the requirements for:  age  residence  disability, early intervention, or both. When a person gives us evidence that they’ve been diagnosed with one or more conditions on List A: Conditions that are likely to meet the disability requirements (external) they’ll likely meet the disability requirements.

Overview – 6

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4 Check for a List A condition

4.1 How to find evidence of a List A Condition?

A person may inform us that they have a List A condition, or we might identify it when reviewing their disability evidence.

Before making an eligibility decision, make sure you review the application and any provided disability evidence for any diagnosed List A: Conditions that are likely to meet the disability requirements (external).

4.2 If the person has a List A condition

If there’s evidence of a List A condition, the disability requirements are met.

You also need to think about the early intervention requirements. Go to article Understand early intervention requirements.

4.3 If the person doesn’t have a List A condition

If the person doesn’t have a List A condition, think about all the disability and early intervention requirements using articles:  Understand disability requirements  Understand early intervention requirements.

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5 Next steps

If you’re an access delegate:  to make an access decision, continue to article Make an access decision – pre- legislation changes or Make an access decision – post legislation changes.  to make an eligibility reassessment decision, continue to article Finalise eligibility reassessment decision.

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Check eligibility - List B condition SGP KP Publishing

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Overview ………………………………………………………………………………………………………………. 6 4 Check for a List B condition ………………………………………………………………………………….. 7 4.1 How to find evidence that a person has a List B condition? ……………………………………….. 7 4.2 If the person has a List B condition ………………………………………………………………………… 7 4.3 If the person doesn’t have a List B condition ……………………………………………………………. 7 5 Next steps …………………………………………………………………………………………………………….. 8

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This article provides guidance for all NDIA staff and partners to check for a List B condition.

Recent updates – 3

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1 Recent updates

24 February 2025 Guidance updated to reference the correct sections of the NDIS Act.

Recent updates – 4

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2 Before you start

You have:

   read Our Guideline – Applying to the NDIS (external)
   read article Understand disability requirements
   read article Understand early intervention requirements
   considered the age and residence requirements using article Check eligibility – age and
   residence requirements.

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3 Overview

To be eligible for the NDIS, the person must meet the requirements for:

  age
   residence
    disability, early intervention, or both.

When a person gives us evidence that they’ve been diagnosed with one or more conditions on List B: Conditions that are likely to result in a permanent impairment (external), they’ll meet some of the disability requirements and early intervention requirements.

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4 Check for a List B condition

4.1 How to find evidence that a person has a List B condition?

A person may inform us that they have a List B condition, or we might identify it when reviewing their disability evidence.

Before making an eligibility decision, make sure you review the application and any disability evidence for any diagnosed List B: Conditions that are likely to result in a permanent impairment (external).

4.2 If the person has a List B condition

If the person has evidence of a List B condition, only some of the disability and early intervention requirements are met.

The following disability requirements are met:

  The person has a disability that us caused by one or more impairments (s24(1)(a)).
  The person's impairment or impairments are likely to be permanent (s24(1)(b)).

The following early intervention requirement is met:

  The person has one or more impairments that are likely to be permanent (s25(1)(a)).

You’ll need to then think about the remaining disability and early intervention requirements using articles:

   Understand disability requirements
   Understand early intervention requirements.

4.3 If the person doesn’t have a List B condition

If the person doesn’t have a List B condition, think about all of the disability and early intervention requirements using articles:

   Understand disability requirements
   Understand early intervention requirements.

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5 Next steps

If you’re an access delegate:

   to make an access decision, continue to article Make an access decision – pre-
     legislation changes or Make an access decision – post legislation changes.
   to make an eligibility reassessment decision, continue to article Finalise eligibility
   reassessment decision.

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Check eligibility - List D condition SGP KP Publishing

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Overview ………………………………………………………………………………………………………………. 6 4 Check for a List D condition ………………………………………………………………………………….. 7 4.1 How to find evidence if a child younger than 7 has a List D condition? ……………………….. 7 4.2 If the person has a List D condition ………………………………………………………………………… 7 4.3 If the person doesn’t have a List D condition ……………………………………………………….. 7 5 Next steps …………………………………………………………………………………………………………….. 8

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This article provides guidance for all NDIA staff and partners to check for a List D condition (children younger than 7 only).

Recent updates – 3

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1 Recent updates

3 October 2024 Updates made to improve the knowledge article and merge information from the archived article Evidence Guide – List D conditions. Article name changed from Check evidence for a decision – List D condition to Check eligibility – List D condition.

Recent updates – 4

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2 Before you start

You have:  read Our Guideline – Applying to the NDIS (external)  read article Understand disability requirements  read article Understand early intervention requirements  considered the age and residence requirements using article Check eligibility – age and residence requirements.

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3 Overview

To be eligible for the NDIS, the person must meet the requirements for:  age  residence  disability, early intervention, or both. When a family or carer gives us evidence that a child younger than 7 has been diagnosed with one or more conditions on List D (external), they will meet the early intervention requirements.

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4 Check for a List D condition

4.1 How to find evidence if a child younger than 7 has a List D

condition?

A family or carer may inform us that a child younger than age 7 has a List D condition or we might identify it when reviewing their disability evidence.

Before making an eligibility decision, make sure you review the application and any provided disability evidence for any diagnosed List D conditions (external)

4.2 If the person has a List D condition

If there is evidence of a list D condition, the early intervention requirements are met.

You also need to consider the disability requirements. Go to article Understand disability requirements.

4.3 If the person doesn’t have a List D condition

If the person is not a child younger than 7 with a List D condition, consider all of the disability requirements and early intervention requirements using articles:  Understand disability requirements.  Understand early intervention requirements.

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5 Next steps

If you are an access delegate:  to make an access decision, continue to article Make an access decision – pre- legislation changes or Make an access decision – post legislation changes.  to make an eligibility reassessment decision, continue to article Finalise eligibility reassessment decision.

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Check eligibility – Terminal illness SGP KP Publishing

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Priority access pathway for people with terminal illness ………………………………………… 6 4 Identify if the applicant may have a terminal illness ……………………………………………….. 7 5 Check for evidence the applicant needs palliative care supports ……………………………. 8 6 Make an eligibility decision for an applicant with a terminal illness ………………………… 9 7 Next steps …………………………………………………………………………………………………………… 10

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This article provides guidance for an access delegate and review officer to:  understand the priority access pathway for people with terminal illness  identify if the applicant may have a terminal illness  check for evidence the applicant needs palliative care supports  make an eligibility decision for an applicant with a terminal illness.

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1 Recent updates

3 October 2024 Article title changed from Check evidence for a decision – terminal illness to Check eligibility – Terminal illness

Recent updates – 4

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2 Before you start

You have read and understood:  Our Guideline – Applying to the NDIS (external) including section Will you likely need NDIS supports for your lifetime?  Our Guideline – Mainstream and community support (external)  article Understand palliative care  article Understand disability requirements  article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes  article Guide – Conversation style guide and appendix B in sections Sensitive conversations and Explaining your access or planning decisions. You have reviewed:  any evidence of informal, mainstream or community palliative care supports.

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3 Priority access pathway for people with terminal

illness

NDIS applications from people with terminal illness are submitted through the priority access pathway. For more information, read article Request priority eligibility decision.

The Priority Health Access Team will make the eligibility decision within 5 days.

If an access met decision is made, the new participant will be streamed to the Aged Care and Hospital Interface branch if they have palliative support care needs. The Aged Care and Hospital Interface branch will develop the participant’s plan within 30 days.

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4 Identify if the applicant may have a terminal illness

In a person’s NDIS application, their primary disability may indicate there is an underlying health condition which may reduce their quality or expected length of life. For example, if their disability is described as an acquired brain injury.

The person may also specify that they have a terminal illness. Terminal illnesses may include many different types of cancers, chronic obstructive pulmonary disease (COPD), or end-stage kidney or liver diseases. Other illnesses may also be terminal but have a relatively long life expectancy. Conditions including Huntington’s Disease, Parkinson’s Disease and dementias may be terminal, but applicants with these conditions may not require palliative care supports at the time of their access application.

Note: These conditions do not automatically mean the applicant is suitable for the priority planning pathway.

Information in an NDIS application may indicate the person has a terminal illness and may need palliative care supports funded by the health system. This information might include:  a prognosis category, such as ‘guarded’ or ‘poor’  time-framed prognosis, for example 3 to 18 months to live  terminal or end-stage illness  staged health condition, for example stage 3, 4 or 5  no longer suitable for active treatment – treatment is for symptom management  reference to pain management related to comfort  references to past treatments, for example chemotherapy, immunotherapy, radiotherapy  organ failure, for example lung, heart, liver, or kidney  high levels of nursing support  specialist or community palliative care team involvement.

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5 Check for evidence the applicant needs palliative

care supports

Before making an eligibility decision for a disability caused by a terminal illness, you must make sure the applicant meets the age and residence requirements. Learn more in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes.

You then need to understand any evidence of palliative care support needs.

Information about current treatments, goals of care, and stage of illness can help you understand the applicant’s support needs. A suitably qualified treating health professional must provide this evidence.

