Right to Information Act 2009
Application for Assessed Disclosure
Department of Police, Fire and Emergency Management (DPFEM)	

	Applicant’s Details:		
	Name	Title	 Date of birth		
	     	     	     		
Postal Address	 	 Post code		
	     	     		

	Contact Information:		
Work Phone	 Home Phone	 Mobile		
	     	     	     		
	Email		
	     		

	Description of efforts made prior to this application to obtain this information:		
				
	     		

	Reason information Sought: 		
				
	     		
	
	Which area of DPFEM are you seeking information from (mark one box)?		
				
		Tasmania Police
	Tasmania Fire Service
	State Emergency Service
	Forensic Science Service Tasmania		

	Specific details of the information sought:		
	
	     		
(If there is insufficient room in the space provided please attach further details).		

	Third Party Information:	
	
A third party is a person other than you the applicant.

If the information you seek includes information provided to DPFEM by a third party (e.g. a statement), DPFEM may be required to consult with the third party to obtain his or her view on whether the information should be disclosed. If applicable, please indicate below by ticking the appropriate boxes.	
	 If available, I am seeking information provided to DPFEM by a third party.
 I consent to DPFEM providing my name to the third party (if consultation is required).*		
*Please note that if you act for a client, and you have ticked the above box, you consent to DPFEM providing your client’s name to the third party (if consultation is required).
Please note that if DPFEM is required to consult with a third party, an additional 20 working days is allowed for your application to be completed. 

	Payment details:		
		
Payment of the $40.50 application fee has been made via the following method		
		Cash (correct amount must be tendered)
	Cheque (made out to ‘DPFEM’)
	Money Order (made out to ‘DPFEM’)
	Credit Card (see below)
	Waiver (see below)		
Credit Card Type	Credit Card Expiry	Name on Card		
	 Visa   Mastercard	      /      	     		
Credit Card Number	Signature		
	     			
Application for waiver:		
		Member of Parliament 
 	Journalist 
	General public interest or benefit
	Financial Hardship (evidence, such as a copy of your Centrelink or Veterans Affairs card, 
must be provided) 		
Reason payment should be waived (If there is insufficient room in the space provided please attach further details)		
	     		

	Proof of Identity:		
If you are seeking personal information about yourself, evidence of your identity must be provided (e.g. copy of your Driver Licence, Birth Certificate or Passport).
 
If lodging by email or mail you will need to provide certified copies.		
	 Proof of Identity provided		

	Applicant’s Signature:	 Date:		
		     		

			
	Information about assessed disclosure under the 
Right to Information Act 2009		

Object of the Act	

Section 3 of the Act includes this statement of the objects of the Act:
(1)	The object of this Act is to improve democratic government in Tasmania – 
(a) 	by increasing the accountability of the executive to the people of Tasmania; and
(b)	 	by increasing the ability of the people of Tasmania to participate in their governance; and
(c)	by acknowledging that information collected by public authorities is collected for and on behalf of the people of Tasmania and is the property of the State.
(2)	This object is to be pursued by giving members of the public the right to obtain information held by public authorities and Ministers.
(3)	This object is also to be pursued by giving members of the public the right to obtain information about the operations of Government.
(4)	It is the intention of Parliament –
(a)		that this Act be interpreted so as to further the object set out in subsection (1); and
(b)		that discretions conferred by this Act be exercised so as to facilitate and promote, promptly and at the lowest reasonable cost, the provision of the maximum amount of official information.

Applications for assessed disclosure	

•	Applications are to be addressed to:
Right to Information Services
Department of Police, Fire and Emergency Management (DPFEM)
GPO Box 308
HOBART  TAS  7001

•	Applications are to be made in writing and include the information required by Section 4 of the Right to Information Regulations 2010.
•	Applications are to be accompanied by the application fee. This fee is 25 fee units, which is $40.50 as at 1 July 2016, and is indexed annually.
•	An applicant can apply for the application fee to be waived where the applicant is a Member of Parliament in the pursuit of their official duty; where the applicant is impecunious; and where the information sought is intended to be used for a purpose that is of general public interest or benefit

Responsibilities of the public authority 	

•	Applicants are to be notified of the decision on an application for assessed disclosure within 20 working days of the application being accepted by the public authority.
•	Before the application is accepted, the public authority has a maximum of 10 working days to negotiate with the applicant to further define the application.
•	If a need to consult with a third party arises, a further 20 working days will be allowed in addition to the original 20 working days.
•	If these time limits are not complied with, the application will be deemed to be refused and the applicant may apply to the Ombudsman for a review of that decision.

Privacy Statement	

DPFEM collects personal information provided in this form for the purposes of processing your Application for Assessed Disclosure under the Right to Information Act 2009. Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to DPFEM.