Government Information (Public Access) Act 2009
Access Application
Please complete this form to apply for formal access to government information held by the
Office of Environment and Heritage (OEH) and/or the Royal Botanic Gardens & Domain Trust
(RBGDT) under the
Government Information (Public Access) Act 2009 (GIPA Act). If you need
help in filling out this form, please contact a Right to Information/Privacy Officer on (02) 9995
6080 or (02) 9995 6497. You can also visit our website:
www.environment.nsw.gov.au/whoweare/information.htm.
1 Your details
Surname:
……………………………………………..Title: Mr / Ms / Other (specify) ……..............
Other names: ……………………………………………………………………………………………….
Organisation/person being represented: ………………………………………………………………...
Postal address (compulsory): ……………………………….……………………………………………….
……………….………………......................................................... Postcode: …………… ………....
Day-time telephone: ………………………………………………….Fax: ………………………………
Email: ......................................................................................................................... …………
I agree to receive correspondence at the above email address.
I agree to the release of my name to any other (third) parties OEH/RBGDT need to
consult as part of my application.
2 Information requested
Are you seeking information held by:
OEH?
Yes / No (circle one) RBGDT?
Yes / No (circle one) Both?
Yes / No (circle one)
Are you seeking personal information?
Yes / No (circle one)
Please describe the information you would like to access in enough detail to allow us to identify
it. You may attach additional pages. If you do not give enough details we may be unable to
process your application.
.... …………………………………………………………………………………………………………….
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Information to cover the period from: ………………………….. to: ……………………………………
3 Proof of identity
This is required only if you are requesting personal information on your own behalf.
When seeking access to personal information, you must provide proof of identity in the form of a
certified copy of any one of the following documents:
Australian driver’s licence (with photograph, signature and current address)
current Australian passport
other proof of signature and current address details.
4 Form of access
We will provide you with a copy of the information released. If the information exceeds 20
pages, it will be provided on a compact disc. Please advise if you require access in another
format. ………………………………………………………………………………………………………
……. ............................................................................................................... ……………………..
5 Application fee and lodgement
Post your application and the $30 application fee (cheque or money order – no cash - made to
the Office of Environment and Heritage) to:
Right to Information/Privacy Officer
Inquiries by telephone to:
Office of Environment and Heritage (02) 9995 6497 or
PO Box A290 (02) 9995 6080
Sydney South NSW 1232
The application fee may also be paid in person by cash, credit card, eftpos, cheque or money
order at Level 14, 59–61 Goulburn Street, Sydney, NSW 2000.
6 Disclosure log
Details of information which is released and would be of public interest may be recorded in a
disclosure log at www.environment.nsw.gov.au/whoweare/disclosurelog.htm.
If you object to this, you will be asked to supply reasons before your application is finalised:
I object
I do not object
7 Discount in processing charges
You may be asked to pay a charge for processing the application ($30 per hour after the first
hour). Some applicants may be entitled to a 50% reduction in of the processing charges. If a
discount is given, the $30 application fee will pay for the first two hours of processing, not just
the first hour. If you are applying for your personal information, the first 20 hours of processing
will be free of charge.
If you wish to apply for a discount, please indicate the reason:
Financial hardship – please attach supporting documentation (such as a copy of a
pensioner concession card; otherwise provide an explanation with proof showing how
much money you receive each week or relevant financial statements):
........................................................................................................................................
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Not-for-profit organisation – please attach supporting documentation
Full-time student – please attach supporting documentation
Special benefit to the public – please specify:
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Applicant’s signature: ............................................................ .Date:…………………….
Privacy notice: The information provided on this application form is being obtained for the purpose of processing your GIPA
application. Providing this information is required by law. It will be stored securely. If you do not provide all or any of this information
it could prevent or delay the processing of your application.
OEH 2013/0801
November 2013
Document Outline
