This is an HTML version of an attachment to the Freedom of Information request 'Instruments of Delegation or Sub-Delegation under the Housing Act'.

Formal Access Application  
(Formerly an FOI application) 
Government Information (Public Access) Act 2009 (GIPA) 
Please print in BLOCK LETTERS with a black or blue pen  
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 (02) 9716 2662 or visit our 
website at  
Please mark relevant boxes with a        If you need more room to answer any questions, please include details on a 
separate page and attach it to this form. 
Please indicate the type of information you are seeking: 
Child Protection 
Ageing and disability 
Application number 
T File number 
Client reference number 
If applicable: 
Your details 
Mr, Mrs, Ms, Miss 
Last name or family name    
Given name (s) 
Unit/House number 
Date of birth 
DD / MM / YYYY      Email   
The questions below are optional and the information will only be used for the purposes of providing          
better service. 
What is the main language you speak at home? 
give details 
In what country were you born? 
Are you of Aboriginal or  
Torres Strait Islander Origin? 
give details 
Torres Strait Islander 
Aboriginal and  
Torres Strait Islander 
Proof of identity 
Australian Driver’s Licence  - with photograph, signature and 
current address  
When seeking access to government 
information, an applicant must provide proof of 
Current Passport 
identity in the form of a copy of any one of the 
Other - proof of signature and current address details  
following documents: 
(e.g. Health Care Card, Pensioner Concession Card)  
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Application fee 
Attach payment of the $30 application fee made payable to the Department of Family and Community Services by 
cheque or money order only. 
Processing charges 
For access to information of a personal nature, the application fee includes 20 hours of processing time, after which a 
processing charge of  $30 per hour will apply. For access to information of a non-personal nature, the application fee 
covers one hour of processing time, after which a processing charge of $30 per hour will apply. 
Discount in application and processing 
Are a holder of a Pensioner Concession Card or Health  
Care Card  
Some applicants may be entitled to a 50% 
A full-time student  
reduction in their application and processing 
Are a non-profit organisation (including a person applying for or 
on behalf of a non-profit organisation)  
If you wish to apply for a discount,                 
Financial hardship – please attach supporting 
please indicate the reason(s).   
documentation (e.g. Health Care Card,  
Pensioner Concession Card).  
Special benefit to the public 
give details 
Authorising a person/agency to act on 
your behalf 

Complete this section ONLY if you are 
authorising someone to act on your behalf 
Name of person /    
agency acting on your behalf 
Address of 
Unit/House number   
person / agency 
acting on your 

Town/Suburb Postcode 
I authorise the persons/agencies named above 
to act on my behalf in matters concerning my 
Formal Access Application.   
I know that I can change my mind and stop my 
consent at any time by writing or telling the 
Department of Family and Community Services 
(FACS) unless there is a current legal order in 
Full name (please print) 

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Information requested 
Is it:    
Personal information   
Non-personal information 
Give details of the information you are seeking: 
A copy of  
Form of Access 
How do you wish 
the document(s)  
to access the 
give details 
The GIPA Act requires an agency to consult with 
third parties when considering the potential 
Yes - I consent to 
No - I do not consent to my identity 
release of information about the other person’s 
my identity as an 
as an applicant under the GIPA 
personal or other affairs.  If we are required to 
applicant under the 
Act being disclosed. 
consult other people about your application, we 
GIPA Act being 
may need your consent to tell that person that 
you are the applicant.  Please indicate if you 
consent to your identity as an applicant being 
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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. 
Please note that this does not apply to your 
own personal information 
                                             Do you object to this?   
give details 
Full name 
Applicant’s Signature 

Where do I lodge this form? 
You can lodge this form by mailing it to:  
Right to Information Unit 
Department of Family and Community Services 
Locked Bag 4028 
Ashfield  NSW 2131 

General information about the GIPA Act is available by calling the Information and Privacy Commission NSW on freecall 
1800 472 679 or at its website: 
 FACS1014  09/16 
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