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FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for...

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G:\coredata\admin\finance\2020 Forms SRS\Finance Checklist 2020 FINANCE CHECKLIST Please refer to information provided on the Student Resource Scheme for 2020 and tick the following: YES I WISH TO PARTICIPATE IN THE STUDENT RESOURCE SCHEME [ ] I have read the information provided and wish to participate in the Student Resource Scheme. [ ] I have completed the Participation Agreement Form and understand this form ensures my participation in the Student Resource Scheme for the duration of my child’s enrolment at Pacific Pines State High School. [ ] I have indicated on the form which payment options I have selected for the Student Resource Scheme fees and will make payment as indicated: [ ] I will pay $300 by Friday 22 November 2019 with discount applied [ ] I will pay over 3 instalments: $125 on Wednesday 22 January 2020 $100 on Friday 6 March 2020 $100 on Friday 1 May 2020 [ ] I will pay $325 in full by Wednesday 22 January 2020 NO I ELECT NOT TO PARTICIPATE IN THE STUDENT RESOURCE SCHEME [ ] I have read the information provided and DO NOT wish to participate in the Student Resource Scheme. [ ] I have completed the Participation Agreement Form indicating I do not wish to be part of the Student Resource Scheme. [ ] I have read in detail the resources I will need to provide for my child for all of their subjects. [ ] I understand that I will be required to meet with the Deputy Principal, or school representative, to discuss my decision. STUDENT NAME: _______________________________________ YEAR LEVEL 2020: _________________ PARENT NAME: _______________________________________ SIGNATURE: _____________________
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Page 1: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

G:\coredata\admin\finance\2020 Forms SRS\Finance Checklist 2020

FINANCE CHECKLIST Please refer to information provided on the Student Resource Scheme for 2020 and tick the following:

YES I WISH TO PARTICIPATE IN THE STUDENT RESOURCE SCHEME

[ ] I have read the information provided and wish to participate in the Student Resource Scheme.

[ ] I have completed the Participation Agreement Form and understand this form ensures my participation in the Student Resource Scheme for the duration of my child’s enrolment at Pacific Pines State High School.

[ ] I have indicated on the form which payment options I have selected for the Student Resource Scheme fees and will make payment as indicated:

[ ] I will pay $300 by Friday 22 November 2019 with discount applied

[ ] I will pay over 3 instalments: $125 on Wednesday 22 January 2020 $100 on Friday 6 March 2020 $100 on Friday 1 May 2020

[ ] I will pay $325 in full by Wednesday 22 January 2020

NO I ELECT NOT TO PARTICIPATE IN THE STUDENT RESOURCE SCHEME

[ ] I have read the information provided and DO NOT wish to participate in the Student Resource Scheme.

[ ] I have completed the Participation Agreement Form indicating I do not wish to be part of the Student Resource Scheme.

[ ] I have read in detail the resources I will need to provide for my child for all of their subjects.

[ ] I understand that I will be required to meet with the Deputy Principal, or school representative, to discuss my decision.

STUDENT NAME: _______________________________________ YEAR LEVEL 2020: _________________

PARENT NAME: _______________________________________ SIGNATURE: _____________________

Page 2: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

G:\coredata\admin\finance\2020 SRS Forms\Student Resource Scheme 2020 Information Sheet

STUDENT RESOURCE SCHEME 2020 YEAR 7 – 12 INCLUSIVE SRS Fee 2020: $325 per student

The Principal and Parents and Citizens Association of Pacific Pines SHS are proud to be able to extend to you the opportunity to take advantage of the school’s Student Resource Scheme. The scheme is authorised to operate under the Education (General Provisions) Act 2006 and Department of Education Training and Employment Policy. The major purpose of the Student Resource Scheme is to provide an extremely cost effective and efficient strategy to parents and students which:

Reduces the heavy financial outlay for parents in providing a wide variety of student resources

Eliminates shopping for text books and resources

Gives students access to a wide range of up-to-date resources

Supplements consumable resources which are used to ensure real life learning experiences for our students

