Document ID: chunk:federal_register_of_legislation:F2022L01161:schedule:1:p5
Version: federal_register_of_legislation:F2022L01161
Segment Type: schedule
Provision Reference: sch 1 (pt 5/6)
Character Range: 14760–17757

work/at work/not available)
         -          Employer (New/ Same)

         -          Cost – total of fees charged for rehabilitation program(s)

    Agreement and Authorisation

Organisation name:

    On behalf of the applicant:

    1)  I/We certify that the information provided in this application and in support of the application is true and correct. I understand that giving false or misleading information is a serious offence under the Criminal Code.

    2)  I/We agree to advise Comcare as soon as is reasonably practicable of any changes to the information provided in this application.

    3)  I/We certify that persons engaged or employed by the applicant have authorised the collection, use and disclosure of their personal information, by Comcare, in relation to this application and for the purposes of enabling Comcare to determine whether the applicant, a relevant principal or employee of the applicant is complying with the criteria and operational standards for workplace rehabilitation providers determined under sections 34D and 34E of the Act. In particular, I/We understand that this authorises Comcare to collect, use and disclose the personal information in order to seek confirmation of the qualifications, probity and financial standing of the applicant, relevant principals and any workplace rehabilitation provider engaged or employed by the applicant, and the likely effectiveness, availability and cost of the rehabilitation programs which may be provided by the applicant.

    4)  I/We consent or certify that persons engaged or employed by the applicant have authorised the collection, use and disclosure of their personal information by Comcare as part of this application or otherwise for, and during, the approval as a rehabilitation program provider for any purpose necessary to consider this application or otherwise determine whether I am/we are complying with any requirement or conditions imposed in relation to the approval as a rehabilitation program provider.

    5)  I/ We understand that the approval as a rehabilitation program provider may be subject to conditions imposed by Comcare as it sees fit. I am/We are aware of the requirements of the conditions of approval and I understand and accept the I/we must meet and continue to conform to the conditions of approval.

    6) I/We understand that failure to comply with the Criteria and the Operational Standards determined under sections 34D and 34E of the Act may result in the revocation of approval under section 34Q of the Act.

    7) I/We understand that failure to comply with any condition(s) specified in the instrument of approval may result in the revocation of approval under section 34Q of the Act.

    8)  I/We agree to advise Comcare as soon as is reasonably practicable of any changes in workplace rehabilitation providers employed or engaged by the applicant to manage return to work plans under the Act, including evidence of qualifications, experience/supervision