Document ID: chunk:federal_register_of_legislation:F2022L01161:schedule:1:p2
Version: federal_register_of_legislation:F2022L01161
Segment Type: schedule
Provision Reference: sch 1 (pt 2/6)
Character Range: 4627–8929

person to provide additional information in connection with their application, processing the application is suspended until the person provides that additional information. If the information requested is not provided within the period specified within the notice requesting the information, the application is taken to have been withdrawn.

An application must be submitted by 31 December unless otherwise advised by Comcare.

Comcare will notify the person in writing whether it has decided to renew the person's approval or not. It will also provide reasons for its decision.

If Comcare refuses to approve your renewal as a rehabilitation program provider, you can have this decision reviewed by the Administrative Appeals Tribunal.

During the approval period, the rehabilitation program provider must participate in evaluations as required by Comcare in order to determine whether the provider is complying with the applicable conditions of approval.
Comcare is authorised by the Safety, Rehabilitation and Compensation Act 1988 and the Privacy Act 1988 to collect, use and disclose personal information.  If Comcare is unable to collect, use and disclose your personal information, we may not be able to determine or approve your application. Comcare is unlikely to disclose personal information collected to an overseas recipient.
For a copy of Comcare's Privacy Policy, to request a change of your personal information or to make a privacy complaint please refer to comcare.gov.au/privacy. You can also contact us on 1300 366 979 or email us at privacy@comcare.gov.au.

PART A –APPLICANT DETAILS

Organisation details
Full name of organisation:
Business or Trading name of organisation:
Nature of Organisation:
(for example. Company, Partnership, Sole trader)
Name and title of Principal/s:
ABN/ ACN (if applicable):
 (Attach copy of the ABN record from the Australian Business Registry):
Organisation address:                                                                                                          State:         Postcode:
Postal address:                                                                                                                State:         Postcode:
Phone:                                                                                                                         Mobile:
Email:
Name of holding company if applicable:
Address of holding company:                                                                                                    State:         Postcode:
Name and position of person/s authorised to sign this application on behalf of the organisation:
Name:                                                                                                             Title:
Name:                                                                                                             Title:

Application contact person
Name:                                                                                                                          Title:
Phone:                                                                                                                         Mobile:
Email:

Previous applications
Have you ever been refused approval, or had your approval withdrawn, to provide workplace rehabilitation services by Comcare or any other Australian workers compensation authority?
                                                                                                                                                                                           Yes       No
If 'yes', please provide details of the reasons for refusal or withdrawal of approval.

Please also detail any steps you have taken since being refused approval to address the identified issue or issues.

Conflicts of interest
                                                                                                                                                                                         Yes        No
Do you have, or are you likely to have any actual or perceived conflict of interest between your role as an approved program provider and any other interest?

If 'yes', what are the details of this conflict?

What steps will you take to manage this conflict?

Professional