Transition to Independent Living Allowance (TILA) application form
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1 Transition to Independent Living Allowance (TILA) application form Page 1 of 2 TILA is a one-off allowance of up to $1,500 per person to help young people and adults who are leaving, or have left, statutory out-of-home care, also known as formal care. The allowance is designed to help young people start living independently. TILA is provided by the Australian Government Department of Social Services (DSS) and in NSW is administered by Southern Youth and Family Services (SYFS). Who should complete this application form? Caseworkers should complete this form once they have assessed a young person or adult as eligible to apply for TILA. Before submitting an application Make sure the person is aged years and has an approved leaving care plan. Help with filling in the application form Ensure you complete all fields within the application form. Ensure you explain the Privacy Notice at the top of the application form to the claimant. Part 1: What is a CRN? A CRN is a Customer Reference Number for Centrelink. If the claimant does not have a CRN, write Nil. Part 2: Caseworker details Caseworker details will be used by SYFS to direct TILA cheques back to claimants. These details will not be forwarded to DSS. You must sign the Caseworker Declaration. Part 4: Payment details If the claimant may previously have received a partial or full amount of TILA, note this in Part 4. This will prompt DSS to check historical records. To ensure cheques are appropriately directed, please provide Agency name Agency type FACS NGO Other Postcode 1 Supplier trading name (for cheque) Amount 2 Supplier trading name (for cheque) Amount 3 Supplier trading name (for cheque) Amount
2 Transition to Independent Living Allowance (TILA) application form Important contacts Page 2 of 2 Agency Phone Website Southern Youth and tilansw@syfs.org.au Family Services Department of tila@dss.gov.au Social Services NSW Department of Family and Community Services Where to send the application When complete, print out, sign and the scanned application to tilansw@syfs.org.au or send via fax (02) FACS
3 Transition to Independent Living Allowance (TILA) Application Form Privacy Notice for Claimant Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Social Services and the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the departments or given to other parties for the purposes of research, investigation or where you have agreed or it is required by law. You can get more information about the way in which the Department of Social Services will manage your personal information, including the department s privacy policy at dss.gov.au/privacy-policy or by requesting a copy from that department. You can get more information about the way in which the Department of Human Services will manage your personal information, including the department s privacy policy at humanservices.gov.au/privacy or by requesting a copy from that department. Part 1 Claimant Details CRN Title First Name Middle Name Surname Date of Birth Male Female Indeterminate/Intersex/Unspecified Home address Line 1 Home address Line 2 Suburb/Town State Select... Postcode Postal if different to Home Postal Line 1 Postal Line 2 Suburb/Town State Select... Postcode The purpose of this form is to collect information about you to determine your eligibility for TILA. If you consent as requested below, this form will be completed by your caseworker and provided to the Department of Social Services and the Department of Human Services to process your TILA Application. The departments and your caseworker may also need to discuss your information for this purpose. While this consent is voluntary, if you do not consent the departments may not have sufficient information to determine your TILA Application. I consent to my caseworker providing my personal and sensitive information to the Department of Social Services and the Department of Human Services as required to assess and administer TILA payments and services to me.
4 Part 1 Claimant Details Claimant Signature Part 2 Caseworker Details Name of Case Worker Full Name of Agency/Support Service Business Phone Number Mobile Phone I confirm that: this young person is an Australian citizen or permanent Australian resident this young person is currently, or has been, the subject of a care and protection order that places them in the care and custody of someone who is not their parent this young person is accessing transition support through a program or agency a Transition Plan is in place for this young person this is an appropriate time and use of TILA to support the goals and activities of the young person s transition plan. Caseworker Signature Part 3 Young Person s Circumstances Young Person s Country of Birth Date the young person will or did exit formal care What is the young person s current accommodation? Renting Private Juvenile Justice Centre Other (Specify) Residential Care Owns or Purchasing Accommodation Community Housing Crisis/Medium Term Accommodation Foster Care/Community Placement Caravan Park Boarding Public Housing What is the current employment status of the young person?
5 Part 3 Young Person s Circumstances Not employed Part Time Employment Volunteering Casual Employment Full Time Employment Unemployed/Looking for Work What is the current education/training status of the young person? Part Time Education and/or Training Full Time Education and/or Training Not Undertaking Any Education or Training What is the young person s primary source of income? Income Support payment from Centrelink No Income Income from Employment Registered for or Awaiting Benefits Select the category of goods and/or services being purchased (select all that apply) Other (Specify) One-off Transport Expense Food/Clothing Training or Life Skills Course Employment Support Home establishment Education or Training Support Bond Payment/Rent Other (Specify) Provide details of the types of goods and/or services being purchased. Stage at which TILA payment is being used? During transition from care After transition from care In preparation for leaving care Does the young person identify as being of Aboriginal or Torres Strait Islander descent? Is the young person from a Culturally or Linguistically Diverse background? Does the young person have a disability? Part 4 Payment Details Amount of TILA to be requested
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