Evidence may include information about:  current and future treatments designed to make people comfortable or slow disease progression rather than make them better  anticipated outcomes of the treatments  evidence of the stage of disease progression  level of care and clinical supports required  current and future goals of care. You may need to request further information from a treating health professional.

Talking about dying and terminal illness can be hard. But it’s important to talk about it so people can be prepared.

To help you prepare to talk with an applicant with a terminal illness, go to article Navigate conversations about life-limiting conditions.

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6 Make an eligibility decision for an applicant with a

terminal illness

A specialised access team, called the Priority Health Access Team, makes decisions about access eligibility for people with terminal illness and disability.

If you identify an applicant may have a terminal illness, you must request advice from the Technical Advice and Practice Improvement Branch (TAPIB). This is regardless of the proposed eligibility decision. To learn more, go to Requesting Advice or article Create a technical advice case.

Before an eligibility decision is made, we’ll need to understand the applicant’s disability and its impact on their life.

Information in the technical advice case helps TAPIB understand the applicant’s situation.

This could include information about if the applicant:  is applying to the NDIS because of an identified terminal illness  is applying to the NDIS because of another reported impairment that’s a direct result of a terminal illness or treatment  has declining function because of the progression of a terminal illness  has palliative support needs, for example supports intended for quality-of-life purposes rather than improving social and economic participation  requires a high level of skilled clinical support, for example palliative pain management or specialist nursing care. Note: The free-text field in the technical advice case has a limit of 255 characters. You can use these as examples to provide a brief summary of the participant’s situation. Follow the guidance in article Create a technical advice case to complete the case and provide supporting information.

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7 Next steps

1. To determine eligibility after you have received advice from TAPIB, continue to follow guidance in article Make an access decision - pre-legislation changes or article Make an access decision – post-legislation changes.
2. If the participant is eligible for the priority pathway and an access met decision is made, the participant will be streamed to the Aged Care and Hospital Interface branch. The Aged Care and Hospital Interface branch will develop the participant’s plan within 30 days.

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Check for compensation when recording disabilities SGP KP Publishing

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Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Understand compensation …………………………………………………………………………………….. 6 3.1 Evidence of compensation ……………………………………………………………………………………. 6 3.2 Contact the applicant ……………………………………………………………………………………. 6 4 Record compensation information ………………………………………………………………………… 7 4.1 Upload evidence ………………………………………………………………………………………………….. 7 5 Next steps …………………………………………………………………………………………………………….. 8

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This article provides guidance for all NDIA staff and partners to:  understand compensation  record compensation information.

Recent updates – 3

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1 Recent updates

3 October 2024 Linked article title updated from ‘How to complete the access request case form’ to ‘Complete form in the access request case’.

Recent updates – 4

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2 Before you start

You have:  read and understood Compensation Operational Guideline (external), including section: Principles relating to compensation and the NDIS (in Overview)  read and understood What you need to know about compensation (external)  been using article Complete form in the access request case.

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3 Understand compensation

If a person has a personal injury claim, an NDIS plan complements the compensation arrangement. It does not replace or fund the same expenses. This will make sure that any NDIS supports doesn’t duplicate any current supports.

Compensation doesn’t affect NDIS eligibility. If a person has an existing or previous claim, they can still apply to the NDIS.

3.1 Evidence of compensation

We gather information when a person is applying to the NDIS. If the applicant has an existing or previous compensation claim you must ask them to complete the Compensation Information Form.

You will also need to ask about any injury related to an accident that they may be eligible for compensation for in the future.

3.2 Contact the applicant

If you need to contact the applicant, their provider, or authorised representative, use guidance in articles:  Check a person’s preferred contact method  Update a person account – if applicable  Log an activity or internal note.

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4 Record compensation information

1. In Access Request case, at Disabilities step.
2. At Have you sought compensation regarding that accident or event?, select Yes. This will cause additional fields to appear.
3. At Has the compensation claim been finalised?, select Yes for a completed claim or No for a current claim. Note: the access request can proceed regardless of whether the claim has been finalised.
4. For a finalised claim, enter the: o relevant date at What date was the claim finalised? o amount at How much was the compensation payment?
5. At Have you received legal advice about your compensation claim? Select Yes or No, as shown in the person’s application.

4.1 Upload evidence

1. From the Access Request case, select the Documents tab.
2. Select Add Documents.
3. At Document Category, select Supporting Information.
4. At Document SubCategory, select Compensation information.
5. Determine if document has any PII (personal identifiable information). Select Yes or No.
6. If Yes, enter Description.
7. Select Next.
8. Select Upload Files.
9. Locate the file with supporting evidence for the compensation claim, select it, and select Open. You do these two steps multiple times to add more than one document.
10. Select Save to upload the document(s) to PACE.
11. Select Close.

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5 Next steps

Continue to use guidance in article Complete form in the access request case.

Check for Degenerative Disabilities

SGP KP Publishing

Exported on 2025-04-03 04:44:42

Table of Contents

1. Recent updates ……………………………………………………………………………………………………..
2. Before you start ……………………………………………………………………………………………………..
3. Understanding degenerative disabilities ………………………………………………………………………..
4. Next steps ……………………………………………………………………………………………………………..

This article provides guidance for a local area coordinator, early childhood partner and all NDIA staff (planner, payment officer, internal review officer, complaints officer, participant service officer, access officer, quality officer, technical advisor, SDA officer, NCC officer, provider support) to understand:

• what a degenerative disability is
• why we need to identify them
• how do we identify them
• what we do differently.

1 Recent updates

October 2023 Current guidance.

2 Before you start

You have:

• read article Complete personal and environmental circumstances case
• read article Create Personal and Environmental Circumstances case
• read article Record Capacity Building information
• read Guide - Conversation style guide.

3 Understanding degenerative disabilities

What is a degenerative disability?

A degenerative disability is a condition which causes a progressive and irreversible loss of a person’s function.

This means the things the person can do changes and declines over time. For some people, and conditions, this change happens quickly. For others, this happens slowly over a long time.

Some examples of degenerative disabilities are:

• Multiple Sclerosis
• Muscular Dystrophy
• Rhett Syndrome
• Motor Neurone Disease.

Check out our disability navigator for more detailed information.

Why do we need to identify degenerative disabilities?

We aim to prioritise people with urgent needs, like degenerative disability. We need to identify them so they can get the right help as soon as possible.

We make quicker decisions about the participant’s eligibility. We do this within 2-5 business days.

To learn more, refer to article Consider priority eligibility decision.

How do we identify degenerative disabilities?

We identify degenerative disabilities by:

• listening to people
• checking any reported conditions
• checking any evidence of disability.

Record support coordination information

Use your interpersonal skills in a guided conversation and listen carefully to the person’s answers. Explain to the person we need the right information before we make an eligibility decision.

This will help you select the most appropriate responses for the Capacity Building questions in the Personal and Environmental Circumstances (PEC) case capacity building questions in PACE. This includes recording an answer to the question Is the Disability stable?

Note: The PEC case Steps and questions are dynamic and may change. This will depend on the person’s situation and age, as well as the response options selected for some questions.

4 Next steps

1. Read article Record Capacity Building information to continue with the PEC case.

Check treating professional details

SGP KP Publishing

Exported on 2025-04-02 05:27:03

Table of Contents

1. Recent updates ……………………………………………………………………………………………………..
2. Before you start ……………………………………………………………………………………………………..
3. Check treating health professional details ………………………………………………………………
4. Next steps ……………………………………………………………………………………………………………..

This article provides guidance for an access delegate to check treating health professional details.

1 Recent updates

November 2023

• Title changed from ‘Check treating health professional details to come into line with companion article ‘Record treating professional details’ and OG – Applying
• AHPRA URL added to 2nd instruction to check details of treating health professional.

2 Before you start

You have read and understood:

• Our Guideline – Applying, in particular How do we decide if you’re eligible?

3 Check treating health professional details

When assessing a person’s NDIS application, you must check that evidence regarding a person’s disability is provided from a suitably accredited and/or registered treating professional.

To check and confirm their details, use the Australian Health Practitioner Regulation Agency (AHPRA) website.

For all evidence of disability documents:

1. Obtain the treating health practitioner details
2. Refer to the AHPRA website
3. Navigate to the Look up a practitioner section in the top right-hand corner of the page
4. Review the list of professions that can be confirmed in AHPRA
5. Search for each treating health professional via Name or Registration Number
6. Use the filters if you need to refine the search results
7. Select the relevant treating professional
8. Review to check they have current qualifications and registration.

Note: All evidence from a treating professional with a profession listed in AHPRA must be checked to make sure they are currently registered. For a list of AHPRA regulated professions visit the AHPRA website.

If you have any concerns about the evidence of the treating professional details, you should escalate as an integrity issue.

4 Next steps

1. To learn more about integrity issues, refer to article Escalate application integrity issue.
2. To record the AHPRA registration number of a treating professional refer to article Record treating professional details.

