DOCUMENT 1

Standard Operating Procedure

For Internal Use Only

The contents of this document are OFFICIAL.

Complete an Access or Revocation Internal Review Decision

The purpose of this document is to guide Internal Review Officers (IRO) through the process to complete internal review (s100) requests made for Access (s20 to s25) and Revocation (s30) decisions.

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

Recent updates

Checklist

• Not been involved in the making of the original decision that is being reviewed. The internal review must be completed by a different delegate.
• Role delegation to access and modify the NDIS Business System (system), Access Internal Review (AIR) Database, and to make Access and Revocation Decisions.
• Been allocated an Access or Revocation Internal Review to complete.
• An understanding of Standard Operating Procedures and Guidance Materials on the intranet which relate to Access, Reviews, Eligibility Reassessment and Revocations of Access
• An understanding of the NDIS Act 2013, Our Guidelines - Applying to the NDIS, and the NDIS (Becoming a Participant) Rules
• You are familiar with the Contact Attempt Process at Appendix A |

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Standard Operating Procedure

For Internal Use Only

Scope of Review

The intent of an internal review is to reconsider a decision by ‘standing in the shoes of the original decision maker’. This means reviewers will usually consider if the original decision was correct under the law. The information from the original decision will be reconsidered along with any additional information or evidence provided or requested for the internal review.

Procedure

4.1 Conduct a Desktop Review

An initial assessment of the internal review should be completed using the information available on the applicant’s record.

4.1.1 Review system record and available evidence

Review the applicant’s record and s100 form to understand all information relevant to the internal review request. This includes:

• The category of the s100 review requested (for example, an access not met decision, or access revocation).

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• Any previous access requests and access decisions, Eligibility Reassessment and revocation decisions, and/or s100 reviews.
• Evidence or supporting information provided to support the review request. This may include reports or documents which confirm the applicant’s impairment, functional capacity, or other information related to the access criteria under the NDIS Act 2013 and the NDIS (Becoming a Participant) Rules.
• Any relevant documents contained in the inbound documents section, particularly in a line item titled ‘s100 internal review request dd/mm/yyyy’ that was created at intake.
• Review and check all documents for integrity issues. While some documents may have been previously checked as part of previous access decisions, it is best practice to review all previous and new documentation. For more information, refer to the Internal Review Access and Revocation Practice Guide.
• Any other details that may impact on the review. For example, the applicant’s impairment, preferred communication method, current circumstances and any identified risk or previous escalations (for example self-harm risks, call back enquiries, open complaints).
• If it is indicated, the applicant has accessibility requirements refer to procedures from Standard Operating Procedure – Assist the participant with their preferred method of communication.
• Confirm appropriate risk level determined at Intake is correct. Refer to Intake of an Access or Revocation Internal Review Request Standard Operating Procedure.

Consider whether additional evidence is required

Generally, you are required to make the decision based on the evidence before you. Given the applicant has had an opportunity to provide additional evidence, the internal review officer should only request additional evidence if it is likely to materially change the decision. Where successful contact has been made with the applicant, the internal review can be paused while awaiting the information to be provided to the agency refer to section 4.2 Contact applicant for steps to request information for the internal review. This only applies where contact has been successful and further information is requested by IRO or the applicant wishes to provide additional evidence for the internal review.

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Note: The pause process including an alert will not be required for where the applicant is unable to be contacted (UTC) and a further information request letter combined with UTC has been provided.

Contact Applicant

After the desktop review is completed, you need to contact the applicant/authorised representative to discuss the internal review. For contact processes refer Appendix A – Contact Attempt Process.

Adding items to Inbound Document Line Item

All related documents to the internal review written or created by the Internal Review Officer are to be uploaded to the Business System under the one line item named “s100 internal review request dd/mm/yyyy” in inbound documents. You can also refer to the video IRT – Uploading s100 documents. All related documents that were considered for the review by the Internal Review Officer need to be linked to the open s100 activity prior to finalising the review. As outlined within 4.8 Submit a decision outcome step 2.

When uploading a document follow this naming convention style: Applicant surname, Applicant first name, NDIS number, Topic/Document Name/Document and Report Date. For example, Smith James 4312345678 Acknowledgement Letter 2021-April-29 or Smith James 4312345678 Occupational Therapist Report 2021-April-29.

Note: Continue to section 4.5 if you are not withdrawing the internal review request.

Withdrawal of Internal Review Request

A request to withdraw an internal review may come at any time throughout the internal review process. Commonly, requests to withdraw an internal review occur after the first contact with the applicant and are either received verbally or via email from the applicant. Where a withdrawal is requested, the following steps will need to be taken.

The applicant must be informed this means an internal review decision will not be made and they will not be able to request external review of this decision at the Administrative Appeals Tribunal (AAT). If the applicant will be over the age requirements for new access applications in the future, the IRO should also explain this impact on meeting access in the future. This communication should occur at the time the review withdrawal is requested by the applicant and be noted in the interactions of their record as per s100 – Request Withdrawn in Internal Review of an Access or Revocation Request Interaction Templates.

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Standard Operating Procedure

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Internal review requests will need to be closed as ‘withdrawn’ in both the system and the AIR Database. Further guidance can be found via the Standard Operating Procedure – Record a request for internal review and AIR Database Manual. The Internal Review Request Withdrawal Letter is completed and sent to the applicant via their preferred communication method.

Upload this letter to the system in Inbound Documents in the appropriate Internal Review line item, and note the date in interactions and the AIR Database. Refer to section 4.3 for guidance on how to add the document to Inbound Documents.

Additional evidence received

If the applicant has requested to provide evidence or evidence was requested by the IRO, the internal review decision must not proceed until this information has been provided, the agreed provision of evidence timeframe has lapsed, or the unable to contact timeframe has lapsed. If the applicant requests an extension of time to submit evidence, refer to further guidance in the Internal Review Access and Revocation Practice Guide.

1. Review the National Access and Reassessment Branch email inbox and internal access reviews email inboxes for any new documents received since allocation - these will need to be uploaded to the relevant inbound document line concerning this request if not already uploaded by BSOs.
2. If consent was received to contact the applicant’s health professionals for further information, contact the health professionals by phone or email. If they are unable to be contacted, send the Internal Review Request for Information Letter to the applicant. Make sure consent and authorisation is recorded in the system. Refer to the Standard Operating Procedure – Check third party consent or authority.
3. Any new evidence or information should be uploaded to the applicant’s record on the system in inbound documents into the line named “s100 internal review request dd/mm/yyyy”. New documents must be checked for integrity issues (refer to Review system record and available evidence). Document receipt should also be recorded via interactions in the system and the AIR Database. When uploading a document follow this naming convention style: Applicant surname, Applicant first name, NDIS number, Topic/Document Name/Document or Report Date (yyyy-mm-dd).
4. If new evidence is provided prior to the agreed timeframe lapsing, the IRO will need to obtain consent from the applicant to proceed with the internal review. This consent should be recorded within the business system interactions. The Alert end date should be updated as per point 5 below. If consent is not provided by the applicant, the IRO will need to wait until the agreed timeframe has lapsed.

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Standard Operating Procedure

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5. End the request for information alert that has been added to the record and update AIR Database with date the evidence was received. To end an alert refer to the Create an alert Standard Operating Procedure. Note: The alert end due date for return of evidence and the AIR Database should be ended, amended or extended to reflect agreed return of information timeframe. Refer to section 8 .1 .3.
6. Once the evidence is available (including evidence received from the applicant/health professionals) you can progress to making a decision.

Make a decision

1. Assess all available information and evidence to build a view on the applicant’s age, residency, functional capacity, impairment and permanence. If there is conflicting information, consider which one is the most credible. Refer to the Our Guidelines - Applying to the NDIS for guidance.
2. Compare your view and the available evidence against the criteria required for a applicant to meet Access criteria as outlined in NDIS Act 2013 and Our Guidelines - Applying to the NDIS.

• S22 - Age requirements
• S23 – Residence requirements
• S24 – Disability Requirements
• S25 – Early Intervention requirements including consideration for children under 6 years of age for Developmental Delay.

Note: Refer to the Our Guidelines - Applying to the NDIS and the Internal Review Access and Revocation Practice Guide for guidance. Seek advice from your Line Manager if required. Seek specialist input from the Technical Advice and Practice Improvement Branch (TAPIB) if required.

• Refer to the Technical Advisory Branch confluence page for mandatory requests and instructions on requesting advice or the escalation process for advice.

For mandatory requests complete the TAB Advice Request form.

• At Summary line enter: IRT s100 for example:

  • IRT s100 45 days – AT Power wheelchair or Multiple requests Note: use the wording Multiple Requests if more than one TAB advice is necessary, you do not need to raise separate tickets for each request for the same review)

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Standard Operating Procedure

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• At Description field copy and paste the below template and complete the details relevant to the internal review and advice requested:
  • a) Date review was requested by the applicant:
  • b) What evidence do you wish to be considered:
  • c) Where is the evidence located on CRM:
  • d) What advice is being sought:
  • e) What is your opinion based on the evidence provided:

Complete the required sections including:

• Applicant Name: <Applicant’s first and last name>
• CRM Number:
• Date of birth: <dd/mm/yyyy>
• Disability type: use this field to indicate the applicant’s primary disability type. Select or search for an item
• Theme: Use this drop down to indicate the theme of your request
• Sub-theme: This drop down will populate based on the theme selected above. Select the sub-theme that most closely relates to your request.

Note: Include secondary disability under other option if required

• Mandatory Referral: <Yes/No>
• Requestor Team: Select Internal Review Team (IRT)
• State: Select the state where your team is located
• Employee Organisation: Not required for NDIA staff
• Secondary contact name: Enter your Assistant Director’s name
• Secondary Contact Number: Enter your Assistant Director’s contact number
• TAB Identifier: Leave blank
• NARB: Leave blank
• PRR Date: Enter the date the internal review was requested by the applicant

When all sections are completed, select Create to submit the form. Note: Once you have created the request you will be sent a TAB identification number for reference. This number can be used for potential IRT prioritisation requests. Await this advice before proceeding with making a decision.

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Standard Operating Procedure

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The relevant criteria should be followed when an access met decision is being considered for an applicant with a Chronic Health Condition. Refer to the Mandatory and Non-Mandatory Advice Requests page for guidance.

Before making a decision, it is mandatory to obtain and follow TAPIB advice in relation to requests for the listed mandatory items. If you disagree with the advice received from TAPIB, discuss first with your Line Manager and then contact TAB enquiries who will contact the TAPIB Advisor or TAPIB Assistant Director for further discussion and resolution.

Note: EL2 approval is required for the escalation of IRT requests and must be based on current criteria and process for requesting prioritisation of advice. Refer to the Technical Advisory Branch confluence page for the escalation process for advice.

3. Using the available evidence, determine whether the original Access not met decision or Revocation decision should be confirmed (applicant is not granted access) or set aside (applicant granted access).

Prepare the internal review decision letter and report

Based on the decision outcome, complete the relevant letter found on the Internal Review Team intranet page. Follow the instructions on the respective letter template to complete the decision letter.

• The date of the decision letter should be the same date the s100 review decision outcome was in effect (date you made the decision on the system).

