Consent to Share Your Information

Please use this form to give your permission (consent) for the National Disability Insurance Agency (NDIA) to share your National Disability Insurance Scheme (NDIS) information with a person or an organisation of your choice. For example, you may wish to share some or all of your NDIS information with a family member who helps you make decisions or with a provider you regularly engage with.

Using this form is optional. You can also give your consent by calling 1800 800 110 or by contacting the NDIA in any of the ways listed under ‘How do I return this form to the NDIA’. If you would like someone to act on your behalf with the NDIS or assist in making decisions, please contact us.

Consent to share information can be provided by an applicant, participant, child representative, plan nominee, or legally appointed decision-maker. “Applicant” refers to a person applying for access to the NDIS.

Your information will only be shared if you have provided consent, or if the NDIA is legally required or authorised to do so.

You can withdraw your consent at any time by contacting us via mail, email, phone or in person.

How do I return this form to the NDIA?

Part A: Applicant/Participant Details

If you are the applicant or participant, go to Part C.
If you are a child representative, plan nominee, or legally appointed decision-maker, complete Part B then Part C.

Part B: Child Representative, Plan Nominee or Legally Appointed Decision Maker Details

Please provide your details if you are completing this form on behalf of the participant:

• For a child under 18 years (child representative)

   

• As a plan nominee

   

• As a legally appointed decision-maker (e.g., a guardian)

   

Part C: Provide Consent

I consent to the NDIA sharing information about me (or the person I represent in Part A) with the following:

Person/Organisation 1

Information you do NOT want us to share (optional)

Tick the boxes for any information you do not want shared:

My personal information
☐ My name, DOB, NDIS participant number and status
☐ My address, email, and phone number
☐ Details about my carers
☐ Details about informal supports
☐ Details about service providers

My NDIS information
☐ Assessments and reports held by the NDIA
☐ My NDIS application form
☐ Outcome of my NDIS application
☐ Confirmation of first plan approval (if eligible)
☐ All parts of my current NDIS plan
☐ My current plan goals and aspirations
☐ Funding and support in my current plan
☐ My NDIS contact details
☐ Any previous NDIS plans
☐ Goals, aspirations, and funding from previous plans

Any other information
☐ If yes, please specify: ______________________________________

Why do you want us to share your information?

We need to know how this information will be used.

For my plan manager to operate effectively in delivering plan management services.

How long is this consent valid for?

☒ Until further notice
☐ Until a set date (DD/MM/YYYY): ______________
☐ One time only

Part D: Declaration

To be completed by the person submitting the form (participant/applicant or their representative).

☐ I have read and understand how the NDIA handles personal information (see the Privacy Notice and Policy on the NDIS website).
☐ I consent to the NDIA sharing the specified information with the third party listed in Part C.
☐ I understand I can withdraw or change this consent at any time.
☐ The information in this form is accurate and complete.
☐ I understand providing false or misleading information is a serious offence.
☐ I acknowledge that this information is protected under law and will only be shared in accordance with legal requirements or my consent.

For more information, visit ndis.gov.au, go to About → Policies → Freedom of Information → Privacy.

Signature: _________________________
Name: ____________________________
Date (DD/MM/YYYY): _______________