Freedom of Information
Statement of hardship form
FOI Reference:
I enclose a cheque or money order for the amount of $28.40, made payable to the Department of Health &
Human Services as payment of the freedom of information application fee.
OR
Statement of hardship. The payment of the application will cause me hardship because:
I also include a copy of my identification document.
Signed:
Dated
:
Name
:
Telephone
:
Address 1:
Address 2:
Please send payment or completed statement of hardship to:
Freedom of Information unit
Department of Health and Human Services
GPO Box 4057
Melbourne Victoria 3001