Further guidance on the templates can be found in the Internal Review Access and Revocation Practice Guide.

Submit a decision outcome

A decision will need to be recorded in the open s100 on the system as per Standard Operating Procedure – Record a request for internal review. Complete a decision interaction according to Internal Review of an Access or Revocation Request Interaction Templates.

1. Open the s100 form for this review under Internal Use: Open Activities and select Edit.

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Image caption: Screenshot of s100 update screen.

2. Update the Supporting Information section stating all evidence/information supporting the decision has been uploaded to the system, and select Save to confirm your updates. Make sure the relevant inbound documents line created for this review has been linked to the s100 activity correctly. Refer to SOP the Standard Operating Procedure – Record of a request for internal review to ensure the documents related to the s100 outcome decision are linked to this section correctly.

3. Record the outcome decision by selecting Ready to Submit Outcome. Select the appropriate decision outcome as Confirm Decision or Set aside Decision.

Image caption: Screenshot of s100 screen.

4. Record the reason for the decision outcome in the Outcome Justification box. Copy and paste information from the interaction outcome as completed in step 4.8 and submit the s100 outcome. The decision is now submitted and one of the following will occur depending on the decision outcome:

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• Set aside decision: If a set aside decision was submitted, the system will redirect you to the pathway tab. You will need to make sure you assess and complete the Streaming and Severity Indicator where appropriate. Refer to the Standard Operating Procedure – Update participant streaming and Standard Operating Procedure – Complete the update Severity Tools Task for guidance. In the interactions, you will then need to note you have considered the streaming – if any changes have been made to the automatic streaming generated, note the reasons in the interaction. The IRO should also confirm the primary/secondary disability in the system, and note in interactions whether this has been changed/has had no change. Refer to the Standard Operating Procedure – Add or Change Disability for guidance.
• Confirmed decisions: If a confirmed decision was submitted, the s100 form will be closed and the pathway tab will not need to be completed.

Communicate the outcome of the decision (if required)

Note: Section 4.9 and section 4.10 Send decision letter can be swapped if IRO determines that based on the initial contact and information reviewed that the written notification is best to be provided prior to making phone contact. The applicant will need to be informed of the outcome of the internal review. Including information about how and why the decision was made, where to seek further assistance if required and their subsequent rights.

If phone contact is preference:

• make one phone call contact.
• One contact consists of a pre call SMS, a phone call and a voicemail if appropriate. The pre-call SMS must be sent at least one hour prior to making phone call contact. Refer to section 8.1.4 for the SMS Process.
• If contact is unsuccessful and if the internal review is a priority or escalation, further outcome contact attempts could be required.

1. Identify who is authorised to discuss this review, as per the applicant’s record on the system.
2. Review accessibility requirements and preferred communication method and refer to the Standard Operating Procedure – Preferred Method Communication.

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1. Begin the contact by stating your name, advising you are from the NDIA, and verifying the identity of the person you are using using the Standard Operating Procedure Complete a security check.
2. Communicate the outcome of the decision. By explaining what evidence was reviewed, the reasons for the decision, and advise a written notice of the decision will be issued by <mail/email>. Depending on the decision made, there is additional information which needs to be communicated.

• Set aside Decisions: The next steps will be a Planner will be in contact to help build a new plan.

• Confirmed Decisions: The applicant will also need to be informed of their Administration Appeals Tribunal (AAT) rights as AAT applications need to be lodged within 28 days of the internal review decision. A disability advocate may also be able to help them with lodging an external review. Refer them to the AAT website or provide the AAT phone number if required (1800 228 33). Where applicable, advise of mainstream services which may be able to assist them such as a General Practitioner care plan or early aged care assessment; notify the applicant, their Local Area Coordinator office or EC Partner will be able to assist them.

5. Record the communication and record that the pre contact or post SMS notification was sent, as per the appropriate Interaction Templates from the Internal Review of an Access or Revocation Request Interaction Templates.

Note: If email preference, communicate the decision with the above points by sending an email to the confirmed address with the decision letter and report attached. Example templates can be found in the Internal Review of an Access Request Email Templates. Once email has been sent, send an SMS notification to the applicant using the SMS process to advise to check their email inbox. If the email bounces back due to an error, confirm the email address is correct and resend if required and explore alternative contact methods. Make a note of this in your interaction.

Send decision letter

NDIA must give written notice to the applicant of the internal review decision. Important: If the letter is sent prior to phone call contact, remove reference to a conversation in the letter.

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1. If there are accessibility requirements required for printing the written notice, follow the process in the Printing plans in braille and other accessible formats guidance. Please note the financial delegate mentioned will be the EL1 of your respective team.
2. If there are language requirements for printing the decision letter, follow the process in the Practice Guide – Assisting Communication.
3. Once the above has been considered, check the applicant’s address and the addressee of the letter is correct before mailing the document in the one envelope. Check with your local site or Line Manager about mailing arrangements.
4. If the letter is required to be emailed, send them as PDFs from the Internal Access Reviews outlook inbox.
5. Upload the decision letter and outbound email if sent, onto the system in Inbound documents, in the “s100 internal review request dd/mm/yyyy” line item already created. This should be uploaded in PDF format. The following steps apply to set aside Access or Revocation internal review decisions only. If the original decision was confirmed, continue to section 4.12.

Priority Planning and Update Workflow Identifier (if applicable)

Refer to Appendix B – Prioritisation Schedule for further guidance. Note that during intake, an IRO/BSO may have identified what the priority is. Add Workflow Criteria for the Priority (High):

1. In the NDIS Account screen: Select Details.
2. Select > next to Workflow Identifier.

Image caption: Screenshot of Details screen. 3. Select Edit.

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1. Select +
2. In Workflow Identifier: Select High for priority planning.
3. In Valid From: Enter today’s date.
4. In Valid To: Leave as 31.12.9999.

Image caption: Screenshot of opened Workflow Identifier field. 5. Select Submit.

Note: Consider if other workflow identifiers are applicable to ensure the case flows through to the correct planning area. For example Hearing Stream for participants between 0-25 years of age with hearing impairment as primary disability.

Complete remaining closure tasks

1. Make sure the s100 is closed on the AIR database, and all required fields and Original Decision Maker (ODM) feedback are completed. Refer to Access Internal Review Database manual.
2. Confirm all relevant interactions have been entered as completed.
3. End the internal review alert and use the date you submitted the decision on the system. Refer to Standard Operating Procedure – Create an alert for how to edit an alert.

Related procedures or resources

• NDIS Act 2013
• NDIS Rules
• Our Guidelines - Applying to the NDIS
• Internal Review Access and Revocation Practice Guide

Feedback

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Standard Operating Procedure

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If you have any feedback about this Standard Operating Procedure, please complete the Internal Review Team Quality and Continuous Improvement Form and email it to the Business Improvement Team. In your email, remember to include the title of the product you are referring to and describe your suggestion or issue concisely.

Version control

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Appendices

Appendix A — Contact process

We consider the applicant’s communication preference. We attempt to include the applicant as part of the decision-making process and where unavailable we proceed with the information at hand. For phone contact, further consideration prior to contact attempt should be made based on

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on time zone for residency, gazetted public holidays and other relevant information such as school drop off and pick up times.

Preparing to Contact the Applicant

Prior to the initial contact the Internal Review Officer (IRO) should:

1. Identify who is authorised to discuss this review, as per the applicant’s record on the system.
2. Review accessibility requirements and preferred communication method and refer to the Standard Operating Procedure – Preferred Method Communication.

• Refer to section 8.1.2.1 for Phone contact
• Refer to section 8.1.2.2 for Email contact
• Refer to section 8.1.2.3 for Mail contact

An initial contact attempt is required for all internal review requests

Phone contact

1. Make one phone contact attempt to contact the applicant. This attempt consists of a pre-call SMS advising that an Internal Review Officer (IRO) will make contact from a private number. This must occur at least one hour prior to making the first phone call attempt. Refer to the SMS Process for instructions. If contact is successful refer to step 7.
2. If contact is unsuccessful, leave a voicemail where appropriate. These three items are considered as one contact attempt (pre-call SMS, phone attempt and voicemail).
3. Record all contact attempts and the pre-call SMS using the Unable to Contact interaction template the Internal Review of an Access or Revocation Request Interaction Templates. The contact attempt process for obtaining consent at intake remains at five contact attempts over two days if risk is determined high or extreme.
4. If phone contact is unsuccessful, the IRO will send the Unable to Contact email advising contact was attempted but unsuccessful and the Agency will wait 7 days from the date the contact was attempted to receive contact and/or further evidence. All emails must be sent from the Internal Access Reviews outlook inbox.
5. Update the AIR Database with UTC letter and due date within the call log tab.
6. If on day 8 the IRO has not received any correspondence or a response to the email sent, they must attempt a final phone call. This includes sending another pre-call SMS at least one hour prior.

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7. If phone call contact is unsuccessful it is time to proceed with the review based on the information available.
8. If phone contact is successful:

• Begin by stating your name, advising you are from the NDIA and verifying the identity of the person you are calling using the Standard Operating Procedure Complete a security check.
• Once identity verification is complete, confirm if it is a suitable time for the phone call. If not arrange a new time.
• Acknowledge the internal review of access not met or revocation of access.
• Advice of the documents received which will be considered in the internal review. This will confirm with the applicant that all evidence submitted has been received.
• If additional evidence is requested by the IRO or the applicant advises they have additional evidence, confirm a time frame to return the information – usually up to 28 days. Other timeframes can be agreed based on the individual circumstances of the internal review. Advise the applicant to return the evidence by emailing the documents to Internal Access Reviews Inbox and inform the applicant to note their full name and NDIS number in the email subject. Some applicants may prefer to send the information by mail, GPO Box 700, Canberra ACT 2601. Send the Internal Review Request for Information Letter to the applicant and upload this document onto the system.
• Manage the applicant’s expectations and advise them if further evidence is provided there is no guarantee the access criteria will be met.
• Inform the applicant they will receive a letter about the outcome of the review
• Refer to section 8.1.3 for recording this on the system.
• If the applicant does not wish to provide further information, advise them the review will progress based on the available information
• Confirm their preferred method of contact for the outcome notification. If the preferred method of contact is different from what is on the System, make a note of this in the s100 – Contact interaction.

9. Record this update on the system. It is time to proceed with the review based on the information available.

Email contact

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1. Send the introduction email to the applicant’s listed email address and request a reply within 7 days.
2. All emails must be sent from the Internal Access Reviews outlook inbox. Refer to the Introduction Email Template.
3. Follow-up the email by sending an SMS to the applicant. Refer to the SMS Process.
4. If on day 8 there has been no response it is time to proceed with the review based on the information available.

Mail contact

1. If the applicant’s preferred method of contact is listed as Letter on the system, the IRO must confirm that the Acknowledgement letter was sent via mail. If this cannot be verified, the IRO must arrange for the acknowledgment letter to be posted to the applicant’s listed address. Important: Check the Details screen to ensure the correct postal address is used. You can refer to the Update Participant details Standard Operating Procedure.
2. If the Acknowledgement letter was sent, the IRO can then send the Internal Review Request for Information Letter. The IRO must remove the “When <I/we> contacted <you/name…” section and must also change the timeframe to 14 days under the Next Steps section.
3. Follow-up the letter by sending an SMS to the participant. Refer to the SMS Process.
4. If on day 15 there has been no response it is time to proceed with the review based on the information available.