Complete a streaming case

(Streaming and Restreaming)

SGP KP Publishing

Exported on 2025-04-03 03:18:16

Table of Contents

1. Recent updates ……………………………………………………………………………………………………..
2. Before you start ……………………………………………………………………………………………………..
3. Understand streaming and restreaming …………………………………………………………………. 3.1 Streaming ………………………………………………………………………………………………………… 3.2 Restreaming …………………………………………………………………………………………………….
4. When to complete a streaming case ……………………………………………………………………….
5. Consider the Complex and YPIRAC streams …………………………………………………………..
6. Create a streaming case …………………………………………………………………………………………
7. Complete the streaming case ………………………………………………………………………………..
8. If restreaming, manually route the streaming case for decision ………………………………
9. Next Steps ……………………………………………………………………………………………………………
10. Identify streaming factors ………………………………………………………………………………….. 10.1 Supported …………………………………………………………………………………………………….. 10.2 Intensive ………………………………………………………………………………………………………… 10.3 Super Intensive ……………………………………………………………………………………………….

This article provides guidance for a planner, early childhood partner, local area coordinator or access delegate:

• to understand streaming and restreaming
• when to complete a streaming case
• to consider the Complex and YPIRAC streams
• to create the streaming case
• to complete the streaming case
• if restreaming, to manually route the streaming case for decision
• to identify streaming factors.

An access delegate will only complete the streaming case if the National Contact Centre (NCC) creates the Access Request case. In all other situations, the planner or local area coordinator that creates the Access Request case will complete the streaming case.

1 Recent updates

29 July 2024 Updated guidance on streaming factors for a person with Motor Neurone Disease (MND). They will need to be referred to the Younger People in Residential Aged Care (YPIRAC) stream.

2 Before you start

You have either:

• been supporting the person to apply to the NDIS and need to create an Access Request case
• identified a new streaming factor that impacts the current stream.

3 Understand streaming and restreaming

3.1 Streaming

Streaming helps to make sure the person receives the support they need to engage with the NDIS. Some people need more support than others. Internally this is called streaming. We don’t use this term with the person.

Streaming doesn’t affect the level of reasonable and necessary NDIS-funded supports in the participant’s plan.

The 6 streaming values and the My NDIS Contact roles are:

• General – local area coordinator or early childhood partner
• Supported – local area coordinator or early childhood partner
• Intensive – early childhood partner or planner
• Super Intensive – early childhood partner or planner
• Complex – planner from the Complex Support Needs (CSN) Branch
• YPIRAC – planner from the Aged Care and Hospital Interface Branch, formerly the Younger People in Residential Aged Care (YPIRAC) Branch.

If the person has restricted access, they will be supported by a planner.

3.2 Restreaming

Restreaming is when you identify a new streaming factor that impacts the current stream.

4 When to complete a streaming case

You must complete a streaming case:

• before creating an Access Request case. This is critical to make sure the Typical Support Package (TSP) is generated if they’re eligible, so they are assigned to the right team.

You must complete a new streaming case (for restreaming) if you identify a new streaming factor that impacts the current stream. This may include:

• being notified the person’s situation has changed
• receiving additional information
• identifying the person was streamed incorrectly.

The streaming case will be allocated to a delegate to approve or override the streaming request. This must be completed before the plan is approved to identify the my NDIS contact that will implement the plan.

5 Consider the Complex and YPIRAC streams

1. Consider if the Complex stream is needed, with referral to CSN. Review article Submit a referral to the Complex Support Needs (CSN) Branch. If:
   • Yes, follow article Submit a referral to the Complex Support Needs (CSN) Branch. If confirmed complex by CSN, they’ll complete the streaming case.
   • No, continue to the next step.
2. Consider if the YPIRAC stream is needed. Review the article Create a referral to Younger People in Residential Aged Care (YPIRAC) in an enquiry case. If:
   • Yes, follow article Create a referral to Younger People in Residential Aged Care (YPIRAC) in an enquiry case. If confirmed by YPIRAC, they’ll complete the streaming case.
   • No, continue to the next step.

For access delegates only Applicants with a disability due to terminal illness who are eligible for the specialised planning pathway don’t need a referral to YPIRAC. Instead, they can be streamed directly to YPIRAC. Follow the steps in section Create a streaming case.

6 Create a streaming case

1. From the Person Account, select Cases.
2. Select New.
3. Select Streaming.
4. Select Next.
5. At Type, select either:
   • Streaming – if Current Streaming is Not Specified in the Details tab
   • Restreaming – if there’s an existing Current Streaming value in the Details tab.
6. Select Save.

7 Complete the streaming case

1. Select the Streaming tab.
2. Select Yes or No to the Streaming Questions based on your conversation with the person and any available supporting information.
   • Review the Streaming factors below to help you answer each question.
3. Select Next.
4. Review the Stream to make sure it’s correct.
5. If incorrect, select Previous to update the Streaming Questions.
6. Select Next.
7. At Streaming Override, confirm the Stream matches the previous screen.
   • Do not select Complex or YPIRAC, unless you’re from the Complex Support Needs (CSN) Branch or the Aged Care and Hospital Interface Branch.
   • For Complex or YPIRAC, you must complete a referral to the relevant branch for consideration. The relevant branch must accept the referral. Refer to section above Consider the Complex and YPIRAC streams.
   • For access delegates only: applicants with a disability due to a terminal illness who are eligible for the specialised planning pathway can be streamed directly to YPIRAC. You don’t need to complete a referral to YPIRAC. This process is only for new applicants. Existing participants with a disability arising from a terminal illness should not be restreamed to YPIRAC.
   • For partners or planners: applicants with a disability arising from a terminal illness who are eligible for the specialised planning pathway should be streamed as Super Intensive. Access delegates will override this to YPIRAC where the applicant is suitable to enter the specialised planning pathway.
8. Select Next.
9. Review the Auto calculated streaming value and Streaming questions and answers to make sure they’re correct. You can look at the Identify Streaming factors section of this article to check the Auto calculated streaming value is correct. The Auto calculated streaming value is based on the answers to the Streaming Questions:
   • General – no streaming factors
   • Supported – one Supported streaming factor
   • Intensive – two or more Supported streaming factors or one Intensive streaming factor
   • Super Intensive – two or more Intensive streaming factors or one Super Intensive streaming factor
10. If incorrect, select Previous to update the Streaming Questions.
11. If streamed Supported, Intensive or Super Intensive, log an Activity:
    • Select the Log Activity tab on the Activity panel on the right of the screen.
    • Select Add.
    • At Activity Type, select Internal Note.
    • At Subject, select Internal Communication.
    • At Comments, record the information you used to select the streaming factor. Your notes must include the streaming factor, why it applies to this participant, and reference to any evidence you used to make this decision.
    • Select Save.

12. Select Submit.

8 If restreaming, manually route the streaming case for decision

If streaming, leave the case allocated to you. If restreaming, allocate the case to the Re- Streaming Routing Queue.

1. Select the Change Owner icon next to the current Case Owner.
2. Select the down arrow next to the Users icon and then select Queues.
3. Search for Re-Streaming Routing Queue (restreaming only).
4. Select Change Owner.

9 Next Steps

1. The streaming case will be assigned to a delegate:
   • They will follow article Approve or override a streaming case (Streaming and Restreaming) to review the streaming value, including the answers to the streaming questions.
   • They will then approve or override the streaming request. This must be completed before you approve the plan to identify the my NDIS contact that will implement the plan.
2. When streaming is approved:
   • if streaming, continue to support the person to apply to the NDIS
   • if restreaming, continue to support the person to develop their plan
   • if the person moves to a different stream, follow articles Understand and check the my NDIS contact and Update the my NDIS contact.

10 Identify streaming factors

10.1 Supported

Unless there are 2 or more, the following factors will result in a Supported stream:

• Person has no known or minimal informal or community support Think about whether a lack of informal supports impacts the person’s ability to engage with the NDIS. Look at how well informal supports can help the person engage with the NDIS, not the number of informal supports.
• Person has a primary disability of mental health condition
• Assistance needed during access. For example, they need a face-to-face appointment
• Person is culturally and linguistically diverse (CALD) and culturally isolated Look at whether the person is from other cultures and are isolated from their community. Or their primary language is not English and they are isolated from their community. Think about whether either or both factors impact the person’s ability to engage with the NDIS.
• Person holds a humanitarian or protection visa Person has a 202 (Global Special Humanitarian), 866 (Protection visa) or 200, 201, 203 and 204 (Refugee visas).
• Parent or carer with disability Think about if the person’s parent or carer has a disability that impacts their ability to engage with the NDIS and other service systems. If the person with disability is a parent or pregnant, think about the support they may need to navigate mainstream birth, parenting and health services and their connection to advocacy and peer support.
• More than one child or family member with a disability

10.2 Intensive

Unless there are 2 or more, the following factors will result in an Intensive stream:

• 2 or more Supported streaming factors
• Person currently involved with the justice system At the time the streaming case is completed, the person is either:
  • in custody in a correctional facility such as prison, remand centre or youth detention centre
  • on bail, probation or parole and required by court order to report to a correctional or community correctional agency
  • serving a community-based order
  • under forensic orders. This may include restrictions on the person’s movements or other requirements. For example, drug testing or going to prescribed treatment. If the person has complex support needs, you may need to refer the person to the Complex Support Needs (CSN) Branch. Follow article Submit a referral to the Complex Support Needs (CSN) Branch.
• Person currently involved with Child Protection.

