Aged Care Fees Income Assessment Request - Australian Department Of Human Services Page 2
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26If you receive a non-income tested payment from the Department of Veterans’ Affairs, such
as the:
• Disability Pension, or
• War Widow’s Pension
and you do not receive the Income Support Supplement with these pensions, you will need to
complete the form, as we will not have enough information about your income to complete
the assessment.
If you complete this form before commencing a Home Care Package, the initial fee notification
advice you receive will be valid for 120 days unless there is a significant change in your
circumstances in which case you will be required to notify us.
Important information for Australian Ex-Prisoners of War and Victoria Cross recipients.
If you are an Australian Ex‑Prisoner of War or Victoria Cross recipient you may not need to fill in
this form. Please contact the Department of Veterans’ Affairs on 133 254, if you live in regional
Australia call on Freecall™ 1800 555 254.
For more information
Go to humanservices.gov.au/agedcare or call us on Freecall™ 1800 227 475.
If you need a translation of any documents for our business, we can arrange this for you free of
charge.
To speak to us in languages other than English, call us on 131 202.
If you receive a payment from the Department of Veterans’ Affairs (DVA), call DVA on 133 254,
if you live in regional Australia call on Freecall™ 1800 555 254.
Note: Call charges may apply.
If you have a hearing or speech impairment, you can contact the TTY service
Freecall™ 1800 810 586. A TTY phone is required to use this service.
2 of 8
SA456.1705
NOTES—
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