Note: Explore alternative contact methods when contact has not been successful, for example phone disconnection or email rejection (especially where risks are identified). Alternatively, key authorised contacts should be in the system associated with the applicant be contacted to help identify any other avenues to contact the applicant. No discussions regarding the purpose of the call should be had with third parties. Determine the best method of contact based on the available information.

8.1.3 System process for recording Request for Information (RFI)

Create an Alert on the applicant’s record as per below with an end date calculated at the agreed end date from the day of request for information:

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Image caption: Screenshot showing a system alert on the applicant’s record.

Note: The alert end due date for return of evidence and the AIR Database should be ended, amended or extended to reflect agreed return of information timeframe.

8.1.4 SMS Process

Note: Ensure the pre call SMS is sent at least 1 hour prior to making contact attempt.

Note: Further consideration prior to contact attempt should be made based on time zone for residency, gazetted public holidays and other relevant information such as school drop off and pick up times.

From Whispir:

1. From the Template Selection dropdown, select the relevant template:

   • Contact attempt SMS Template for sending an SMS prior to making a phone call contact.
   • Unsuccessful Contact attempt for sending an SMS after a phone call attempt where the participant or applicant was unable to be contacted.
   • SMS Email Sent for sending an SMS to notify the participant or applicant to check their email inbox as an email has been sent.

2. In the Mobile Number field, enter the number you are sending the SMS to.

3. Select Send SMS. The SMS will be sent immediately.

Unable to contact email template

Refer to Internal Review of an Access or Revocation Request Email Templates.

Introduction Email Template

Refer to Internal Review of an Access or Revocation Request Email Templates.

Appendix B – Prioritisation Schedule

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Our prioritisation schedule is available in Our Guidelines [When do we make priority eligibility decisions? | NDIS].

Important: In addition to the above schedule, Revocation internal reviews are priorities.

If an IRO has been allocated a priority decision, or has identified a priority decision, the IRO must contact the Applicant or their Authorised Representative within 48 hours of the review request. The IRO has up to 5 business days (from the date of the request) to either complete the review or have an Unable to Contact or Further Information Request actioned.

If you are unsure if the prioritisation schedule is met, or require assistance progressing a priority decision, please speak with your Line Manager.

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Applying to the NDIS

Quick summary: If you want to become an NDIS participant and get supports through an NDIS plan, you’ll need to apply to the NDIS. There are some requirements you need to meet to be eligible for the NDIS.

First, you need to be younger than 65 when you apply, be an Australian citizen or permanent resident, and live in Australia. Then, you’ll need to meet the disability or early intervention requirements.

You may be eligible under the disability requirements if you have one or more impairments that are likely to be permanent and this substantially impacts your ability to do daily life activities. Your impairment must also affect your social life, or your ability to work and study, and you must be likely to need support under the NDIS for your whole life.

Or you may be eligible under the early intervention requirements if you have one or more impairments that are likely to be permanent and supports would help you by reducing your need for supports in the future. We will also consider if these needs could best be met by the NDIS, or by other government and community services.

If you think you might be eligible, we can help you apply to the NDIS. We will talk to you about your needs, current situation and what is important to you. We’ll look at all the information you give us to decide if you’re eligible. If you’re eligible for the NDIS, you’ll become a participant and we’ll work with you to start creating your plan. If you’re not eligible, an early childhood partner or local area coordinator can help you explore and access mainstream and community supports in your community. When we work with children under 9 and their families, we call this early connections. When we work with people aged 9–64, we call this community connections.

What’s on this page?

• What do we mean by applying to the NDIS?
• Do you meet the age requirements?
• Do you meet the residence requirements?
• Do you meet the disability requirements?
• Do you need early intervention?
• What about children younger than 6 with developmental delay?
• How do you apply to the NDIS?

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What do we mean by applying to the NDIS?

Applying to the NDIS means doing things to find out if you can become a participant and start getting supports under the NDIS. There is a process to follow when you apply to the NDIS. After you apply, we’ll look at all the information you provide and decide if you’re eligible.

If we decide you’re eligible, you’ll become a participant in the NDIS. We’ll then work with you to create your first plan, which will include funding for any reasonable and necessary supports.

If you’re not eligible, there are other services available to you, such as other government and community services. We can help you connect to these other services.

For children younger than 9, we encourage families to talk to an early childhood partner before applying to the NDIS. They can help families connect to the right supports and let families know if the NDIS is right for their child. Learn more about our early childhood approach and early connections.

Are you eligible for the NDIS?

To be eligible for the NDIS, you first need to meet the age requirements and residence requirements. This means you need to be younger than 65 when you apply, live in Australia, and be an Australian citizen or permanent resident.2

You also need to have a disability caused by an impairment.

When we say impairment in this guideline, we mean a loss or significant change in your body’s function, structure, or in how you think and learn. Under the law for the NDIS, we check if you’re eligible based on your impairments, not your type of disability or diagnosis.

You will need to meet either the disability requirements3 or the early intervention requirements.4

Disability requirements

To meet the disability requirements, we must have evidence of all of the following:

• You have a disability caused by an impairment.
• Your impairment is likely to be permanent.
• Your impairment means you have a substantially reduced functional capacity to do one or more daily life activities. These activities include moving around,

Early intervention requirements

To meet the early intervention requirements, we must have evidence of all of the following:

• You have an impairment that’s likely to be permanent, or that you are a child younger than 6 with developmental delay.
• Early intervention will help you by reducing your need for supports in the future.
• Early intervention will help you by either reducing the impact your impairment has on your functional capacity or support your informal supports to build their skills to help you.
• The early intervention you need is most appropriately funded by the NDIS.

If you’re receiving disability supports from the Western Australian government, you might already meet most of the eligibility criteria.

We’ll use information in your application to decide if you’re eligible for the NDIS.

If you’re eligible, you become an NDIS participant. The length of time you’ll be an NDIS participant will depend on your situation and disability support needs. For more information, check out our information on leaving the NDIS.

This guideline has detailed information on how we decide if you’re eligible for the NDIS. For general information about who’s eligible, read Am I eligible and Applying to the NDIS factsheet. Check out our website for information about children younger than 9.

We also have information on Mental health and the NDIS. If you have a psychosocial disability, this webpage has information on whether the NDIS is right for you, and what information we need if you apply.

A psychosocial disability isn’t a mental health condition or diagnosis. A psychosocial disability means you have reduced capacity to undertake tasks and activities of daily living due to your mental health.

Do you meet the age requirements?

To be eligible for the NDIS, you must first meet the age requirements. This means:

• You are younger than 65 on the day you apply.

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How old are you?

You must be younger than 65 on the day you make your NDIS application.

This means your application needs to be complete, in the format we ask for, and received by the NDIA before you turn 65. Learn more about how to complete your NDIS application.

If you’re turning 65 soon and want to apply, contact us so we can help you apply on time.

Do you meet the residence requirements?

Then you must meet the residence requirements. This means:

• You are an Australian citizen or permanent resident.
• You live in Australia.

Are you an Australian citizen or permanent resident?

You must be an Australian citizen,8 or have one of two visa types that means you can live here:

• A permanent visa9
• A protected special category visa10 – this is only for some citizens of New Zealand.

Do you live in Australia?

You must live in Australia.11 This means Australia is your home and you spend most of your time here.

To help us decide, you need to give us evidence to show us you live here. If you give us consent to use your Centrelink record, that usually gives us enough evidence to decide if you live in Australia.

If you don’t give us consent, you need to give us enough information to help us decide that you live in Australia. You’ll need to answer these questions:

• Where do you live?
• Where is your family?
• Do you work in Australia?
• Do you own property in Australia?
• How much time do you spend outside Australia?

Some of these questions might not apply to you, but we must consider them when we decide whether you live in Australia.12

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We may also ask you other questions to determine whether you live in Australia.

Where do you live?

We consider where you live, and your living situation. We’ll look at whether you have more permanent accommodation in Australia than any other country. For example, you might own a home or have a formal rental agreement in Australia. This is a good sign to us that you live in Australia.

Where is your family?

We also consider where your immediate family lives. We look at where you spend most of your time with them, face-to-face. We don’t consider how you connect with your family on the phone or internet.

Do you work in Australia?

If you work, we look at where you normally work or make money. If you work or make money in Australia, that’s a good sign you live here. If you don’t work or are unemployed, we’ll consider the other questions to determine whether you live in Australia.

Do you own property in Australia?

We consider what assets or property you own in Australia. We also see if you have an Australian bank account. If you own assets or property here, it doesn’t always mean you live in Australia. Your assets or property will need to show you have an ongoing connection to Australia. You don’t live in Australia just because you own assets or property here.

How much time do you spend outside Australia?

We consider how often you go overseas, and how long you’re outside Australia when you travel. We also consider why you travel overseas, such as for work, holiday or to live with family. This is usually the most important point to help us decide if you live in Australia. You need to show us that you have a long-term and meaningful connection to living in Australia. You don’t need to stay in Australia all the time. You can still work overseas or go on a holiday.

Do you meet the disability requirements?

You will need to show a stronger connection to Australia than other countries if you spend a lot of time overseas.

If we decide you’re eligible and create your plan, there may be times you can’t use your NDIS funding overseas. This is usually after you’re overseas for more than 6 weeks unless we give you more time. Learn more about when you can’t use your plan.

Do you meet the disability requirements?

You meet the disability requirements if we have evidence of all of the following:19

• Your disability is caused by an impairment.
• Your impairment is likely to be permanent.
• Your permanent impairment substantially reduces your functional capacity to undertake one or more of the following activities: moving around, communicating, socialising, learning, or undertaking self-care or self-management tasks.
• Your permanent impairment affects your ability to work, study or take part in social life.
• You’ll likely need support under the NDIS for your whole life.

If you give us evidence you have been diagnosed with one or more conditions on List A, we’ll likely decide you meet the disability requirements.

If you meet the disability requirements, it’s likely you’ll need the NDIS for a long time. This means you won’t have to prove your disability every time we reassess your plan.

If at any time your disability support needs or situation changes, we may need to check your supports or NDIS eligibility. We will talk with you if this happens.

Learn more about how we check if you are still eligible for the NDIS.

Is your disability caused by an impairment?

When we consider your disability, we think about whether any reduction or loss in your ability to do things, across all life domains, is because of an impairment.

An impairment is a loss or significant change in at least one of:

• Your body’s functions
• Your body structure
• How you think and learn.

To meet the disability requirements, we must have evidence your disability is caused by at least one of the impairments below:20

• intellectual – such as how you speak and listen, read and write, solve problems,
• cognitive – such as how you think, learn new things, use judgment to make decisions, and pay attention
• neurological – such as how your body functions
• sensory – such as how you see or hear
• physical – such as the ability to move parts of your body. You may also be eligible for the NDIS if you have a psychosocial disability.21 This means you have reduced capacity to do daily life activities and tasks due to your mental health. It doesn’t matter what caused your impairment, for example if you’ve had it from birth, or acquired it from an injury, accident or health condition. It also doesn’t matter if you have one impairment, or more than one impairment.

