By complting and signing this form you give the National Disability Insurance Agency (NDIA) permission to share your information on your behalf. The information we will share will depend on the permission you give us on this form.
if you are completing this form on behalf of a participant:
The NDIA may ask you to provide confirmation that you are authorised to represent the participant and to verify your identity.
Please mark the relevant boxes below to indicate the information you give consent to share with this person and/or organisation
Please mark the relevant box below to indicate the length of time you are providing the consent forOngoing For the duration of my current NDIS plan For a set time ending Date Once only
Please mark the relevant box below to indicate the length of time you are providing the consent forOngoing For the duration of my current NDIS plan For a set time endingDate Once only
Please note: NDIS participants’ aged 18 and over have other options instead of signing this consent form.
If you direct a delegate to sign on your behalf, your delegate and witness needs to complete Part E. Otherwise, please sign, below.
Please note: This section is only to be completed if you, the participant, is unable to sign this form in Part D. Instead, your chosen ’delegate’ must be aged 18 and over and can sign in the presence of a witness.
Collection of your personal information
The National Disability Insurance Agency (NDIA) would like some personal information from you to simplify your engagement with the NDIS. Any personal information you provide to the NDIA is safe under the National Disability Insurance Scheme Act 2013 and the Privacy Act 1988. You can also ask to see what personal information (if any) we hold about you at any time and can seek correction if the information is wrong.
Personal information use and disclosure
The NDIA will use your information to support your involvement in the NDIS.
The NDIA will NOT use any of your personal information for any other purpose, or disclose your personal information to any other organisations or individuals (including any overseas recipients), unless authorised by law or you provide your consent for us to do so.
You can find the policy at the NDIS website (ndis.gov.au/privacy).
Personal information storage
The NDIA uses an Australian Government computer system to store personal information. System users, other than NDIA staff, may at times be able to see your name when they perform program duties, however they can’t record, use or disclose information, and they will not know if you become an NDIS participant. State or territory government officials may also have personal information access as part of the agreement between governments to assist the states and territories in their NDIS evaluation.