At the time the streaming case is completed, either:

• the person is at risk of harm or neglect and has been removed from their primary carer. Or is living in an arrangement under active investigation by Child Protection
• there are active child protection orders in place and the child is not in a settled environment. For example, temporary assessment order, interim accommodation order, family preservation order, family reunification order or a long-term care order where the child’s living arrangement is not stable.

Government department involvement does not always mean the person is currently involved with Child Protection. A child under long-term care orders and in a stable placement may not need an Intensive streaming factor, as their Child Protection worker can support them to engage with the NDIS effectively.

• Person has recently been funded for 1:1 24-hour (or greater) care due to behaviours of concern.

Behaviours of concern can be any behaviour that results in adverse impact on the person’s quality of life, including:

• physical or verbal aggression
• property damage
• inappropriate sexual behaviour
• disinhibited and impulsive behaviour
• self-injurious behaviour also referred to as self-harm, which can present differently with each person. It can include head banging or picking and hitting, although may not be an attempt to cause harm.

In mental health settings, the term ‘self-harm’ usually refers to intentional harm without suicidal intent such as neglect, cutting, ingesting objects and self-poisoning. If the participant has complex support needs, you may need to refer the person to the Complex Support Needs (CSN) Branch. Follow article Submit a referral to the Complex Support Needs (CSN) Branch.

• Person is currently in, or will be moving into, shared supported accommodation or a large residential centre.

Person permanently lives in a large residential centre or in supported independent living (SIL). Or they have been approved for SIL or individualised living options (ILO) funding. Living in or being likely to live in a residential aged care facility is a YPIRAC streaming factor.

• Person has a primary disability of spinal cord injury which is recently acquired (<9 months)
• Person has a primary disability of severe brain injury which is recently acquired (<9 months)
• Multiple meetings or multiple stakeholders to engage with the planning pathway. May include stakeholders with conflicting inputs. Look at whether the person needs an intensive level of support to engage with the NDIS and navigate the NDIS market. For example, if the person has complex disability-related health support needs and needs extensive therapy and equipment.
• Person has been a victim of abuse (physically, verbally and or emotionally) or neglect

The history of abuse or neglect significantly impacts the person’s ability to engage with the NDIS.

• Person has a history of abuse or risk behaviour towards others
• Person has severe intellectual disability (level 10 or above) and no informal supports to help with decision-making.

Level 10 or above refers to the Internal Agency Assessment Tool (IAAT). Disregard the IAAT level when determining streaming. Instead, use available evidence from reports, assessments and other supporting information.

• Person has a severe acquired brain injury (level 10 or above) and no informal supports to help with decision-making

Level 10 or above refers to the IAAT. Disregard the IAAT level when determining streaming. Instead, use available evidence from reports, assessments, and any other supporting information.

• Person has a diagnosed degenerative neurological condition which is progressing rapidly

For example, Motor Neurone Disease (MND), Huntington’s disease, Kuf’s disease, some progressive Multiple Sclerosis types and early onset dementia.

If the person has MND, you’ll need to refer the person to the YPIRAC stream. Follow article Create a referral to Younger People in Residential Aged Care (YPIRAC) in an enquiry case.

10.3 Super Intensive

2 or more Intensive streaming factors will result in a Super Intensive stream.

Complete pre-assessment for an access decision

SGP KP Publishing

Exported on 2025-04-02 05:29:36

Table of Contents

1. Recent updates ……………………………………………………………………………………………………..
2. Before you start ……………………………………………………………………………………………………..
3. Accept an access decision case …………………………………………………………………………….
4. Check prioritisation ……………………………………………………………………………………………….
5. Review key information ………………………………………………………………………………………….
6. Complete initial checks …………………………………………………………………………………………. 6.1 Complete procedural fairness check ………………………………………………………………………. 6.2 Check there is no internal review or ART review in progress …………………………………….. 6.3 Check if remote, YPIRAC or terminal illness ……………………………………………………………. 6.3.1 Update subject to terminal illness ……………………………………………………………………….. 6.3.2 Complete the specialises cohort – unavailable treatments form ………………………………. 6.3.3 Unable to complete Access Decision – Send back to queue ………………………………….. 6.4 Check for eligibility evidence not linked to the case ………………………………………………… 6.5 Check for Access Integrity Management referral (AIM) tasks …………………………………… 6.6 Check authorised representatives …………………………………………………………………………
7. Check if access request is complete ……………………………………………………………………. 7.1 Verify consent to apply ……………………………………………………………………………………….. 7.2 Verify identity …………………………………………………………………………………………………….. 7.3 Verify age and residence …………………………………………………………………………………….. 7.4 Check evidence of disability ………………………………………………………………………………… 7.5 Complete identity evidence ………………………………………………………………………………….
8. Mark application as invalid …………………………………………………………………………………..
9. Cancel an Access Decision case ………………………………………………………………………….
10. Next steps ………………………………………………………………………………………………………..

This article provides guidance for an access delegate (assessor) to:

• accept an access decision case
• check prioritisation
• review key information
• complete initial checks
• check if access request is complete
• mark application as invalid if required
• cancel the access decision case if required.

1 Recent updates

4 November 2024 Guidance added for cancelling an access decision case.

14 October 2024

• Guidance updated to reflect legislation to start a new body called the Administrative Review Tribunal (ART). The ART replaced the Administrative Appeals Tribunal (AAT) on Monday 14 October 2024.
• Administrative Appeals Tribunal (AAT) changed to Administrative Review Tribunal (ART) throughout.

2 Before you start

• You have read Our Guideline – Applying to the NDIS (external), including section How do you apply for the NDIS?

3 Accept an access decision case

1. At Home page, select Omni-Channel tab at the bottom of the screen.
2. A Status message will appear. Select Available from the drop-down list.
3. Select the tick box for the case to make a decision on. The Access Decision case will open.
4. Set Omni-Channel status to Offline. This will make sure you’re only allocated one case at a time to complete.

4 Check prioritisation

1. Select Details tab.
2. Review and note the Prioritisation. If the access request is complete and there’s a Prioritisation Reason, you have 2-5 business days to make an access decision or request further information. For more information go to article Request priority eligibility decision.
3. Select Decision tab. The Pre-Assessment screen will display.

The following sections are in the order you need to complete them, rather than the order in PACE.

5 Review key information

1. Select the Progress Case button to move the status from New to In Progress.
2. Review Key Information, including:
   • Name
   • Date of Birth
   • Age
   • Home Address
   • Australian Citizenship
   • Permanent Resident
   • Visa Class
   • CRN (customer reference number)
   • CRN consent
   • legislation version that will be used for the access decision. This will help you decide what article to go to in section Next Steps.

6 Complete initial checks

6.1 Complete procedural fairness check

Procedural fairness makes sure our decisions for applicants are fair, respectful, and unbiased.

1. If you have a conflict of interest, then you must unassign the work item.
2. Check you’re an independent delegate to work on an application decision. To be independent means you:
   • don’t have a personal interest in the applicant’s status
   • don’t have a relationship with the applicant outside the NDIA
   • haven’t made a previous access not met or revocation decision for the applicant. Note: For more information, go to the Policy Hub – Conflict of Interest.
3. Do you have a conflict of interest (COI)? If:
   • No, at Sent back to queue?, Select No and go to section Check for eligibility evidence not linked to the case.
   • Yes, go to section Unable to complete Access Decision – Send back to queue.

6.2 Check there is no internal review or ART review in

progress

1. From the Person Account screen, select the Cases tab.
2. Under Open Cases, check if there’s an Internal Review case or Administrative Review Tribunal (ART) review. If:
   • No, go to section Check if remote, YPIRAC or terminal illness.
   • Yes, go to next step.
3. Check if the review is for an access decision or revocation decision. If:
   • access decision, go to section Mark application as invalid.
   • revocation decision, go to next step.
4. Check when revocation decision was made. If:
   • on or after 3 October 2024, go to section Mark application as invalid.
   • before 3 October 2024, contact your team leader to decide next steps.

6.3 Check if remote, YPIRAC or terminal illness

The access decision case must be completed by an access delegate in the Priority Health Access Team or Specialised Access Team if the applicant:

• lives in a remote or very remote location (MMM6 and MMM7)

Note: for more information go to Modified Monash Model (external)

• is a younger person in residential aged care, also known as, YPIRAC
• is living with a terminal illness
• is living with Motor Neurone disease or Kennedy’s disease

SGP KP Publishing – Complete pre-assessment for an access decision

• has unavailable treatment options.

If you’re not in these teams, you need to change the case owner of the access decision case.

1. Check if one of the above situations applies. If the applicant:
   • lives in a remote or very remote location (MMM6 and MMM7), change Case Owner to Danika redacted: s47F - personal privacy (DJS497).
   • is a younger person in residence aged care (YPIRAC), change Case Owner to Sam redacted: s47F - personal privacy (SCM231).
   • is living with a terminal illness, go section Update subject to terminal illness
   • is living with Motor Neurone disease or Kennedy’s disease, go to section Update prioritisation reason to Motor Neurone Disease.
   • has unavailable treatment options, go to section Complete the specialises cohort – unavailable treatments form.