Is your impairment likely to be permanent?

We need evidence that you’ll likely have your impairment for your whole life. You might have some periods in your life where there is a smaller impact on your daily life, because your impairment may be episodic or fluctuate in intensity22. Your impairment can still be permanent due to the overall impact on your life, and the likelihood that you will be impacted across your lifetime. Even when your condition or diagnosis is permanent, we’ll check if your impairment is permanent too. For example, you may not be eligible if your impairment is temporary, still being treated, or if there are remaining treatment options. Generally, we’ll consider whether your impairment is likely to be permanent after all available and appropriate treatment options have been pursued. If you give us evidence you have been diagnosed with a condition on List B, we’ll likely decide your disability is from an impairment that’s likely to be permanent.

Is there any medical treatment for your impairment?

We don’t fund supports to treat your impairment. Instead, the supports we fund can help you reduce or overcome the impact your impairment has on your daily life. They can also help you increase your functional capacity, independence, and your ability to work, study or take part in social life. Your impairment will likely be permanent if your treating professional gives us evidence that indicates there are no further treatments that could relieve or cure it. 01 February 2024 Applying to the NDIS Page 7 of 52 This document is correct at the date of publication. Always visit ourguidelines.ndis.gov.au for the latest version. 27 of 72

Your treating professional will tell us or be asked to certify if there are medical, clinical or other treatments that are likely to remedy your impairment.

We need to understand whether there are treatments that are:23

• known and available
• appropriate for you and your impairment
• evidence-based – that is, there’s proof they are likely to be effective.

The word treatment should be understood in a broadest sense and may include changes to your diet and lifestyle. So, for example, conditions such as obesity are unlikely to be found to be permanent.

If you’re still undergoing or have recently had treatment, we’ll need to wait until you know the outcome of the treatment before we can decide your impairment is likely to be permanent.24

In some situations, it may be clear your impairment is likely to be permanent while you’re still undergoing treatment or rehabilitation. For example, you may still need treatment and rehabilitation for a spinal cord injury, but it’s clear you’ll have a permanent impairment.

You might still have a permanent impairment, even if its effects may change over time.25

For degenerative impairments, or those that get worse over time, we consider them permanent if treatment isn’t likely to help or improve the impairment’s effects.26

Does your impairment substantially reduce your functional capacity?

Your permanent impairment needs to substantially reduce your functional capacity or ability to undertake activities in one of the following areas:

• Communicating – how you speak, write, or use sign language and gestures, to express yourself compared to other people your age. We also look at how well you understand people, and how others understand you.
• Socialising – how you make and keep friends, or interact with the community, or how a young child plays with other children. We also look at your behaviour, and how you cope with feelings and emotions in social situations.
• Learning – how you learn, understand and remember new things, and practise and use new skills.
• Mobility, or moving around – how easily you move around your home and community, and how you get in and out of bed or a chair. We consider how you get out and about and use your arms or legs.
• Self-care – personal care, hygiene, grooming, eating and drinking, and health. We consider how you get dressed, shower or bathe, eat or go to the toilet.

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• Self-management (if older than 6) – how you organise your life. We consider how you plan, make decisions, and look after yourself. This might include day-to- day tasks at home, how you solve problems, or manage your money. We consider your mental or cognitive ability to manage your life, not your physical ability to do these tasks.

Your impairment substantially reduces your functional capacity if you usually need disability- specific supports to participate in or complete the above tasks.27

These disability-specific supports include:

• a high level of support from other people, such as physical assistance, guidance, supervision or prompting.28

• assistive technology, equipment or home modifications that are prescribed by your doctor, allied health professional or other medical professional.29

To help us decide if you’re eligible, we need to know your capacity and where you need more help. We get this information from your NDIS application.

If you have more than one permanent impairment we will consider them together, to see if they substantially reduce your functional capacity.

We consider how you’re involved in different areas of life like home, school, work and the community, and how you carry out tasks and actions. We also consider any other factors that may impact your day-to-day life.

Your needs might go up and down each day or each month. Progressive Multiple Sclerosis (MS) can be a good example of this. We consider your ability over time, taking into account your ups and downs.

How does a child’s impairment affect their daily life?

To help us decide if a child’s ability is substantially reduced, we compare their abilities with other children of the same age.

If a child’s ability is much less than most other children the same age, they may meet the disability requirements. For example, if they:

• need assistive technology, equipment or home modifications to participate in daily activities – except for common items like glasses

• usually need more assistance to join activities, or they can’t join in.

Sometimes when a child’s impairment doesn’t substantially reduce their ability right now, but might in the future, we will look at the early intervention requirements. Similarly, if a child’s impairment currently substantially reduces their ability, but may not after receiving supports, we will look at the early intervention requirements. Early intervention can be for children of

What if you have a hearing impairment?

Some hearing impairments may lead to a substantially reduced functional capacity.

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

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

• you also have another permanent impairment, such as a vision or cognitive impairment

• you give us evidence your speech detection and speech discrimination outcomes are significantly poorer than expected.

Does your impairment affect your social, work or study life?

Then, we look at how your impairments affect your ability to work, study or take part in social life.30 This means your permanent impairments affect how you can find and keep a job, contribute to your community, or join social activities. We get this information from your NDIS application.

We look at your ability to do things like:

• find and keep a job, or start your own business

• study

• spend and save money

• play sport

• go to the movies

• volunteer

• travel.

It doesn’t matter how much your ability to work, study or socialise is affected by your impairment. It only needs to affect your social or work life in some way for you to meet the criteria.

Will you likely need support under the NDIS for your whole life?

You must be likely to need support under the NDIS for your whole life.

NDIS supports are investments that help you build or maintain your functional capacity and independence, and help you work, study or take part in social life.

Even if your needs go up and down over time, or happen episodically32, we may still consider it’s likely you’ll need lifetime support under the NDIS.33

We consider your overall situation to answer this question.

When we decide if you’ll likely need support under the NDIS for your whole life, we consider:

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

For example, you may have an impairment which is caused by a chronic health condition. Many chronic health conditions are most effectively managed or remedied through medical management through the health system. If this is the case, we may decide that you don’t have a lifetime need for support under the NDIS.

Do you need early intervention?

If you don’t meet the disability requirements, you may be eligible for the NDIS under the early intervention requirements. Early intervention is usually early access to support, to help reduce the functional impacts of your impairment.

Early intervention can be for both children and adults. You won’t need these supports for your lifetime, so your treating professional or your early childhood partner will tell us how early intervention support could benefit you or your child.

You will meet the early intervention requirements if you meet all of the following:

• You have an impairment that’s likely to be permanent.
• Early intervention supports will help you, for example if it means you’ll need less disability support in the future and your functional capacity will improve.
• The early intervention you need is most appropriately funded by us.

There are different requirements for children younger than 6 with developmental delay to meet the early intervention requirements.

If we have evidence a child younger than 7 has been diagnosed with a condition on List D, we’ll decide they meet the early intervention requirements.

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Do you have an impairment that’s likely to be permanent?

To meet the early intervention requirements, there must be enough evidence that you have at least one of the impairments below and your impairment is likely to be permanent.

An impairment is a loss or significant change in at least one of:

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

An impairment could be:

• intellectual – such as how you speak and listen, read and write, solve problems, and process and remember information
• cognitive – such as how you think, learn new things, use judgment to make decisions, and pay attention
• neurological – such as how your body functions
• sensory – such as how you see or hear
• physical – such as the ability to move parts of your body.

We also need evidence at least one of your impairments will be permanent, or likely to be permanent. In other words, you’ll likely have your impairment for your whole life.

When we decide if your impairment is likely to be permanent, we consider the same things as in the disability requirements.

You may also be eligible for the NDIS if you have a psychosocial disability. This means you have reduced capacity to do daily life activities and tasks due to your mental health. Your psychosocial disability might vary at different times in how much it impacts your daily life.

How will early intervention help you?

We need to decide that getting early intervention supports means you’ll likely need fewer disability supports in the future.

We need to know that early intervention supports will help you with at least one of the following:

• addressing the impact of your impairment on your ability to move around, communicate, socialise, learn, look after yourself and organise your life
• preventing your functional capacity from getting worse
• improving your functional capacity
• supporting your informal supports, which includes building their skills to help you.

To help us decide if the early intervention will help you in these ways, we look at:

• how your impairment might change over time
• how long you’ve had your impairment
• if there’s been a significant change to your impairment
• if your needs are likely to change soon, such as if you’re finishing school.

Is your early intervention most appropriately funded by the NDIS?

The support you need must be most appropriately funded or provided by us. You won’t be eligible if we decide the support you need is more appropriately funded or provided:

• by other general systems of service delivery or support services, such as a workers compensation scheme
• under a universal service obligation that other government services must provide to all Australians, such as schools and public hospitals
• as a reasonable adjustment under discrimination law, such as making places or venues accessible for you. For example, you usually won’t be eligible if you only need the following supports. These are more appropriately provided by other government and community services:

Applying to the NDIS

• medical services,⁴² and treatments for health conditions, including ongoing or chronic health conditions⁴³
• clinical early intervention mental health supports, such as services to help children, teenagers and young people grow and develop⁴⁴
• clinical acute and crisis mental health supports⁴⁵ – such as care in a hospital or similar setting
• inclusion supports to help young children join early childhood learning and care settings⁴⁶
• Disability Employment Services,⁴⁷ and reasonable adjustments in the workplace to make your job suit your needs.⁴⁸

For more information on when early intervention supports are most appropriately funded by us or by other services, check out:

• Our mainstream and community supports guideline
• Schedule 1 of the NDIS (Supports for Participants) Rules
• Applied Principles and Tables of Support.

What about people aged between 0 and 25 with a hearing impairment?

If you’re aged between 0 and 25 with a hearing impairment, you may meet the early intervention requirements. We’ll decide you meet the early intervention requirements if you give us evidence of all of the following:

• You’re aged between 0 and 25.
• You have auditory neuropathy or hearing loss of at least 25 decibels in either ear at 2 or more adjacent frequencies – see below.

We need evidence of your auditory neuropathy or hearing loss from a specialist audiological assessment. The assessment might include electrophysiological testing when required. The evidence must show your hearing loss is likely to be permanent.

If you’re aged 26 or older with hearing loss, we’ll check if you’re eligible in the same way we consider all other impairments. You may be eligible under the disability requirements.

What about children younger than 6 with developmental delay?

Children younger than 6 with a developmental delay may be eligible for the NDIS under the early intervention requirements.⁴⁹

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Developmental delay

Developmental delay is a term used to describe a delay in a child’s development. It means that a child finds it much harder to do everyday things that other children their age can do, for example, dress themselves, talk or walk. A child with developmental delay needs lots of extra help to do everyday things compared to children of the same age.

First, we need to know the child:

• is younger than 6 on the day we decide whether they’re eligible50
• lives in Australia51
• is an Australian citizen or permanent resident.52

Then, we need to know the child has a developmental delay.53

Finally, we need to know the child’s supports are most appropriately funded or provided under the NDIS.54

An early childhood partner can also provide supports to children who aren’t eligible for the NDIS.

Learn more about the early childhood approach.

Does the child have a developmental delay?