Assists in maintaining a high level of technology across the school learning environment Accommodates a range of school based and workplace programs to enhance student skill development. Provision of student’s personal stationery requirements will be the responsibility of the parents and students. Please refer to the stationery list attached. As this school promotes an electronic learning environment, with all students providing their own device, stationery items are minimal. It is important to note that there are limited additional fees for subject levies. The majority of subject levy costs are included in your Resource Scheme fee. All monies raised through this scheme are expended directly on the students of the school on an annual basis. In return for payment of the Student Resource Scheme participation fee, your student will be provided with:

· All prescribed textbooks and digital version access · Initial Photographic ID card · Use of class sets of books and resources for in-class activities · Short term loans (e.g. plays, novels, and poetry for English) · Use of reference materials · The necessary range of teacher prepared notes and/or student worksheets in all subject areas · Use of equipment, consumable materials and photocopies for a range of subjects across all year levels · Student computer printing · Qld Core Skills preparation, practice and marking (Year 11 and 12 only) · The scheme contributes to the cost of materials in the majority of practical subjects · Access to Daymap, EdPerfect, Clickview and use of a number of computer software programs

The Government supplies tuition fees and basic general foundations for the delivery of student curriculum programs. Please note, the student resource scheme fees have had the cost of the government textbook allowance deducted to reduce the total cost which parents are required to pay. The Principal may refuse to admit a student to the scheme where there are outstanding fees from previous years. A student may also be excluded from extra-curricular activities due to non-payment of the student resource scheme. If you wish to discuss your payment options, please make contact with the finance office as soon as possible. Parents who elect not to participate in the Student Resource Scheme will be required to complete and sign certification that all necessary resources listed will be provided on time for their student. Failure to provide all resources as required could negatively impact student learning outcomes.

REFER TO SRS FEE SCHEDULE AND PAYMENT OPTIONS OVER PAGE

Page 3: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

G:\coredata\admin\finance\2020 SRS Forms\Student Resource Scheme 2020 Information Sheet

STUDENT RESOURCE SCHEME FEE SCHEDULE FOR 2020

The Student Resource Scheme fee will be $325 for students in Year 7 to Year 12 and the following payment options will apply: Payment in full by Friday 22 November 2019 will ensure a discount of $25, reducing the fee to $300 per student. You may elect to pay instalments (no discount will be applied):

· 1st instalment - $125 due on Wednesday 22 January 2020 · 2nd instalment - $100 due on Friday 6 March 2020 · 3rd instalment - $100 due on Friday 1 May 2020

The total amount of $325 will be due on Wednesday 22 January 2020 if the instalment option is not chosen. The school provides a number of payment plan options. Please refer the information listed below on direct debit and Centrepay.

Payment Options DIRECT DEBIT Student Resource Scheme Fee can be broken down in instalments of weekly, fortnightly or monthly. These can be set up from Bank Accounts and Credit Cards and made directly to the students invoice. Please contact Finance Office on 07 55025130 to set up your individual plan. OVER THE PHONE 24/7 To make a payment over the telephone please call 1300 631 073 and follow the instructions. Please note: Telephone payments cannot be made at Finance Office. CENTREPAY – Payment using your Centrelink/Family Tax Benefit funds. Fortnightly deductions from these payments can be set up via Finance Office. All completed forms must be returned to the Finance Office. Please do NOT send your form directly to Centrelink. The finance office will record your payment preference and submit the form digitally on your behalf. PAYMENT BY INTERNET BANKING/DIRECT CREDIT – Direct payment into school bank account Bank – Commonwealth Bank of Australia Account Name – Pacific Pines State High School General Account BSB – 064-474 Account Number – 10072737 Payment Description: Student EQ ID number or Invoice number It is very important that you are accurate with your payment description. If we cannot identify your student or what you are paying for, we cannot allocate the payment correctly. Please note – to ensure payment reaches the school’s bank account prior to the payment cut-off date, all internet bank payments must be made no later than 48 hours prior to the cut-off date/time. Payment through your internet banking can be made 24 hours a day, 7 days a week. PAYING IN PERSON – Payment by Credit Card, EFTPOS, Cash, Cheque Payments can be made at the Payment Window during office opening hours of Tuesday / Wednesday / Friday 8.30am to 2.00pm

Page 4: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

Student Resource SchemeParticipation Agreement Form

Version 1.1

For Secondary School Curriculum

Participation

Student Details

Student name:_______________________________ Year level:_________

Parent name :_______________________________

Parent signature:____________________________ Date:________________

o I am experiencing financial hardship and wish to meet with the

school to discuss my options (see clauses 10-14 overleaf)

I agree to the above made selection, until such point as I inform the school otherwise

I do not wish to participate in the above-named Student

Resource Scheme. I have read and understand the Terms and

Conditions (see reverse).