6.3.1 Update subject to terminal illness

1. From the Access Decision case, select the Details tab.
2. Scroll down to System information.
3. At Subject, select Edit Subject, which looks like a pencil icon.
4. Enter Terminal Illness.
5. Select Save.
6. Repeat steps above for the Access Request case.
7. Change Case Owner to Access Decision Routing Queue.
8. Update prioritisation reason to Motor Neurone Disease From the Access Decision case, select the Details tab.
9. Scroll down to Prioritisation.
10. Select Edit, which looks like a pencil icon, next to Prioritisation Reason.
11. At Prioritisation Reason, select Disability.
12. At Priority Description, select Motor Neurone Disease.
13. Select Save.
14. Change Case Owner to Access Decision Routing Queue.

6.3.2 Complete the specialises cohort – unavailable treatments form

This is when there are known treatments, however treatment is unavailable to the applicant. This may be because of their location, finances, religion or because their disability prevents them from accessing it. This doesn’t apply where there are no known treatments likely to remedy the impairment.

1. Complete the Specialised Cohort – Unavailable Treatments form (external).

The access decision case will remain assigned to you. A QDO Team Leader will review the application and either:

• reassign the access decision case to themselves
• give feedback if you need to progress with an access decision.

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6.3.3 Unable to complete Access Decision – Send back to queue

1. At Sent back to queue?, select I am no longer able to complete this Access Decision.
2. At Reason, select the relevant option.
3. At Justification, enter details about the conflict of interest.
4. Select Next.
5. At Confirmation, select Done. The application will be sent back to the queue and another access delegate will be assigned the access decision case.

6.4 Check for eligibility evidence not linked to the case

1. Check for eligibility evidence not linked to the access decision case that needs to be considered. This includes evidence in SAP CRM, enquiries inbox and enquiry cases.
2. Check the Account Timeline for any cases, alerts, tasks or log activities relevant to the case. For further guidance, refer to article View the Person Account Timeline.
3. If required, add and link any eligibility evidence to the access decision case. Go to article Add and link evidence to a case.

6.5 Check for Access Integrity Management referral (AIM) tasks

If there’s an application or evidence document that may not be genuine or real, this is an integrity issue.

1. From the Person Account, check the Account Timeline for any AIM referral tasks. For further guidance, refer to article View the Person Account Timeline. If:
   • No, go to section Check authorised representatives.
   • Yes, open the task and review Comments for instructions under Task Information.

Note: There may also be alerts in the person account relating to integrity concerns.

6.6 Check authorised representatives

This will make sure that correspondence is generated correctly.

1. From the Person Account, select the Relationships tab.
2. Select the Authorised Reps tab.
3. Check the authorised representative is listed and their correspondence details are correct, if there’s evidence to compare to.

Note: Authorised representatives, including child representative for applicants younger than 18, except in exceptional circumstances, must be listed.

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7 Check if access request is complete

7.1 Verify consent to apply

1. Check if there’s an internal note that records who provided consent to apply. For how to find internal notes, go to article View the Person Account Timeline.
2. Use article Applicant consent to apply to look at whether the person has consent to apply on behalf of the applicant. If:
   • the applicant or their authorised representative provided consent, go to section Verify identity.
   • the person doesn’t have consent or there’s no internal note, go to section Mark application as invalid.

7.2 Verify identity

1. Check the correct identity documents have been provided and verified for the applicant, and their authorised representative, if they have one. Go to article Understand how to verify identity documents.

2. If all of the required identity documents aren’t provided and verified, check if there’s an internal note that explains a genuine reason why. If there’s an internal note, contact your team leader to decide next steps.

   Note: Identity documents with a Verification Status of Verified DVS don’t need to be uploaded. All other documents must be uploaded to the person account.

3. If identity is:

   • verified or there’s an internal note to explain why not, go to section Verify age and residence.
   • not verified and there’s no internal note to explain why, the access request isn’t complete. Go to section Mark application as invalid.

7.3 Verify age and residence

1. Go to article Consent to use Centrelink information to check if the person has given consent to check age and residence in Centrelink. For child applicants, we also need consent to check the child representative’s Centrelink. If:
   • Yes, go to article Verify age and residence with Centrelink information.
   • No, go to article Understand age and residence evidence.
2. With consent, check if Account Name, Date of Birth, Address and Residence Information matches Centrelink or documents. If age and residence is:
   • Verified, go to section Check evidence of disability.
   • Not verified, go to section Mark application as invalid.

7.4 Check evidence of disability

1. Check evidence of disability has been provided. If:
   • Yes, go to next step.
   • No, go to section Mark application as invalid.

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2. Check if child younger than 6 with developmental delay:
   • Yes, go to next step.
   • No, go to section Complete identity evidence.
3. If an early childhood partner gives any evidence of developmental delay (EODD) form on or after 16 September, check the correct version (version Aug 24) of the form was used. If:
   • Yes, go to section Complete identity evidence.
   • No, go to section Mark application as invalid.

Note: This is a check to make sure the access request is complete. You’ll complete Disability Evidence in a later step using either article Make an access decision - Pre-legislation changes or Make an access decision – Post-legislation changes.

7.5 Complete identity evidence

1. Select Yes or No for questions:

   • Have you verified the Evidence of Age?
   • Have you verified the Evidence of Residency?
   • Have you verified the Evidence of Identity?

   Note: You can’t complete the access decision case until the evidence has been verified and you select Yes for all questions.

2. If:

   • Yes to all questions, go to section Next Steps.
   • No to any question, the access request is not complete. Go to section Mark application as invalid.

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8 Mark application as invalid

An access request isn’t complete if there’s no evidence of:

• consent to apply from the applicant or their authorised representative
• age, residence and disability
• identity or an internal note confirming why identity documents haven’t been provided

An access request isn’t complete if there’s evidence of:

• an internal review or Administrative Review Tribunal (ART) review in progress for an access decision
• an internal review or Administrative Review Tribunal (ART) review in progress for a revocation decision made on or after 3 October 2024.

1. At Is the Access Request Invalid or Incomplete?, select Yes or No. If:
   • No, select Next and go to section Next Steps.
   • Yes, go to step 2.
2. At Provide reason why the application is invalid, enter the details into the free text field.
3. Select Next. The access decision case is now closed. The access request case will automatically reassign to the Access Request Routing Queue.
4. Complete the AO Support Webform (external) to notify the access officer’s team leader.

If at any point you need to cancel the Access Decision case go to section Cancel an Access Decision case. Otherwise continue to Next Steps.

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9 Cancel an Access Decision case

Note: Don’t cancel the case once you’ve approved the decision for access met or access not met. If you make an error at this stage, select Previous to correct the error.

For more information go to articles Complete pre-assessment for an access decision or When to withdraw an access application.

The Access Decision case can only be cancelled by an access delegate in the Scheme Eligibility branch.

The Cancel Case button is available when:

• the Access Decision case is in the status New or In Progress.

Note: When you cancel an Access Decision case, the Access Request case will automatically change to In Progress. You’ll need to cancel or withdraw the Access Request case. Go to article When to withdraw an access application.

1. Select the Cancel Case button in the top right hand corner of the Access Decision case.

2. At Closure Reason select Administration error.

   Note: This is the only reason an access decision can be cancelled.

3. At Closure Comments enter details as to why the case is being closed.

4. Select Confirm. A note will state the case is now closed.

5. Select Done to finish the process.

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10 Next steps

1. Check Legislation version that will be used for the access decision. Go to section above Review key information to find this. If using:

   • National Disability Insurance Scheme Amendment (getting the NDIS Back on Track No.1) Bill 2024, go to article Make an access decision – Post-legislation changes.

     Note: This is the latest version of the National Disability Insurance Scheme Act 2013 which incorporates amendments as per the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No.1) Bill 2024.

   • National Disability Insurance Scheme 2013, go to article Make an access decision – Pre-legislation changes.

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FOI 24/25-1473 DOCUMENT 30

OFFICIAL SGP Knowledge Article Template For Internal Use Only

The contents of this document are OFFICIAL.

Complete personal and environmental circumstances case

This article provides guidance for a local area coordinator, early childhood coordinator and all NDIA staff (planner, payment officer, internal review officer, complaints officer, participant service officer, access officer, quality officer, technical advisor, SDA officer, NCC officer, provider support) to understand:

• why we complete the personal and environmental circumstances (PEC) case
• the PEC steps and questions
• how to prepare for the conversation to complete the PEC case
• how to complete the PEC
• what to do when an applicant doesn’t want to complete the PEC case
• next steps.

Recent updates

July 2023

• Update to system steps and language to align with PACE and knowledge consistency.

Before you start

You have:

• read and understood Our Guideline – Creating Your Plan
• read and understood Our Guideline – Disability-related health supports
• checked if:
  • there is an application exception
  • the applicant has a priority situation
  • there are any identified risks
  • they have already applied within the last 6 months

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• the applicant doesn’t want to complete the PEC
• read the Conversation Style Guide
• read article Checking and updating a participant’s preferred communication method.