When we decide if a child has developmental delay, we use the definition in the law for the NDIS.55

We need to know the delay:

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

Is the delay due to mental or physical impairments?

We first need to know the developmental delay is due to a mental or physical impairment, or a combination of mental or physical impairments.56

An impairment is a loss or significant change in at least one of:

• the child’s body’s functions
• the child’s body structure
• how the child thinks and learns.

Families, early childhood partners and other professionals can understand the child’s body function

• Observing their activities during play and daily tasks
• Comparing their activities to other children of the same age.

For some very young children, problems in body function can’t be easily measured. If so, the child may be eligible if there is significant risk of a future disability diagnosis or developmental delay. We need evidence of this from a health or allied health professional’s judgment or informed clinical opinion.

Does the delay substantially reduce the child’s functional capacity?

We need to know the delay substantially reduces the child’s functional capacity compared to other children their age.57

This means the child has a significantly lower ability to do everyday activities, when compared to children of the same age. Or the child does things in a significantly different way to other children their age because of their reduced capacity.

The child would also need much more support to do the activity, compared to other children the same age.

The substantial reduction in functional capacity must be in at least one of the following areas of major life activity:

• Self-care – how children take care of themselves, shower, bathe, dress, eat, drink, toilet, groom, and sleep.

• Receptive and expressive language – this involves skills such as gesture, sign language, listening, giving and receiving information, communicating wants and needs through facial expressions, vocalisations or speech, and interaction with others. A substantial reduction in functional capacity for either receptive language or expressive language will meet the criteria – it doesn’t need to be both.

• Cognitive development – learning and applying knowledge. This includes areas such as:

  • Understanding and remembering information
  • Attention
  • Learning new things
  • Practising and using new skills
  • Planning and making decisions

Applying to the NDIS

Motor development – this includes participation in everyday activities like moving around the home and community and manipulating objects.

We need evidence from a health, allied health or early childhood professional, who uses multiple sources of information about the child’s ability to do everyday activities.

This will include information that parents or carers report about their child. It will also include a mix of standardised assessments of developmental and functional capacity, both in everyday activities and natural settings.

It should also include observations in everyday play, learning, activities or routines to better understand how the child participates in these everyday activities.

For very young children where functional capacity can’t be measured, the child may be eligible if there is significant risk of a future disability diagnosis or developmental delay. We need evidence of this from a health or allied health professional’s informed clinical opinion.

Does the child need specialist services from more than one type of professional and for longer than 12 months?

We need to know that the child needs a mix of specialist care, treatment or other services, due to their developmental delay. The child must also need these services for an extended duration – that is, longer than 12 months.

We need to know the child needs all of the following:

• A service response that involves more than one professional working as a team to support the child. This means the child needs support for multiple activities, and across multiple natural settings such as the home, community and early childhood centres. The child must need more support than what’s expected for a child the same age.

• A team that works collaboratively, by communicating and sharing information, knowledge and skills. The support must be individually planned and coordinated. The team will build the

How do we work out if the child meets the criteria for developmental delay?

We’ll need a range of information about the child, observed in everyday activities and settings they usually participate in. This should include parent or carer reports and standardised assessments of developmental and/or functional capacity.

Early childhood partners are early childhood professionals who give us evidence of developmental delay to help us decide if the child is eligible. An early childhood partner will

Applying to the NDIS

What if there are no early childhood partners in your area?

If there are no early childhood partners in the child’s area, a mainstream, community, or health service can give us a report for evidence of developmental delay.

If you’re in one of these areas, learn more about what evidence we need for developmental delay.

Is the child’s early intervention most appropriately funded by the NDIS?

To meet the early intervention requirements, the support must be most appropriately funded or provided by us.59

A child won’t be eligible if the support they need is more appropriately funded or provided:

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

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

• medical services,60 and treatments for health conditions61
• inclusion supports to help young children join early childhood learning and care settings62
• school readiness programs to help children prepare for school63

What happens if a child with developmental delay is eligible?

If we decide a child with developmental delay is eligible for the NDIS, they’ll become a participant. But they’re usually no longer eligible after they turn 6.

This is because they will no longer meet the eligibility criteria under developmental delay. To remain an NDIS participant after they turn 6, the child will need to have an impairment that’s likely to be permanent, and meet either the disability requirements or the early intervention requirements.

We’ll talk to families or carers before a child turns 6 and explain what information we need to decide if the child is still eligible. Learn more about leaving the NDIS.

Example

Hunter is 5 years old and became a participant under the early intervention requirements for developmental delay.

We give him a new 12-month NDIS plan in August. We also talk to Hunter’s family about Hunter leaving the NDIS after he is 6 years old.

Hunter’s family will be able to use his NDIS funding for the full 12 months, until August the next year. By then, he’ll be aged 6 years.

At the end of the 12 months, we’ll talk to Hunter’s family about his progress. We’ll listen to understand if he built capacity to work towards his goals. If there’s evidence that Hunter does not need NDIS funded early intervention or disability supports, we’ll decide Hunter will leave the NDIS. We’ll help his family stay connected to government and community services.

Learn more about leaving the NDIS and mainstream and community supports.

What if a child doesn’t meet our criteria for developmental delay?

Early childhood partners can still provide supports to children younger than 6 who don’t meet our criteria for developmental delay.

How do you apply to the NDIS?

Applying to the NDIS is how you let us know you want to become an NDIS participant.

If you’re aged 9 and older, there are a few ways you can apply:65

• Your local area coordinator can help you apply. They can help you through the application process and be your point of contact. If you become an NDIS participant, they will support you to prepare for creating your NDIS plan. Find your nearest location.

• Sometimes you may not have a local area coordinator in your area. You can contact us on 1800 800 110 to discuss other options available to you.

For children younger than 9, we encourage families to talk to an early childhood partner before applying to the NDIS. They can provide supports to children before they apply, and let families know if the NDIS is right for their child.

When you apply, you or your authorised representative will need to:

• give us the information and any documents we need to confirm your identity. Learn more about evidence of identity and privacy.

• give us the information and any documents we need to decide if you’re eligible66

• sign or certify the NDIS application67

• talk to you about your needs and current situation.

When we talk to you, we’ll listen to understand what is important to you. We’ll also ask questions to make sure we know all the ways we can help.

We can use this information to help you make community connections if you want us to. Learn more about community connections.

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This document is correct at the date of publication.

Always visit ourguidelines.ndis.gov.au for the latest version.

What information do we need in your application?

The Evidence of Identity factsheet shows what information we need to verify your identity. When you apply for the NDIS, you’ll need to give us copies of these documents. If you can’t do this, let us know so we can work out what to do depending on your situation. We will still need to check your identity before progressing your application.

To show us you’re younger than 65 when you apply, live in Australia, and that you’re an Australian citizen or permanent resident, you can give us either of the following:

• consent to access and use your Centrelink record
• copies of documents or other evidence that we ask for if you apply in person or over the phone. In most cases, we can just use your identity documents.

Who can give us evidence of your impairments?

We need evidence of your impairments, to help us work out if you’re eligible. To provide this, ask your treating professional. For children younger than 6 with developmental delay, an early childhood partner can provide evidence of developmental delay. Your treating professional or early childhood partner can contact us if they need to discuss what evidence to provide.

Your treating professional might be your doctor, specialist, or allied health service provider. You should use a professional who:

• has worked with you for a long time, usually for at least 6 months
• is the most appropriate type of professional to give evidence about your impairment
• is qualified and registered in their area of practice with the Australian Health Practitioner Regulation Agency or relevant professional authority. If your treating professional does not meet these requirements, we may not be able to confirm the information in your access request and may need to request further information. When we check if you’re eligible for the NDIS, we mainly consider the information you give us when you apply. Learn more about who can give us evidence of your disability or impairment on the following pages: 01 February 2024 Applying to the NDIS Page 22 of 52 This document is correct at the date of publication. Always visit ourguidelines.ndis.gov.au for the latest version.

Applying to the NDIS

• Providing evidence of your disability
• Providing evidence of disability for children
• Information for GPs and health professionals. You can also learn more about how we use, collect and store your personal information.

What if you’re in a remote or very remote area?

We understand it might be hard to get your treating professional to provide evidence of your impairments in a remote or very remote area. If it’s hard to get your treating professional to do this, let us know. You might not need to give us as much evidence about your impairment as people in big cities, depending on what services are available in your area. We use a technical definition for remote and very remote. You will need to live in an area that’s classified as MM6 or MM7 on the Modified Monash Model to be considered remote or very remote.

How do we check your application?

Before we can accept your application, we make sure it’s been made by the right person. That is, the application is from you, or someone who can apply for you. We then check all the answers we need have been provided, and that it is the correct information.68 If you don’t have all the answers at the meeting, we’ll help you work out what to do. You can also let us know if there is a mistake. We can work with you to help complete the application properly. We can’t decide if you’re eligible until we have a complete application. We’ll also let you know if we need more information and, if so, what you need to give us. Once you have completed your application with all the right information, we’ll check whether you’re eligible. That is, we’ll check that:

• you meet the age and residence requirements
• you meet either the disability requirements or the early intervention requirements. Learn more in the Applying to the NDIS factsheet.

Who can help you apply?

You can ask someone to help you apply if you want to. They can help you:

• make your decision to apply to the NDIS
• gather the information we need. You can choose who helps you. For example, you could ask for help from: 01 February 2024 Applying to the NDIS Page 23 of 52 This document is correct at the date of publication. Always visit ourguidelines.ndis.gov.au for the latest version. 43 of 72

• a family member
• a friend
• a carer
• a partner
• a support worker or service provider
• staff in a residential aged care facility
• your treating health professional
• hospital staff. With your permission, we can share information with these people during your application. For example, they could call us to check how your application is progressing. You can let us know if you would like us to share information. Can someone else apply for you? If someone else has legal authority to make decisions for you, they can apply to the NDIS on your behalf. If you’re younger than 18, the people with parental responsibility for you will apply for you.69 This is often your parents or legal guardian. In some situations, we can decide someone else has parental responsibility.70 Learn more about child representatives. If you’re an adult, these people may be able to apply to the NDIS on your behalf:
• a person you give consent to act as your authorised representative – this means you give them permission to apply for you
• your guardian
• a person with power of attorney who can make personal and health decisions for you
• a person with advance care health directive. If you’re an adult and want someone else to apply for you, you can tell us in person, or over the phone. When do we contact you to help you apply? Sometimes, we’ll reach out to you to help you apply. This might be if you live in a:
• group home or supported accommodation
• large residential facility 01 February 2024 Applying to the NDIS Page 24 of 52 This document is correct at the date of publication. Always visit ourguidelines.ndis.gov.au for the latest version. 44 of 72

How do we decide if you’re eligible?

Once we have your application, we review all the information we have in your application.

This will help us decide if you’re eligible for the NDIS. As part of the process, we will also need to check your identity.

You are eligible for the NDIS if you meet:

• the age and residence requirements
• either the disability requirements or the early intervention requirements.

If you’re 7 or older, the first thing we decide is whether you meet the disability requirements. If you don’t, we will then decide whether you meet the early intervention requirements.

For children younger than 7, it’s the other way around. First, we’ll decide whether they meet the early intervention requirements. If they don’t, then we will decide whether they meet the disability requirements.

