G overnment Information (P ublic Acces s ) Act 2009
AC C E S S   AP P L IC ATION
Please complete this form to apply for formal access to government information under the Government Information
(Public Access) Act 2009 (GIPA Act). If you need help in filling out this form, please contact the Right to
Information Officer on 8741 5110.
1.
Applicant Details
Title (please circle one):  Dr / Mr / Ms / Mrs / Miss / Other ………………………………………………...............
Surname:
.....................................................................................................................................
Other names:
.....................................................................................................................................
Organisation (if applicable):  ………………………............................................................................................
Postal address:
...............................................................................................   Postcode:  .................
Day-time telephone:
...................................................   Facsimile: ..............................................................
Email:
.....................................................................................................................................
    I agree to receive correspondence at the above email address.
Type of applicant:
(tick as appropriate)
  Member of Parliament
  Member of Public (application by legal representative)
  Media representative
  Private sector business
  Member of the Public (Other)
  Not for Profit/Community organisation
The questions below are optional and the information will only be used for the purposes of providing better
service.
Place of birth:
…………………………………..Main language spoken: ……………………..
Aboriginal or Torres Strait Islander: Yes / No (circle one)
Do you have special needs for assistance with this application? .........................................................
………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………..
Office use only
Date application received:
…………………………
File reference: ...................................................

Government Information (Public Access) Act 2009
ACCESS APPLICATION FORM
2.
Proof of identity
Only required when an applicant is requesting information on their own behalf.
Are you seeking personal information?   Yes / No  (circle one)
When seeking access to personal information, an applicant must provide proof of identity in the form
of a certified copy of one of the following documents:
  Australian driver’s licence
  Current Australian passport
  Other proof of signature and current address details
3.
Government information
Please describe the information you would like to access in enough detail to allow us to identify it.
Note: If you do not give enough details about the information, the agency may refuse to process your application.
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4.
Form of access
How do you wish to access the information?
A copy of the document(s)
Inspect the document(s)
Access in another way (please specify) ........................................................................................................
..............................................................................................................................................................................
5.
Application Fee
I attach payment of the $30 application fee by cheque / money order (circle one).
(Note: Cheques and money orders are to be made payable to the NSW Rural Fire Service)
6.
Disclosure log
If the information sought is released to you and would be of interest to other members of the public, details
about your application may be recorded in the agency’s ‘disclosure log’. This is published on the agency’s
website.
Do you object to this?    Yes / No  (circle one)
General information about the GIPA Act is available by calling the Office of the Information Commissioner on
freecall 1800 INFOCOM (1800 463 626) or at its website: www.oic.nsw.gov.au

Government Information (Public Access) Act 2009
ACCESS APPLICATION FORM
7.
Discount in processing charges
If you are given access to the information sought, you may be asked to pay a charge for processing the
application ($30 / hour). Some applicants may be entitled to a 50% reduction in their processing charges. If
you wish to apply for a discount, please indicate the reason:
    Financial hardship – please attach supporting documentation (eg a pension or Centrelink card).

AND / OR
    Special benefit to the public – please specify why below:
..............................................................................................................................................................................
..............................................................................................................................................................................
Applicant’s signature:  .......................................................................................
Date:   ...............................................................................................................
Please post this form to:
NSW Rural Fire Service

Attention: The Right to Information Officer

Locked Bag 17

Granville NSW 2142
Or lodge it at:
15 Carter Street

Lidcombe

INFORMATION FOR APPLICANTS
  •  Summary incident related report: NSW Rural Fire Service (RFS) usually  provides access to the ‘Fire
Incident Reporting System (FIRS) Summary Report’ free of charge through the State Operations Centre. If
you are seeking access to this document only,  please contact the Right to Information Officer prior to
submitting a formal access application to discuss the scope of your application.

•  Application fee: if you can demonstrate financial hardship (Pensioner or Centrelink card) the  RFS will
reduce the application fee by 50%. Please attach proof of financial hardship with your application.

•  Scope of your application: clearly outline the information you are seeking and provide sufficient detail to
identify the information requested. This reduces the processing time required for your application. Further,
when seeking incident related information and you are seeking information on behalf of a third party (for
example if you are an insurance company and seek information on behalf of an insured party) please
specify this information at section 3 above.

•  Consultation with third parties: if the information you are seeking access to 1) contains personal
information of third parties 2) concerns a third party’s business, commercial, professional or financial
interest 3) concerns research carried out by or on behalf of a third party or 4) affairs of a government of the
Commonwealth or  another State, the RFS may be required to consult with the relevant third parties. This
increases the decision period for processing your application and may increase the processing costs you
may incur. If you wish to exclude information requiring consultation from the scope of your application in
order to avoid an extension in the decision period or reduce processing charges please note this at section
3 above.

G
    eneral information about the GIPA Act is available by calling the Office of the Information Commissioner on
freecall 1800 INFOCOM (1800 463 626) or at its website: www.oic.nsw.gov.au

Document Outline