Note: PEC case questions will be different for:

• child applicants younger than 7. To learn more, read early childhood articles:
  • Early childhood – Overview – Personal Environmental Circumstances (PEC) including Capacity Building questions
  • Early childhood – How to complete the Personal Environmental Circumstances (PEC) Capacity Building questions
• applicants 7 to 14 years
• applicants over 15.

Understanding the personal and environmental circumstances case

Why do we complete the PEC case?

We complete the Personal and Environmental Circumstances case when a person is applying to the NDIS. Completing the questions in the PEC case helps us to understand:

• the person’s support needs
• how the person manages daily life

We will use the information from the PEC case to understand the types of supports that could help an applicant. This can include:

• family, friends, and unpaid carers
• community
• mainstream
• funded supports (if they become a participant of the NDIS).

Understand Personal and Environmental Circumstances steps and questions

In the PEC case, you must first review the applicant’s:

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• identity details, including their primary reported disability, if relevant
• authorised representative details, if relevant.

Continue the conversation and select or enter responses for all required questions in the case Steps marked with an asterisk.

The PEC case Steps and questions will vary depending on the person’s situation. The case Steps are shown on the right of the PEC case screen. To learn more, go to articles:

• Record Housing information
• Record Daily Support information
• Record Carers information
• Record Capacity Building information
• Record Support Coordination information
• Record Employment and Training information
• Record Equipment and Consumables information
• Record Assistive Technology information.

Note: You can’t go forward in the Steps sequence until you complete all required questions and select Next. You can view or update previous Steps by selecting Previous. Once you complete the PEC case you can’t edit your responses.

Prepare for the conversation to complete the PEC case

You need to:

• use the Conversation Style Guide and your interpersonal skills to have a free flowing, person-centred conversation with the applicant
• select the appropriate answers. Don’t read the questions out loud to the person. Listen carefully to their answers so you can choose the most appropriate answers in PACE, based on the information they provide.
• avoid selecting blank or unanswered answers in PACE when entering responses. This may result in a Typical Support Package (TSP) being created that doesn’t reflect the participant’s real circumstances. Instead, ask the person open-ended questions to help them provide more detailed responses.

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Note: The PEC case questions are dynamic and may change in PACE. This will depend on the person’s situation, age and some of the response options you select.

How to complete the PEC case for children living in statutory out of home care

During your conversation, record responses to the questions on the basis that the child has a capable parent who provides the same level of informal supports that would be expected from a parent of a child of that age. For example, the state or territory.

When asking these questions, remember to consider the role of the state/territory as the parent and holding parental responsibility, rather than the foster carers. Your responses need to consider the state/territory’s statutory responsibility as well as considering valuable matters raised by the individual foster parent responses.

For example, when asking if they can continue to care for the child in the way they currently do you should always respond - Yes. Do not answer No to this question. If the foster carer cannot continue to care for the child, the state/territory remains responsible for the child’s care and providing a suitable care arrangement at all times.

The planning conversation allows you the opportunity to gather detailed and concise information. This is also a great opportunity for the child to tell their story and voice their goals and aspirations where possible. The following points can support you to have a high-quality conversation:

• Ask the child the relevant questions where appropriate and where they can understand and respond. When you can’t direct questions to the child, you should ask the person with parental responsibility.
• Include the child representative in all conversations and decisions.
• Don’t give a service provider or support coordinator any decision-making power in relation to the child’s plan at any time.
• Never presume to know what the family is going through or why the child is in statutory out of home care.
• It is possible that the child has experienced trauma, and this should be considered in the context of their vulnerability when discussing some subjects that may be difficult for them.
• Refer to NDIS Intranet page guidance by searching Disability Snapshots and Disability Navigator for further and specific guidance relating the child’s disability.

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How to complete the PEC case

You should help the applicant feel comfortable during the discussion. When speaking face-to-face or over the phone you must:

• prepare for the conversation
• build rapport and listen actively
• tailor the wording from the assessment questions
• understand the question you are asking
• understand the person-centred approach
• ask effective questions
• manage expectations with the person so they understand this doesn’t necessarily mean they will get a funded NDIS plan.

You should note the following when completing the PEC questions.

Consumable supports

• consumable support has different levels for adults and children
• continence products include catheter consumables such as tubing and bags
• for children younger than 18 the available answers to choose from include:
  • level 1 (high user only, or moderate use and higher cost). For example, the child uses 6 or more continence products per day and higher cost tube feeding.
  • level 2 (moderate use, moderate cost). For example, the child uses 4-6 continence products and low-cost tube feeding, or high-cost tube feeding and less than 4 continence products.
  • level 3 (low to moderate use, low to moderate cost). For example, the child uses less than 4 continence products and low-cost tube feeding.
  • level 4 (low use, low cost). For example, the participant uses continence products only (less than 4), or low-cost tube feeding only.

Note: In rare situations we may include funding for continence supports for an eligible child participant younger than 5 with disability related medical conditions. To learn more refer to Our Guidelines – Continence Supports.

Capacity building supports (for applicants over 6)

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Use the following examples as a guide to understand the different levels of capacity building support. Select the most appropriate option when answer the PEC questions about capacity building.

Note: As a guide to understanding an applicant’s goals, consider:

• for simple goals:
  • these are likely to be short-term
  • the applicant and the people who support them can easily identify steps to work towards it
• for complex goals:
  • these are likely to be medium to long-term
  • we would need to work with the applicant participant, and the people who support them, to identify how to work towards the goal
  • we may need to request progress reports to understand how supports were helping the person to work towards their goal.

None (Capacity Building Level 5) may include:

• The participant only has simple goals in their plan and can work towards these with support from informal, community or mainstream supports.
• Selecting this option means that the participant can work towards their goals without any funded Capacity Building support.

Low (Capacity Building Level 4) may include:

• The participant may have one simple goal in their plan that requires some support to work towards.
• Selecting this option means they may be able to work towards this goal with support from one provider, such as an allied health professional or support worker.

Moderate (Capacity Building Level 3) may include:

• The participant has up to 3 simple goals in the plan that require some support to work towards.
• They might need support from a few different support providers or allied health professionals to work towards their goal.

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• For example, a participant may want to work towards being able to use transport independently. To do this they might need some help from an Occupational Therapist to understand how to get to the bus stop and buy a ticket and help from a Speech Therapist to be able to communicate with the bus driver.
• Selecting this option usually means the participant can work towards their goal during the current plan period.

High (Capacity Building Level 2) may include:

• The participant has up to 4 simple goals and one complex goal in their plan.
• They might need help from a few different allied health professionals and a support worker to work towards their goal.
• For example, a participant might need to have a support worker travel with them on the bus to build their independence, as well as work with the Occupational Therapist and Speech Therapist to support their communication and planning skills.
• Selecting this option usually means that the participant’s goals are long-term and something they will work towards over more than one plan period.

Very High (Capacity Building Level 1) may include:

• The participant has more than one complex goal in their plan and requires some behaviour support to be able to work towards their goals.
• You would have already referred to Practice Guide – Positive Behaviour Support and Behaviours of Concern if you have decided that behaviour supports are reasonable and necessary to support the participant to work towards their goals.

I don’t know/Unsure (Capacity Building Level 5) may include:

• Using this response may mean the participant does not receive the appropriate level of support to help them work towards their goals.
• Note: Avoid using this response wherever possible.

What if the applicant does not want to complete the PEC?

The applicant may not want to complete the PEC. It’s important to complete the PEC so we can generate the right budget and support for participants. It’s important you let the person know their application could be delayed if we don’t complete the PEC.

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Next Steps

Read article Create a Personal and Environmental Circumstances case.

Once we have completed the PEC case, we need to:

• complete functional capacity assessment. Read article Understand functional capacity assessments.
• complete Streaming. Read article Participant streaming.
• complete then submit the access request case. Read article How to apply for the NDIS in PACE.

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FOI 24/25-1473 DOCUMENT 31

Consent to act on applicant behalf

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Understand consent to act on applicant behalf ………………………………………………………. 6
4. Check consent to act on applicant behalf ………………………………………………………………. 7
5. Next steps …………………………………………………………………………………………………………….. 8

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This article provides guidance for a local area coordinator, early childhood partner and all NDIA staff (planner delegate, payments officer, internal review delegate, complaints officer, participant support officer, access delegate, technical advisors, National Contact Centre, liaison officers (HLO/JLO), complex support needs (CSN) planner, national reassessment delegate) to:

• understand consent to act on the applicant’s behalf
• check the applicant has given this consent.

This article is about NDIS applicants. For participant consent guidance, go to article Understand the process for consent, nominee, child representative or self-representation.

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1 Recent updates

December 2023

Guidance improvement with knowledge update and PACE alignment, including:

• name change from Check evidence to act on behalf of another person.