It’s likely children younger than 6 with developmental delay will not meet the disability requirements. So, they may only be eligible under the early intervention requirements.

If you don’t meet either the disability requirements or the early intervention requirements, you won’t be eligible for the NDIS. But an early childhood partner or local area coordinator can help you connect with other government and community supports.

When will we decide if you’re eligible?

Once we have your application, we have 21 days to decide one of the following:71

• you’re eligible for the NDIS
• you’re not eligible for the NDIS
• we need more information.

We can make a decision quicker in urgent circumstances. Let us know if your situation is urgent, for example, if you’re about to leave a hospital or custodial setting. Learn more about our timeframes for urgent decisions.

How do we consider your evidence of disability?

When we’re deciding if you’re eligible, we may look at things like:

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What if we need more information to decide if you’re eligible?

When we decide if you’re eligible, we look at:

• the information in your NDIS application
• any other information we have.

We need enough information in your application to show us you’re eligible for the NDIS by meeting the disability requirements or the early intervention requirements.

Sometimes we might need to ask you for more information. For example, we may not have enough information about your functional capacity.

We’ll ask you for more information if we need it to make sure we have the full picture.72

We might ask you for more information if:

• your application doesn’t have all the information we need
• we need to answer a particular question.

We only ask for more information if we need it to decide if you’re eligible.73 If we need more information, we’ll let you know:

• what you need to do
• what information we need
• when you need to give us the information.

If we ask for more information, you’ll have at least 90 days to give it to us. We can’t decide if you’re eligible until we have this. You can ask for more time if you need it. We can give you more time if we think it’s reasonable for your situation.74

If we can’t contact you within 90 days, or you don’t give us the information within the timeframe, we’ll withdraw your application. This means we’ll stop processing your application.

If you don’t get the information to us in time, you can apply again.

What happens after we get your information?

Once you give us the information we need, we then have 14 days to decide if:75

What happens if we don’t decide on time?

If we don’t meet our decision-making timeframes, we have to treat this as if we decided you’re not eligible.

If this happens, we’ll automatically review this decision that you’re not eligible. We’ll send you a letter to explain this. You don’t need to do anything.

We’ll then make sure your application is reviewed by a staff member who wasn’t involved in the original application. We’ll contact you to let you know the outcome.

Learn more about reviewing our decisions.

What happens after we decide?

What happens if you’re eligible?

On the day we decide you’re eligible for the NDIS, you become an NDIS participant.

The time that you remain eligible for the NDIS depends on your individual circumstances and disability support needs.

You’ll need to continue to be eligible for the NDIS. This means you’ll need to continue to live in Australia and be an Australian citizen or permanent resident. You’ll also need to continue to meet either the disability requirements or the early intervention requirements. Learn more about whether you will always be eligible and leaving the NDIS.

We’ll send you a letter to let you know:

• you are eligible
• if you met the disability requirements or the early intervention requirements
• the next steps.

Your letter will also confirm the date you became eligible for the NDIS.

How will we create your first plan?

After you receive the letter confirming you’re eligible, we’ll contact you to organise your first planning conversation. We’ll contact you within 21 days.

Applying to the NDIS

You will need to bring your original identity documents from the Evidence of Identity factsheet to your first planning meeting so we can confirm them. If you can’t provide these documents, let us know so we can work out what to do depending on your situation. We will still need to check your identity before approving your plan.

We’ll then work together to create a plan for your disability support needs. If you received help to make community connections, we can build on the information and goals we talked about and include these supports in your plan. Learn more about community connections.

Your plan will include any supports we fund that meet the NDIS funding criteria.

We fund supports for any impairments that meet the eligibility criteria.

For example, you may have many impairments, but only one meets our eligibility criteria. Or you might get another impairment after we decide you’re eligible. If so, we only fund supports for impairments that meet either the disability requirements, or the early intervention requirements.

If you’re aged 7 or older, we must approve your first plan within 56 days after you become a participant.

For children younger than 7, we’ll approve their first plan within 90 days after they become a participant.

For more information, check out creating your plan.

Will you always be eligible for the NDIS?

There are many reasons for leaving the NDIS.

Some people decide they don’t want to be a participant anymore.

You’ll also leave the NDIS if you’re no longer eligible.

When we reassess your plan, we check that all your details are correct and up to date. We also look at any new information we have received.

If you’re eligible under the early intervention requirements, your support needs are more likely to change. We’ll check at each plan reassessment whether you still meet the early intervention requirements.

For example, during a reassessment it may show you no longer meet the early intervention requirements because you have built your skills and capacity and will no longer benefit from early intervention supports.

If you’re eligible under the disability requirements, your disability is permanent. We don’t expect your disability to change, and it’s likely you’ll need the NDIS for a long time. We will only ask you for more information about your eligibility if there is evidence that you may no longer meet the disability requirements.

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Always visit ourguidelines.ndis.gov.au for the latest version.

What happens if you’re not eligible?

If you’re not eligible, you can’t become an NDIS participant.

We’ll try and contact you by phone, or your preferred contact method, 80 to explain why you’re not eligible. We will give you reasons for our decision, and also answer any questions you might have.

We’ll also send you a letter with our decision, including the reasons you’re not eligible and what to do next. Your letter will confirm the date we made the decision.

Even if you’re not eligible for the NDIS, your early childhood partner or local area coordinator can help you explore and access mainstream and community supports in your community. When we work with children under 9 and their families, we call this early connections. When we work with people aged 9–64, we call this community connections.

Your early childhood partner or local area coordinator will use the information you shared to suggest mainstream and community supports in your community. They will work with you to see how these supports may help you with what is important to you. We also have a list of other government and community supports you can get, even if you’re not eligible for the NDIS.

What if you don’t agree with our decision?

If you don’t agree with our decision that you’re not eligible, you should contact us. We can help explain our decision and what your options or next steps might be.

You can also ask for an internal review, 81 Another staff member, who wasn’t involved in the original decision, will then check if we made the right decision. You need to ask for an internal review within 3 months after receiving the decision. 82 Learn more about reviewing our decisions.

But you can’t ask for an internal review if:

• you withdraw your application because you don’t want to apply anymore
• a decision has not been made and we ask you for more information
• we withdraw your application because you didn’t give us information on time
• it’s been more than 3 months since you received our decision that you’re not eligible.

If you don’t agree with the internal review decision, you can ask the Administrative Appeals Tribunal to review it. We call this an external review. You can’t ask for an external review until after we make the internal review decision.

You can contact us to discuss any concerns you may have about the process. You can also make a complaint if you’re not happy with any part of the process.

Can you apply again?

Yes. If we decide you’re not eligible, you can apply again.83 You’ll follow the same process to apply as you did the first time. Remember, you need to be younger than 65 on the day you make your new application. And children with developmental delay will need to be younger than 6 on the day they apply.

But if you’ve asked for an internal review of the decision, you can’t apply to the NDIS again until we’ve completed that review.84 You can ask us to stop our internal review at any time.85

Also, if your review is with the Administrative Appeals Tribunal after an internal review, you can’t apply again until it has made a decision.86 You can also ask the Tribunal at any time to withdraw your application. Learn more on the Administrative Appeals Tribunal website.

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Applying to the NDIS – Appendices

What’s on this page?

• List A: Conditions that are likely to meet the disability requirements
• List B: Conditions that are likely to be permanent
• List C: What if you’re receiving disability support in Western Australia?
• List D: Conditions that are likely to meet the early intervention requirements for children younger than 7
• When do we make priority eligibility decisions?
• How do we weigh evidence of disability?

List A: Conditions that are likely to meet the disability requirements

1. Intellectual disability diagnosed and assessed as moderate, severe or profound in accordance with current DSM criteria.
2. Autism diagnosed by a specialist multi-disciplinary team, paediatrician, psychiatrist or clinical psychologist experienced in the assessment of Pervasive Developmental Disorders and assessed using the current Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic criteria as having severity of Level 2 (Requiring substantial support) or Level 3 (Requiring very substantial support).
3. Cerebral palsy diagnosed and assessed as severe (e.g. assessed as Level 3, 4 or 5 on the Gross Motor Function Classification System - GMFCS).
4. Genetic conditions that consistently result in permanent and severe intellectual and physical impairments:

• Angelman syndrome
• Coffin-Lowry syndrome in males
• Cornelia de Lange syndrome
• Cri du Chat syndrome
• Edwards syndrome (Trisomy 18 – full form)
• Epidermolysis Bullosa (severe forms):
  • YR

NDIS

• Autosomal recessive dystrophic epidermolysis bullosa
• Hallopeau-Siemens type
• Herlitz Junctional Epidermolysis Dystrophica

• Lesch-Nyhan syndrome

• Leigh syndrome

• Leukodystrophies:

  • Alexander disease (infantile and neonatal forms)
  • Canavan disease
  • Krabbe disease (globoid cell leukodystrophy) – Infantile form
  • Pelizaeus-Merzbacher Disease (Connatal form)

• Lysosomal storage disorders resulting in severe intellectual and physical impairments:

  • Gaucher disease Types 2 and 3
  • Niemann-Pick disease (Types A and C)
  • Pompe disease
  • Sandhoff disease (infantile form)
  • Schindler disease (Type 1)
  • Tay-Sachs disease (infantile form)

• Mucopolysaccharidoses – the following forms:

  • MPS 1-H (Hurler syndrome)
  • MPS III (San Fillipo syndrome)
  • Osteogenesis Imperfecta (severe forms):
    • Type II - with two or more fractures per year and significant deformities severely limiting ability to perform activities of daily living

• Patau syndrome

• Rett syndrome

• Spinal Muscular Atrophies of the following types:

  • Werdnig-Hoffmann disease (SMA Type 1- Infantile form)
  • Dubowitz disease (SMA Type II – Intermediate form)

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List B: Conditions that are likely to result in a permanent impairment

Conditions primarily resulting in intellectual or learning impairment

• Intellectual disability
• Pervasive developmental disorders not meeting severity criteria in List A or List C, such as autism
• Asperger syndrome
• Atypical autism
• Childhood autism.

Chromosomal abnormalities resulting in permanent impairment and not specified on List A

• Aicardi-Goutières syndrome
• CHARGE syndrome
• Cockayne syndrome Types I and Type II/Cerebro-oculo-faciao-skeletal (COFS) syndrome /Pena Shokeir syndrome Type II/Weber-Cockayne syndrome/Neill-Dingwall syndrome)
• Cohen syndrome
• Dandy-Walker syndrome
• DiGeorge syndrome /22q11.2 deletion syndrome/Velocardiofacial syndrome/ Shprintzen syndrome/Conotruncal anomaly face syndrome
• Down syndrome/Trisomy 21
• Fragile X syndrome
• Kabuki syndrome
• Menkes disease
• Prader-Willi syndrome
• Seckel syndrome /microcephalic primordial dwarfism/Harper’s syndrome/Virchow-Seckel dwarfism
• Smith-Lemli-Optiz syndrome
• Smith-Magenis syndrome
• Spinal muscular atrophy Types III and IV
• Sturge-Weber syndrome
• Trisomy 9
• Tuberous sclerosis
• Turner syndrome
• Williams syndrome
• Wolf-Hirschhorn syndrome.