I understand I must provide my child with all items that would

otherwise be provided to my child by the SRS as detailed on

the information provided by the school.

I understand that if my child is eligible for the Textbook and

Resource Allowance (TRA) the school will contact me. For

more details regarding the TRA and eligibility criteria enter

"Textbook and Resource Allowance" into the search tool on the

Department's Policy and Procedure Register at

http://ppr.det.qld.gov.au

I understand that I can choose to join the SRS in future years

by completing a new Participation Agreement Form.

I wish to participate in the above-named Student Resource

Scheme for the duration of my child’s enrolment at the school. I

have read and understand the Terms and Conditions (see

reverse) and agree to abide by them and to pay the annual

participation fee. I understand that the school will publish

information about the SRS costs and inclusions each year.

I understand that I can opt out of SRS participation in any year by

completing a new Participation Agreement Form before the

invoice due date.

I wish to make payment each year by:

o A single payment for the full year’s fee

o Term instalments (paid over the first 3 terms)

o An instalment plan as negotiated with the school

(e.g. via direct debit, centrepay or other payment method)

o Yes o No

PACIFIC PINES STATE HIGH SCHOOL

The Student Resource Scheme (SRS) provides parents with a convenient and cost-effective way to access educational resources

their children need for school. These resources supplement the school’s resources and enhance students’ learning experience at

school.

Please indicate your intention to participate or not by selecting "yes" or "no" and completing the information in the

relevant box below:

The School has developed a form to cover participation in the Student Resource Scheme for the duration of your child's enrolment.

This participation agreement covers students in Year 7. For more information regarding the SRS refer to the information sheet

provided or log-on to the school website.

• require the return of items provided by the SRS

School use only:

Negotiated instalments:______________________________________ Approved by:____________________

Uncontrolled copy. Refer to Department of Education Policy and Procedure Register at http://ppr.det.qld.gov.au to ensure you have the most current version of this document.

Page 5: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

Terms and Conditions of the Student Resource Scheme

Privacy Statement

The Department of Education collects this information in accordance with

section 51 of the Education (General Provisions) Act 2006 ("the Act") in order

to administer the Student Resource Scheme (SRS). The information will only

be accessed by school employees administering the SRS. However, if

required, some of this information may be shared with departmental

employees for the purpose of debt recovery.

Definitions

1. Reference to a “parent” is in accordance with the definition in the Actand refers equally to an independent student.

The Student Resource Scheme (SRS)

2. The cost of providing instruction, administration and facilities for theeducation of students enrolled at state schools is met by the State.

3. The school is not responsible for providing textbooks, in-classconsumables and personal resources for students.

4. The SRS enables parents to access certain resources, as detailed by the school, for an annual fee.

5. Participation in the SRS is optional: parents are under no obligation toparticipate.

Textbook and Resource Allowance (TRA)

6. The State provides the TRA annually to parents of eligible secondary students to assist with the costs of education.

7. The TRA is paid to the school based on enrolment data and willreduce the cost of particpating in the SRS.

8. Parents who choose NOT to participate in the SRS and whose childrenare eligible for the TRA have the option to receive the TRA as a credit totheir child’s school account or directly from the school.

Parents and Citizens’ (P&C) Association support of the SRS

9. All parents are invited to participate in the annual meeting of the P&CAssociation at which the income and expenditure report is presentedand the proposed SRS inclusions and fees are tabled for approval.

Parents experiencing financial hardship

10. Principals may vary payment options and/or waive all or part of theparticipation fee for parents experiencing financial hardship.

11. Parents experiencing financial hardship who wish to participate in theSRS should contact the Principal to discuss options.