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2 Before you start

You have read and understood:

• Our Guideline – Privacy and information, including section Do we need your consent to ask other people for your information?
• Our Guideline – Applying to the NDIS, including section Who can help you apply? article Understand consent requirements, for all different consent

When relevant, utilise these articles:

• For support options when applying to the NDIS. Use Applicant consent to apply.
• To obtain and record in PACE, consent for a third party to act on the applicant’s behalf. Go to Record consent to share information or for a third party to act and Understand how to verify identity documents.

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3 Understand consent to act on applicant behalf

This is when the applicant agrees to another person or organisation to do things for them with the NDIS. For example, they may give a family member consent to manage personal information on their behalf. The applicant may also consent to a person they trust to submit a complaint or provide feedback.

This consent does not include permission to collect or share their information. These consents are separate agreements. Go to article Applicant consent to collect information or article Applicant consent to share information.

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4 Check consent to act on applicant behalf

Check applicant account

When the applicant gives consent to act on their behalf, we record this information. To check if we have act on applicant behalf consent for a third party:

1. From the Person Account, select Relationships tab.

2. Select Authorised Reps tab.

3. At Authorities, the Role column will show the role type.

   For more information on role types, go to article Understand the process for consent, nominee, child representative or self-representation.

4. At Authority column, select Check Authorities

5. In Details tab, for Information confirm the following check boxes:

   • Active is selected.

   • Suspended is not selected.

   • Conflict of Interest is not selected.

     If Active is selected, note the end date, and check it matches with relevant documentation.

     If selected for Suspended and Conflict of Interest, go to step 2 in Next steps.

6. Scroll to Authorities to check the permissions the applicant has authorised for this person.

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5 Next steps

1. If the correct role and permissions are in place, the process can continue. If the incorrect role (or no role) and permissions are not in place, the process cannot continue. Then for a security check, go to article Consider a request for personal information.

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Consent to use Centrelink information

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Understand consent to use Centrelink information ………………………………………………… 6
4. Check an applicant’s consent to use Centrelink information ………………………………….. 7
   • 4.1 Check applicant account ………………………………………………………………………………………. 7
   • 4.2 Check application form …………………………………………………………………………………………. 7
   • 4.3 Record an applicant’s consent to use Centrelink information …………………………………….. 7
   • 4.4 No consent to use Centrelink information. ………………………………………………………………. 8
5. Next steps …………………………………………………………………………………………………………….. 9

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This article provides guidance for all NDIA staff (planner delegate, payments officer, internal review delegate, complaints officer, participant support officer, access delegate, technical advisors, National Contact Centre, liaison officers (HLO/JLO), planner (non-partnered area), national reassessment delegate) to:

• understand consent to use Centrelink information
• check an applicant’s consent to use Centrelink information.

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1 Recent updates

18 December 2023

Minor update to add guidance for requesting consent from both parents of a child applicant to access their Centrelink records’

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2 Before you start

You have:

• read and understood Our Guideline – Applying to the NDIS, including section What information do we need in your application? about age and residence proof.
• read and understood Our Guideline – Your privacy and information, including sections Why do we ask for information? and Do we need your consent to ask other people for your information?
• read article Understand consent requirements
• utilised article Understand age and residence evidence.

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3 Understand consent to use Centrelink information

An NDIS applicant must give evidence of their age and residence. To do this, they can:

• consent to use their Centrelink information
• send us copies of relevant documents.

An adult applicant or an applicant’s authorised representative can give consent for us to use their Centrelink information. To give consent they can:

• say yes when we ask about it - this is verbal consent
• tick yes on page 6 of the NDIS application form - this is written consent.

For a child applicant, the parent or child representative applying on their behalf must also give consent to use their Centrelink information. This will be for both the child and parent or child representative records. This is needed because these are linked records in the Centrelink business system.

Note: You should seek consent from both parents to access their Centrelink records where possible. Access to the child’s information is not possible if consent hasn’t been given by the parent to whom the child’s record is linked.

For more information about consent when applying for the NDIS, go to the Access request form, section B.

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4 Check an applicant’s consent to use Centrelink information

4.1 Check applicant account

First check in PACE if we have applicant Centrelink consent.

1. From Person Account, select Details tab
2. Scroll to Consents section
3. If Consent to use CRN is selected, we have applicant consent. Go to Next steps in this article.
4. If not selected, go to the Check application form section in this article.

4.2 Check application form

To check in the application form if we have applicant Centrelink consent.

1. From Person Account, select Documents tab
2. If application form is there, select check box to open, select Download.
3. Scroll to Section 1 - Privacy and Consent Declaration, part B, question 2, on page 6.

4.3 Record an applicant’s consent to use Centrelink information

In PACE, you need to obtain and record consent to use Centrelink information.

1. From Person Account, select Cases
2. Check for an existing Create Person Account or Update Person Account case with a new status, select to open.
3. If no existing case, select New to set up a case. Go to article Update a person account
4. Progress the case to What would you like to update? step.
5. Select Consents and select Next.
6. At Consent to use for the Centrelink question, match to applicant’s selection in the application form with either:
   • Yes, I consent, and my CRN is
   • Yes, I consent, and I do not know my CRN
7. Select Next
8. Confirm information is correct.

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9. To change, select Previous. If correct, select Submit.

Note: For a child applicant – follow this guidance for both PACE person accounts for the child and parent or child representative.

4.4 No consent to use Centrelink information.

If the applicant does not give consent to use their Centrelink information, they will need to provide document copies as evidence.

To check the applicant’s choice to provide evidence of document copies, you need to confirm they have selected the third option on their application form on page 6, in Section 1 – Privacy and Consent Declaration, part B, question 2. Go to previous article section Check application form.

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5 Next steps

1. If you have obtained Centrelink consent, go to article Verify age and residence with Centrelink information.
2. If you are unable to obtain Centrelink consent, and the applicant has chosen use document copies, go to article Understand how to verify identity documents.
3. Continue to follow article Understand age and residence evidence.

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Consent to use document verification service

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Table of Contents

1. Recent updates …………………………………………………………………………………………………….. 4
2. Before you start …………………………………………………………………………………………………….. 5
3. Understand why DVS consent is important ……………………………………………… 6
4. Get DVS consent …………………………………………………………………………………………………… 7
   • 4.1 Read introduction to applicant ……………………………………………………………………………….. 7
   • 4.2 Read declaration to applicant word-for-word:…………………………………………………………… 7
   • 4.3 Ask for consent ……………………………………………………………………………………………………. 8
   • 4.4 Record DVS consent to verify identity documents in PACE ………………………………………. 8
5. Confirm the person has given us DVS consent …………………………………………………….. 10
6. What happens if this consent is not provided? …………………………………………………….. 11
7. Next steps …………………………………………………………………………………………………………… 12

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This article provides guidance for all NDIA staff and partners to:

• understand why document verification service consent (DVS) is important
• get DVS consent
• confirm the person has given DVS consent
• understand what happens if DVS consent is not provided.

This article is for NDIS applicants. For participant consent guidance, go to article Understand the articles to use for the Manage Authorised Representative case.

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1 Recent updates

3 October 2024 Linked article title changed from How to complete the access request case form to Complete form in the access request case.

Guidance updated to improve accessibility and consistency with related articles.

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2 Before you start

You have:

• read and understood Our Guideline - Applying to the NDIS (external) including section How do you apply to the NDIS?
• read and understood article Understanding consent requirements
• followed guidance in articles How to apply for the NDIS in PACE and Complete form in the access request case

To confirm a person’s identity this is a 2-part process:

• gain DVS consent – this article
• verify identity documents with DVS – after this article. Refer to Next steps.

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3 Understand why DVS consent is important

You can’t legally use someone’s identity documents or disclose them to a third party without the person’s consent.

To verify someone’s identity with a separate organisation, you need to disclose part of their identity information to that organisation. This is the quickest and easiest way to verify their identity documents. However, to protect the person’s privacy you must get their formal consent to do so.

If they don’t give their DVS consent, there are other ways to verify their identity documents. However, this may be more difficult, and take longer.

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4 Get DVS consent

You get DVS consent to verify identity documents by directly asking for it. We call this verbal consent.

If a person can’t give verbal consent, you must help them find accessible ways to give consent. Go to article Understand how to verify identity documents. Your team leaders can help with this too.

To obtain verbal DVS consent there are 4 steps:

1. Read introduction to applicant.
2. Read declaration to applicant word-for-word.
3. Ask for consent to verify identity documents.
4. Record DVS consent in PACE.

4.1 Read introduction to applicant

You need to read the following information aloud to the applicant.

“I’m going to read a legal declaration about why the NDIA collects and shares information to check your identity documents. This will take a few minutes. Then I will ask if you give us consent to check your identity documents. You say either, ‘Yes’ to give consent or ‘No’ if you don’t.”

“Before I start, do you want to know more about our Privacy policy?”

If the person answers:

• No, then skip to Step 2: Read declaration to applicant word-for-word
• Yes, then explain the following:

“You can find our Privacy Policy on our website at ndis.gov.au. Scroll to the very bottom of the page and click on the Privacy link in the bottom menu. If you need an easy English version, you can then click the Privacy Easy Read link in the right-hand menu of the privacy page.”

“Are you ready to listen to the declaration?”