Conditions primarily resulting in Neurological impairment

• Alzheimer’s dementia
• Creutzfeldt-Jakob disease
• HIV dementia 01 February 2024 Applying to the NDIS Page 34 of 52 This document is correct at the date of publication. Always visit ourguidelines.ndis.gov.au for the latest version.

• Huntington’s disease
• Multi-infarct dementia
• Parkinson’s disease
• Post-polio syndrome
• Vascular dementia.

Systemic atrophies primarily affecting the central nervous system

• Abetalipoproteinaemia
• Adult-onset spinal muscular atrophy/late-onset SMA type III)
• Fazio-Londe disease/Progressive bulbar palsy of childhood
• Friedrich’s ataxia
• Hereditary spastic paraplegia/ Infantile-onset ascending hereditary spastic paralysis/ L1 syndrome/ spastic paraplegias types 2 and 11Huntington’s disease/Huntington’s chorea
• Louis-Bar syndrome/Ataxia-telangiectasia
• Motor neuron disease/Motor neurone disease/ Lou Gehrig’s disease /Amyotrophic lateral sclerosis
• Primary lateral sclerosis
• Progressive bulbar palsy
• Spinal muscular atrophy – all types
• Spinocerebellar Ataxia – all types, including Machado-Joseph disease.

Extrapyramidal and movement disorders

• Hallervorden-Spatz syndrome /Pantothenate kinase-associated neurodegeneration (PKAN)/neurodegeneration with brain iron accumulation 1 (NBIA 1)
• Parkinson’s disease
• Shy-Drager syndrome /Multiple System Atrophy /Striatonigral degeneration (MSA-P)/ Sporadic olivopontocerebellar atrophy (MSA-C)
• Steele-Richardson-Olszewski syndrome/Progressive supranuclear ophthalmoplegia
• Stiff-man syndrome /Stiff-person syndrome.

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Other degenerative diseases of the nervous system

• Alzheimer’s disease
• Alpers disease/Grey-matter degeneration/Alpers syndrome/progressive sclerosing poliodystrophy/progressive infantile poliodystrophy
• Lewy body dementia
• Pick’s disease.

Demyelinating diseases of the central nervous system

• Adrenoleukodystrophy
• Multiple sclerosis
• Schilder’s disease /Diffuse myelinoclastic sclerosis – non-remitting.

Episodic and paroxysmal disorders

• Brain stem stroke syndrome
• Cerebellar stroke syndrome
• Motor and sensory lacunar syndromes
• Lennox syndrome /Lennox-Gastaut syndrome
• West’s syndrome.

Polyneuropathies and other disorders of the peripheral nervous system

• Adult Refsum disease
• Charcot-Marie-Tooth disease/Hereditary motor and sensory neuropathy/ peroneal muscular atrophy
• Dejerine-Sottas disease /Dejerine-Sottas syndrome/Dejerine-Sottas neuropathy/progressive hypertrophic interstitial polyneuropathy of childhood/onion bulb neuropathy
• Infantile Refsum disease.

Other disorders of the nervous system

• Hydrocephalus
• Multiple system atrophy.

Conditions resulting in Physical impairment

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• Congenital absence of limb or part thereof
• Epidermolysis bullosa
• Harlequin type icthyosis
• Juvenile arthritis / Stills Disease (excluding monocyclic/self-limited Adult Onset Stills disease)
• Rheumatoid arthritis.

Diseases of myoneural junction and muscle

• Andersen-Tawil syndrome/ Periodic paralysis /myoplegia paroxysmalis familiaris
• Becker muscular dystrophy
• Congenital muscular dystrophy
• Distal muscular dystrophy
• Duchenne muscular dystrophy
• Facioscapulohumeral muscular dystrophy
• Limb-girdle muscular dystrophy
• Mitochondrial myopathy
• Myotonic dystrophy /dystrophia myotonica
• Myotonic muscular dystrophy
• Myotubular myopathy
• Oculopharyngeal muscular dystrophy
• Paramyotonia Congenita
• Thomsens disease /Congenital myotonia/ Becker myotonia).

Cerebral palsy and other paralytic syndromes not meeting severity criteria on List A

• Cerebral palsy
• Diplegia
• Hemiplegia
• Monoplegia
• Paraplegia
• Quadriplegia

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• Tetraplegia.

Conditions resulting in Sensory and/or Speech impairment

Disorders of the choroid and retina where permanent blindness diagnostic and severity criteria on List A are not met

• Behr’s syndrome
• Kearns-Sayre syndrome
• Optic atrophy
• Retinitis pigmentosa
• Retinoschisis (degenerative and hereditary types/juvenile retinoschisis)
• Stargardt disease
• Usher syndrome.

Disorders resulting in hearing loss

• Cortical deafness
• Pendred syndrome
• Sensorineural hearing loss
• Stickler syndrome
• Usher syndrome
• Waardenburg syndrome.

Conditions resulting in multiple types of impairment

• Aceruloplasminemia
• Addison-Schilder disease /Adrenoleukodystrophy
• Albinism
• Arginosuccinic aciduria
• Aspartylglucosaminuria
• Cerebrotendinous xanthomatosis /cerebral cholesterosis
• Congenital cytomegalovirus infection
• Congenital iodine-deficiency syndrome /cretinism
• Congenital rubella syndrome

• Glycine encephalopathy /non-ketotic hyperglycinaemia
• GM1 gangliosidosis
• Hartnup disease
• Homocystinuria
• Lowe syndrome/ Oculocerebrorenal syndrome
• Mannosidosis
• Menkes disease
• Mucolipidosis II /I-cell disease
• Mucolipidosis III /pseudo-Hurler polydystrophy
• Mucolipidosis IV
• Neuronal ceroid lipofuscinosis (NCL)/ Adult type (Kuf’s or Parry’s disease)/ Juvenile (Batten disease)/ Late infantile (Jansky-Bielschowsky)
• Niemann-Pick disease
• Pyruvate carboxylase deficiency
• Pyruvate dehydrogenase deficiency
• Sialidosis
• Sulfite oxidase deficiency.

The following mucopolysaccharidoses

• Scheie syndrome /MPS 1-H
• Hurler-Scheie syndrome /MPS 1 H-S
• Hunter syndrome /MPS II
• Morquio syndrome /MPS IVA
• Maroteaux-Lamy syndrome /MPS VI
• Sly syndrome /MPS VII.

Congenital conditions – cases where malformations cannot be corrected by surgery or other treatment and result in permanent impairment but with variable severity

• Arnold-Chiari Types 2 and 3/Chiari malformation
• Microcephaly
• Fetal alcohol spectrum disorder

List C: What if you’re receiving disability support in Western Australia?

We have an agreement with the Western Australian government to bring Western Australians onto the NDIS. If you’re receiving disability supports in Western Australia, you might already meet most of the eligibility criteria. We’ll send you a letter with all the details on how to apply.

The Western Australian government will let us know if you’re on a program for faster access to the NDIS. This is called a defined program.

If you’re on one of these programs, you need to show us that you:

• are younger than 65 on the day you apply
• live in Australia permanently
• are an Australian citizen or permanent resident.

We’ll let you know what evidence you need to give us when you apply.

If you show us you meet the above requirements, we’ll decide you’re eligible under the disability requirements.

Which Western Australian defined programs are eligible for the NDIS?

• WA state-administered National Disability Insurance Scheme
• Supported Community Living
• Community Residential
• Day Options
• Disability Professional Services
• Emergency Accommodation
• Respite
• LAC Coordination
• Recreation.

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List D: Permanent impairment/Early intervention, under 7 years. No further assessment required.

Synonyms for conditions are also shown (e.g. condition / synonym / synonym).

Conditions primarily resulting in Intellectual/ learning impairment

Chromosomal abnormalities resulting in permanent impairment

• Global Developmental Delay
• Aicardi syndrome
• Aicardi-Goutières syndrome
• Angelman syndrome
• CHARGE syndrome
• Cockayne syndrome/ Types I and Type II / Cerebro-oculo-faciao-skeletal (COFS) syndrome/ Pena Shokeir syndrome Type II / Weber-Cockayne syndrome/ Neill-Dingwall syndrome
• Coffin-Lowry syndrome
• Cohen syndrome
• Cornelia de Lange syndrome
• Cri du Chat syndrome
• Dandy-Walker syndrome
• DiGeorge syndrome/ 22q11.2 deletion syndrome/ Velocardiofacial syndrome/ Shprintzen syndrome/ Conotruncal anomaly face syndrome
• Down syndrome/ Trisomy 21
• Edwards syndrome/ Trisomy 18
• Fragile X syndrome
• Kabuki syndrome
• Lesch-Nyhan syndrome/ Nyhan’s syndrome/ Kelley-Seegmiller syndrome/ Juvenile gout
• Leigh syndrome/ Leigh’s disease/ subacute necrotizing encephalomyelopathy
• Menkes disease
• Patau syndrome/ Trisomy 13

• Prader-Willi syndrome
• Rett syndrome
• Seckel syndrome/ microcephalic primordial dwarfism/ Harper’s syndrome/ Virchow-Seckel dwarfism
• Smith-Lemli-Optiz syndrome
• Smith-Magenis syndrome
• Sturge-Weber syndrome
• Trisomy 9
• Tuberous sclerosis
• Williams syndrome
• Wolf-Hirschhorn syndrome.

Conditions primarily resulting in Neurological impairment

Systemic atrophies primarily affecting the central nervous system

• Friedrich’s ataxia
• Hereditary spastic paraplegia/ Infantile-onset ascending hereditary spastic paralysis/ L1 syndrome/ spastic paraplegias types 2 and 11
• Louis-Bar syndrome/ Ataxia-telangiectasia
• Niemann-Pick disease (Types A and C)
• Progressive bulbar palsy of childhood/ Fazio-Londe disease.

The following spinal muscular atrophies

• Spinal muscular atrophy Type I/ Werdnig Hoffmann disease/ infantile SMA
• Spinal muscular atrophy Type II/ Dubowitz disease
• Spinal muscular atrophy Type III Kugelberg-Welander disease/ juvenile SMA
• Spinal muscular atrophy lower extremity dominant/ SMA-LED
• X-linked spinal muscular atrophy.

Extrapyramidal and movement disorders

• Hallervorden-Spatz syndrome / Pantothenate kinase-associated neurodegeneration (PKAN)/ neurodegeneration with brain iron accumulation 1 (NBIA 1)

• Alpers disease/Alpers syndrome/Grey-matter degeneration/Progressive

• sclerosing poliodystrophy/Progressive infantile poliodystrophy

• Demyelinating diseases of the central nervous system

• Adrenoleukodystrophy / X-linked childhood cerebral form

• Alexander disease

• Canavan disease

• Krabbe disease/Globoid cell leukodystrophy

• Pelizaeus-Merzbacher disease.

Episodic and paroxysmal disorders

• Lennox-Gastaut syndrome/Lennox syndrome

• West’s syndrome.

Polyneuropathies and other disorders of the peripheral nervous system

• Dejerine-Sottas disease/Dejerine-Sottas syndrome/Dejerine-Sottas neuropathy/ progressive hypertrophic interstitial polyneuropathy of childhood/onion bulb neuropathy

• Infantile Refsum disease.