12. The onus of proof of financial hardship is on the parent.

13. The school may require annual proof of continuing financial hardship.

14. All discussions will be held in the strictest confidence.

Parents participating in the SRS

15. Parents indicate whether or not they wish to participate in the SRSby completing this Participation Agreement Form.

16. [An] invoice/s for the amount of the annual participation fee will beissued to the parent providing consent to participate in the SRS.

17. This agreement is for the duration of the student’s enrolment at theschool, unless a new Participation Agreement Form is completed.

18. Parents must notify the school before the invoice due date if they intend to cease their participation in the SRS in any year.

19. Where a parent chooses to participate, they are agreeing to pay theannual participation fee, in accordance with the payment frequency option selected on the form. There is no provision for part - participation.

20. All SRS resources provided for the student’s temporary use remainthe property of the school and must be returned when requested by the school or if the student leaves the school.

21. Parents are responsible for ensuring that any SRS resourcesprovided for the student’s temporary use are kept in useablecondition. Where an issued item is lost, not returned, or negligently damaged, parents will be responsible for payment to the school ofthe value of the item or its repair.

22. Parents must inform the school if items on the list of resources arenot received.

23. Non-payment of the participation fee by designated payment date(s)may result in debt recovery action in accordance with theDepartment’s Debt Management procedure. In such cases, thePrincipal may:

• withdraw the student’s participation in the SRS

• require the return of items provided by the SRS

• withhold the provision of any further items under the SRS

• refuse participation in the SRS where participation fees areoverdue from the previous year(s), and/or

• exclude the student from optional, non-curricular activities and/or

• initiate debt recovery action.

Parents NOT participating in the SRS

24. Parents indicate whether or not they wish to participate in the SRSby completing this Participation Agreement Form.

25. This agreement is for the duration of the student’s enrolment at theschool, unless a new Participation Agreement Form is completed.

26. Where a parent has previously indicated that they will participate in theSRS, but wishes not to participate in any year(s), the parent must notifythe school prior to the invoice due date of their intention to ceaseparticipation.

27. Parents who choose not to participate in the SRS are responsiblefor providing their child with all items that would otherwise beprovided by the SRS. School-produced resources (e.g. StudentDiary) will be available for separate purchase from the school for non-participants.

Operating the SRS

28. Schools will provide all parents with a list of resources provided by theSRS to enable parents to assess the cost effectiveness of participation.

29. Schools will also provide non-participating parents with detailed lists ofresources to supply for their child.

30. All items included in the SRS must be able to be independently sourcedby parents who choose not to participate in the SRS, either from a thirdparty supplier or by purchasing a school-specific resource (such as adiary or workbook) from the school.

31. Schools may distribute information and invoices to parents in the yearpreceding the SRS but invoices must not be due before the end of thefirst week of term 1 of the SRS year. All invoices must have a minimum

of 30 days for payment.

32. Parents must be given the option annually to choose not participate inthe SRS.

33. In return for payment of the participation fee, the SRS will provideparticipating students with the resources and materials as outlined in theschool SRS documents.

34. SRS moneys received are to be expended only on studentresources outlined in the school’s SRS and must not be expended onother items or used to raise funds for other purposes.

35. As the SRS operates for the benefit of participating parents and isfunded primarily from participation fees, the school retains control of the resources and determines the rules around their availability to non-participants.

36. A student entering the school during the school year is entitled to pay apro-rata fee to participate.

37. Where participation fees have been paid and a student leaves theschool during the year, schools must determine if parents will beeligible for a pro-rata refund. This calculation will also take intoaccount any pro-rata allocation of the TRA (if eligible) and anyoutstanding SRS debts (including any debts from damaged or non-returned items). Where the cost of outstanding debts is higher thanthe calculated refund, parents will be liable to pay this balance offunds.

38. The replacement cost of any resource will be up to the maximumvalue (subject to depreciation where appropriate) of the acquisitioncost to the school, as detailed on the annual SRS informationprovided to parents.

39. Schools may initiate debt recovery action in accordance with the debtmanagement procedure where a parent has an outstanding debt

Uncontrolled copy. Refer to Department of Education Policy and Procedure Register at http://ppr.det.qld.gov.au to ensure you have the most current version of this document.