If the person answers:

• No, support them to resolve any questions or issues
• Yes, move to Step 2: Read declaration to applicant word-for-word

4.2 Read declaration to applicant word-for-word:

“The National Disability Insurance Agency (NDIA) collects your personal information to:”

• “Confirm your identity so that we can be sure that we’re dealing with the right person when you deal with us about your NDIS application and (if eligible) your NDIS plan”
• “Help develop, implement and reassess your NDIS Plan (if eligible) and do other things related to the NDIS.”

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“The personal information that we collect may include your full name, address and date of birth, and identity documents such as driver’s licence, passport, or Medicare card. Sometimes this information may include your sensitive information such as health information or information about your racial or ethnic origin or your religious beliefs.”

“We’ll collect your personal information directly from you unless it’s not practical to do so. We may also collect your information from others when it’s allowed under a law, or if you give us consent to do so.”

“To confirm your identity, we may need to disclose your personal information to:”

• “A state, territory or commonwealth government agency that issued an identity document that you’ve provided”
• “Other people such as: family members; health professionals who have treated you; support workers; organisations that are our Partners in the Community; state, territory or commonwealth government agencies.”

“If we don’t collect your personal information, we may not be able to confirm that you’re the person making this application or, if you’re eligible for the NDIS, that you’re an NDIS participant. This may mean that we’re unable to interact with you about this application and we may be unable to decide if you’re eligible for the NDIS. It may mean that, if you’re eligible, we may not be able to interact with you to assist you with preparing and implementing an NDIS plan.”

“You can find out more about how we collect, use and disclose your personal and sensitive information by visiting the NDIS website at ndis.gov.au.”

“That’s the end of the declaration. Are you ready to answer the consent question?”

If the person answers:

• No, support them to resolve any questions or issues
• Yes, move to Step 3: Ask for Consent.

4.3 Ask for consent

You must ask the person the following question and record their response.

“Do you consent to the NDIA collecting, using and disclosing your personal and sensitive information for the above purposes, including to verify your identity with the document issuer or official record holder via third party systems, and in accordance with our Privacy Policy?”

If the person answers:

• Yes, then note their response and move to Step 4: Record consent in PACE
• No, then ask, “Can you briefly explain why you said no, so I can note it for our records?” and note their response.

“Thanks. I’ll include those details on your record, so you don’t have to tell us this again.”

4.4 Record DVS consent to verify identity documents in PACE

Enter this DVS consent in the applicant’s Consent section of their Person Account. To do this, either use article Create a Person Account or Update a Person Account.

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In the Person Account case, the Consent step has 5 questions. You’ll only record DVS consent to verify identity. You can only answer the other questions if you have the applicant’s specific consent.

The DVS consent question is the same as the one you asked the applicant - Do you consent to the NDIA collecting, using and disclosing your personal and sensitive information for the above purposes, including to verify your identity with the document issuer or official record holder via third party systems, and in accordance with our Privacy Policy?

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5 Confirm the person has given us DVS consent

To check if the person has given DVS consent to verify their identity documents, you must check their PACE account.

1. Search for the Person Account.
2. In the Details tab, scroll to the Consents section at the bottom.
3. Check if the Consent DVS checkbox is ticked.

You must confirm the person has given consent before any use of their identification information.

It’s important you verify the person’s identity. You can’t progress a person’s application until you’ve verified their identity documents.

If the person hasn’t given consent to use their information, you’ll need to refer the case to your team leader, or to the Access Integrity Management (AIM) team.

If no information is displayed in the Consents section of the Person Account, it’s likely we haven’t asked the person for consent.

You’ll need to directly ask them. Refer to Get DVS consent in this article.

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6 What happens if this consent is not provided?

You can’t use the person’s identity documents without their consent. When you verify a person’s identity, if they’ve not given consent to use their identity documents then we must use other methods. This takes longer and may delay the person’s application. Refer to Next Steps in this article.

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7 Next steps

To verify identity documents with the DVS, go to article Understand the Document Verification Service.

If you’re unable to use DVS, go to article Understand how to verify identity documents.

To complete an access request case, continue to follow guidance in article Complete form in access request case.

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DOCUMENT 34 FOI 24/25-1473

OFFICIAL

Knowledge Article

For Internal Use Only

The contents of this document are OFFICIAL.

Consider a request for personal information

Guidance in this document is not approved for use unless you view it in PACE.

This article provides guidance for all NDIA staff and partners to understand:

• how to complete a security check
• what to do if a person doesn’t have the correct roles or authorities.

Recent updates

14 October 2024

Guidance updated to help NDIA staff and partners check that the person they’re wanting to contact has an active relationship with a participant.

Before you start

You have:

• received a request from a person asking you to share the participant’s, applicant’s or person with disability’s personal information
• checked if the person has authority to access the personal information using article Check consent, nominee, child representative or self-representation authorities
• read and understood the NDIA privacy policy (external) and Australian Privacy Act 1988 (external).

How to complete a security check

To comply with Australian privacy laws, you must take all reasonable steps to make sure the caller can prove their identity.

This is done by asking the caller to give 3 pieces of personal or unique information about themselves over the phone. Unique means only a limited number of people would be able to provide that information.

We can then match this with the information we have recorded. This is called a security check.

You must perform a security check on every caller before disclosing any information.

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Knowledge Article

For Internal Use Only

What to do if a person doesn’t have the correct roles or authorities

If the participant or plan nominee hasn’t given authority to contact a person, the enquiry can’t continue.

To check if the person has an active relationship with the participant, go to section Check that the relationship is active in article Add or cancel a relationship.

The NDIA is bound by the Privacy Act 1988 and the National Disability Insurance Scheme Act 2013.

Under these Acts, we aren’t authorised to discuss whether the person is or isn’t known to the NDIA or disclose any personal information without consent.

You must record the interaction and confirm that the person doesn’t have authority by completing the following PACE steps:

1. Select Authorised Representatives or Supporters from the Who is enquiring? drop down.
2. Select No at Does this person have the authority or consent to discuss information about the participant?
3. Advise the person that you can’t discuss participant matters with them. To progress the enquiry, the participant will need to give them authority. To understand the different authorities go to article Check consent, nominee, child representative or self-representation authorities.

Article labels

PACE user role names

Delete: dc_users_localareacoordinator, dc_users_earlychildhoodpartner

Topics

Add: t_privacyandinformation

Case names

No change.

V3.0 2024-09-26 Consider a request for personal information 229724050 Page 2 of 3

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Knowledge Article

For Internal Use Only

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V3.0 2024-09-26 Consider a request for personal information 229724050

This document is uncontrolled when printed

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FOI 24/25-1473 DOCUMENT 35

Consider priority eligibility decision

SGP KP Publishing

Exported on 2025-04-02 05:42:18

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SGP KP Publishing – Consider priority eligibility decision

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Before you start …………………………………………………………………………………………………….. 5 3 Check priority eligibility request ……………………………………………………………………………. 6 3.1 Omni-channel ……………………………………………………………………………………………………… 6 3.2 Check prioritisation details …………………………………………………………………………………….. 6 3.3 Check disability ……………………………………………………………………………………………………. 6 3.4 Check priority evidence ………………………………………………………………………………………… 6 4 Action priority eligibility decision ……………………………………………………………………… 7 4.1 Consider priority eligibility decision ……………………………………………………………………… 7 4.2 Make priority eligibility decision ……………………………………………………………………………… 7 5 Next steps …………………………………………………………………………………………………………….. 9

Table of Contents – 2

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This article provides guidance for an access delegate and quality officer to:

• check priority eligibility request
• action the priority eligibility decision.

Recent updates – 3

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1 Recent updates

3 October 2024

Update to linked article titles. This reflects articles which have had a name update for legislation changes.

Recent updates – 4

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2 Before you start

You have:

• read and understood Our Guideline – Applying to the NDIS (external), including section When do we make priority eligibility decisions? (external)
• received a priority eligibility decision request
• read article Check decision – Legislative timeframes
• been following guidance in article Make an access decision – pre-legislation changes or Make an access decision – post legislation changes.

Note: to request a priority eligibility decision, refer to article Request priority eligibility decision.

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3 Check priority eligibility request

3.1 Omni-channel

1. At Home page, select Omni-channel. Screen tip: find the omni-channel in the bottom-left of the screen.
2. A Status message will display. Above this message select from the drop-down menu and set status to Available.
3. Select the tick box to action the case.
4. The Access Decision case will open.
5. Set Omni-channel status to Offline.

3.2 Check prioritisation details

1. Select the open Access Decision case, then select Details.
2. Scroll to Prioritisation section.
3. Review the Prioritisation Reason and Priority Description.
4. Review the information in Prioritisation Comment.

3.3 Check disability

In Person Account, select My Profile tab, select Disabilities tab.

If applicable, also refer to these articles:

• Check eligibility - EI - developmental delay
• Check eligibility - EI - hearing loss 0-25 years of age.

3.4 Check priority evidence

If applicable, also refer to these articles:

• Check eligibility - EI - developmental delay
• Check eligibility - EI - hearing loss 0-25 years of age.