Conditions primarily resulting in physical impairment

• Amputation

• Diamond-Blackfan anaemia

• Epidermolysis bullosa

• Harlequin type icthyosis

• Hay Wells syndrome/ankyloblepharon/ectodermal dysplasia/clefting [AEC] syndrome

• Joint or limb deformities resulting in impaired mobility

• Juvenile arthritis/Stills Disease

• Osteogenesis imperfecta

• Sjogren Larsson syndrome.

Diseases of myoneural junction and muscle

• Congenital muscular dystrophy

• Congenital myotonia / Thomsens disease/ Becker myotonia
• Distal muscular dystrophy
• Duchenne muscular dystrophy
• Emery-Dreifuss muscular dystrophy
• Facioscapulohumeral muscular dystrophy
• Myotubular myopathy
• Oculopharyngeal muscular dystrophy
• Paramyotonia Congenita.

Cerebral palsy and other paralytic syndromes

• Cerebral palsy
• Diplegia
• Hemiplegia
• Monoplegia
• Paraplegia
• Quadriplegia
• Tetraplegia.

Conditions resulting in sensory and/or speech impairment

• Permanent blindness in both eyes, diagnosed and assessed by an ophthalmologist as follows:
• Corrected visual acuity (extent to which an object can be brought into focus) on the Snellen Scale must be less than or equal to 6/60 in both eyes; or
• Constriction to within 10 degrees or less of arc of central fixation in the better eye, irrespective of corrected visual acuity (i.e. visual fields are reduced to a measured arc of 10 degrees or less); or
• A combination of visual defects resulting in the same degree of visual impairment as that occurring in the above points.
• (An optometrist report is not sufficient for NDIS purposes.)
• Deafblindness confirmed by ophthalmologist and audiologist and assessed as resulting in permanent and severe to total impairment of visual function and hearing.

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Conditions resulting in multiple types of impairment

• Aceruloplasminemia
• Addison-Schilder disease/ Adrenoleukodystrophy /
• Albinism
• Arginosuccinic aciduria
• Aspartylglucosaminuria
• Cerebrotendinous xanthomatosis/ cerebral cholesterosis
• Congenital cytomegalovirus infection
• Congenital hypothyroidism
• Congenital iodine-deficiency syndrome /cretinism
• Congenital rubella syndrome
• Galactosaemia with long term learning disabilities and neurological impairment
• Glycine encephalopathy/ non-ketotic hyperglycinaemia
• GM1 gangliosidosis
• Hartnup disease
• Homocystinuria
• Lowe syndrome/ Oculocerebrorenal syndrome
• Mannosidosis
• Menkes disease
• Mucolipidosis II / I-cell disease
• Mucolipidosis III / pseudo-Hurler polydystrophy
• Mucolipidosis IV
• Neuronal ceroid lipofuscinosis
• Niemann-Pick disease
• Phenylketonuria
• Pyruvate carboxylase deficiency
• Pyruvate dehydrogenase deficiency
• Sialidosis

• Sulfite oxidase deficiency.

The following mucopolysaccharidoses

• Hurler syndrome/MPS1-H
• Scheie syndrome/ MPS 1-S
• Hurler-Scheie syndrome/ MPS 1 H-S
• Hunter syndrome/ MPS II
• San Fillipo syndrome/ MPS III
• Morquio syndrome/ MPS IVA
• Maroteaux-Lamy syndrome/ MPS VI
• Sly syndrome/ MPS VII.

The following lysosomal storage disorders

• Gaucher disease Types 2 and 3
• Niemann-Pick disease (Types A and C)
• Pompe disease
• Sandhoff disease (infantile form)
• Schindler disease (Type 1)
• Tay-Sachs disease (infantile form).

Congenital conditions – cases where malformations cannot be corrected by surgery or other treatment and result in permanent impairment

• Chiari malformation/Arnold-Chiari malformation
• Congenital absence of limb(s)
• Congenital hydrocephalus
• Fetal alcohol spectrum disorder
• Fetal hydantoin syndrome
• Microcephaly
• Spina bifida
• VATER syndrome (VACTERL association).

When do we make priority eligibility decisions?

If you’re in one of the following situations, we’ll decide if you’re eligible within 2 to 5 business days.

• Child younger than 7 years with a hearing impairment, either:
  • Identified as Hearing Australia or Early Childhood Partner Priority
  • Identified as ‘newly diagnosed’
• A child is identified as having a developmental delay and is turning 6 years old within 30 days of a valid NDIS application.
• Immediate risk to self, others, community or agency where appropriate disability or informal supports are not in place.
• Unexpected, significant deterioration of disability-related functional capacity where appropriate disability or informal supports are not in place.
• Rapid deterioration in functional capacity of a person with one of the following permanent disabilities:
  • Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease)
  • Brain Cancer
  • Motor Neurone Disease (MND)
  • Progressive Bulbar Palsy (PBP)
  • Primary Lateral Sclerosis (PLS)
  • Progressive Muscular Atrophy (PMA).
• Imminent risk (within 1–14 days) of breakdown of either:
  • Accommodation – risk of homelessness
  • Caring arrangements, including informal supports, due to death, serious illness or injury of informal supports, or significant and unexpected deterioration of disability-related functional capacity.
• Appropriate disability supports are not in place and are re-entering the community after a long-term residence or hospital stay (specific release date not required):
  • A person with a newly acquired, significant disability, such as spinal cord injury, being discharged from hospital
  • A younger person living in residential aged care
  • A person being discharged from an inpatient mental health facility

How do we weigh evidence of disability?

We understand that you may have evidence of your disability from different health professionals at different times. When we’re deciding if you’re eligible for the NDIS, we look at:

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

We weigh evidence based on what we consider ‘best practice’, or highest quality. We consider this evidence most strongly when we make a decision.

What type of evidence should you provide?

We need evidence to help us consider if you meet the disability or early intervention requirements.

For the disability requirements, we need evidence to confirm your permanent impairment and evidence about how this impacts your functional capacity.

For the early intervention requirements, we need evidence to confirm your permanent impairment and evidence that confirms you need early intervention.

It’s important to understand the type of evidence that you are providing us. You may have evidence from a doctor or specialist confirming your permanent impairment or you may have evidence from an allied health professional or other medical professional that tells us about impacts to your functional capacity (your ability to do daily life activities). These are different types of evidence which will often be provided by different health professionals based on their qualifications.

How old should your evidence be?

How old should your evidence be to confirm your permanent impairment?

We need evidence from your doctor or specialist to confirm your permanent impairment. You can give us evidence confirming this from any age. However, evidence about how your impairment impacts your functional capacity should be from the last 12 months.

How old should your evidence be to confirm your functional capacity?

Generally, we need evidence about how your impairment impacts your functional capacity from the last 12 months. This is because your functional capacity may change over time – even if your impairment does not. It’s important that we have evidence of your current circumstances to ensure we understand your support needs.

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If you give us more than one type of evidence, we might weigh the newer evidence over the older evidence.

How old should your evidence be to confirm you need early intervention?

We need evidence from your doctor or specialist to confirm your permanent impairment and that you need early intervention.

Generally, we need evidence about that confirms you need early intervention from the last 12 months. This is because your functional capacity may change over time – even if your impairment does not. It’s important that we have evidence of your current circumstances to ensure we understand your support needs.

Who should provide evidence?

We generally prefer evidence that comes from a treating professional who:

• is the most appropriately qualified person to provide evidence of your primary disability
• has treated you for a significant period of time (at least six months)
• is registered to practise in Australia or New Zealand
• provides disability evidence (such as a medical report) that is original, genuine and specific to you.

Depending on your situation, you might get your evidence of permanent impairment from a different treating professional than your evidence of functional capacity.

If you need help to get your evidence together, your local area coordinator or early childhood partner can help you.

Who should provide evidence of your permanent impairment?

We generally prefer evidence from your doctor or specialist to confirm your permanent impairment.

Examples of common doctors or specialists include:

• General Practitioner (GP)
• Paediatrician
• Orthopaedic surgeon
• Neurologist
• Psychiatrist.

Who should provide evidence of your functional capacity?

We generally prefer evidence from a doctor, specialist, allied health or other medical professional for confirm how your permanent impairment impacts your functional capacity.

In addition to doctors and specialists, examples of common allied health or other medical professionals include:

• Occupational Therapist
• Speech Pathologist (Therapist)
• Psychologist
• Physiotherapist.

Who should provide evidence that you need for early intervention?

We generally prefer evidence from your doctor or specialist to confirm your permanent impairment.

Whereas a doctor, specialist, allied health or other medical professional can give us evidence to confirm you need early intervention.

In addition to doctors and specialists, examples of common allied health or other medical professionals include:

• Occupational Therapist
• Speech Pathologist (Therapist)
• Psychologist
• Physiotherapist.

Health professionals registered to practise in Australia and New Zealand

We strongly prefer evidence of your disability to come from a registered Australian or New Zealand health professional. Most Australian health professionals are registered with the Australian Health Practitioner Regulation Agency (AHPRA).

We will still consider evidence from non-Australian or New Zealand health professionals, or unregistered health professionals. However, this evidence will be given less weight.

If we cannot confirm the registration of your health professional, we will ask you (and your health professional) for more information in the first instance. If we still cannot confirm their registration, we will likely decide that you are not eligible for the NDIS.

Reference list

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Applying to the NDIS

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NDIS Act s 25(3). If we decide a child has a developmental delay under NDIS Act s 9 (definition of ‘developmental delay’), we’re satisfied they meet the requirements under NDIS Act ss 25(1)(b)-(c): see NDIS (Becoming a Participant) Rules r 6.8.

• NDIS Act ss 9 (definition of ‘developmental delay’), 25(1)(a)(iii).
• NDIS Act s 9 (definition of ‘developmental delay’ para (a)).
• NDIS Act s 9 (definition of ‘developmental delay’ para (b)).
• NDIS Act s 9 (definition of ‘developmental delay’ para (c)).

NDIS Act s 25(3); NDIS (Becoming a Participant) Rules rr 6.1, 8.4.

• NDIS (Supports for Participants) Rules r 7.5(b).
• NDIS (Supports for Participants) Rules r 7.5(a).
• NDIS (Supports for Participants) Rules r 7.10(a).
• NDIS (Supports for Participants) Rules r 7.9(a).
• NDIS (Supports for Participants) Rules r 7.10(c).

NDIS Act s 19(1)(a).

• NDIS Act s 19(1)(b).

• NDIS Act s 19(1)(c).

• NDIS Act s 197(1).

• NDIS Act s 74(1)(a).

• NDIS Act s 74(1)(b).

NDIS Act s 20.

• NDIS Act s 26(2)(d).

• NDIS Act s 26.

• NDIS Act s 26(3)

• NDIS Act s 26(2).

• NDIS Act s 21(3).

• NDIS Act s 100(5)(b).

• NDIS Act s 28(1).

• NDIS Act s 28(2).

• NDIS Act s 7(2).

• NDIS Act s 100(2).

• NDIS Act s 19(2).

• NDIS Act s 19(2)(c).

NDIS Act s 102.

• NDIS Act s 19(2)(d).