Page 6: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

The Student Resource Scheme provides parents with a convenient and cost-effective way to access

educational resources their children need for school. These resources supplement the school’s

resources and enhance students’ learning experience at their school.

If you have selected NOT to participate in the Student Resource Scheme and pay the annual fee of

$325.00, please ensure that your student has all resources below to ensure your’ student can fully

participate in the curriculum.

The cost of non-participation in SRS may be in excess of $3000.00.

I HAVE MADE AN APPOINTMENT WITH THE DEPUTY PRINCIPAL, OR A DESIGNATED SCHOOL REPRESENTATIVE, TO DISCUSS MY RESPONSIBILITIES IN PROVIDING THE NECESSARY RESOURCES

TO ENSURE MY STUDENT CAN FULLY PARTICIPATE IN THE CURRICULUM.

2020 Year 7

TOTAL COST OF NON PARTICIPATION –Not including Special Education $3,356.65

SUBJECT SUPPLIED UNDER SCHEME COST

ALL STUDENTS DIGITAL

PLATFORM

Daymap https://pacificpinesshs.eq.daymap.net (Unavailable individually) $22.00

Clickview https://online.clickview.com.au (Unavailable individually) $8.00

Education Perfect https://www.educationperfect.com $100.00

Pearson Places https://www.pearsonplaces.com.au $20.00

Printing Credit $10.00

Cost to purchase $160.00

BUSINESS

Worksheets/Booklets $10.00

Cost to purchase $10.00

CREATIVE ARTS

DANCE

Centre stage (2nd ed.) Book ISBN 9781740813372 $54.00

Dance : Count me in ISBN 9780170346887 $49.95

Consumables: baby wipes & make-up $30.00

Cost to purchase $133.95

CREATIVE ARTS MEDIA

2 GB SD card $20.00

16 GB USB flashdrive $25.00

Head phones $10.00

Media : new ways and meaning $63.00

Consumables $30.00

Cost to purchase $148.00

CREATIVE ARTS MUSIC

Yamaha keyboard $250.00

Global percussion instrument pack $450.00

Sheet Music x 3 @ $25.00 $75.00

Worksheets/booklets $20.00

Consumables $10.00

Cost to purchase $805.00

CREATIVE ARTS VISUAL ARTS

Artwise $77.00

School produced booklets 4 @ $5.00 $20.00

The complete guide to painting & drawing techniques &materials $108.50

CONSUMABLES: (Media) Pencils, Watercolours, Charcoal, Graphite

Cartridge paper, Coloured pencils, Fine tip markers, Markers, Paper Mache, Acrylic paints (blue, red, yellow, green, black, white, orange, purple, brown) Scissors, Paper glue, Canvas

$100.00

Cost to purchase $305.50

Page 7: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

ENGLISH

Complete English Basics 1 $45.00

Appreciating Poetry $54.50

Novels x 1 (Title to be notified) $22.00

Worksheets/booklets $25.00

Oxford Australian School Dictionary & Thesaurus (2nd ed.) $25.00

DVD's x 4 $80.00

Cost to purchase $251.50

HEALTH AND

PHYSICAL EDUCTION

Health & Physical Education for the Australian Curriculum $60.00

Jump Start 7 & 8 $70.00 School produced workbooks & handouts $20.00 Sports equipment $150.00 Sunscreen $10.00

Cost to purchase $310.00

HOME ECONOMICS

Textbooks (sewing and cooking) $25.00

Materials for Pillow Case and Owl $10.00

Sewing equipment and maintenance $250.00

Aprons and gloves $15.00

Specialty ingredients usually school supplied $25.00 Consumables (glad wrap, foil, foil trays) $10.00

Consumables (detergent, dishcloths, laundry, ect) $10.00 Cost to purchase $345.00

INDUSTRIAL DESIGN AND

TECHNOLOGY

Junior Workshop A & B $39.00 Junior Workshop A Workbook 1 & 2 $20.00 Safety Movies $100.00 Worksheets/booklets $20.00 Consumables $20.00 Cost to purchase $199.00

JAPANESE

Flashcards, cardboard $10.00 Flashcards, Hiragana $30.00 Flashcards, Katakana $30.00 Japanese & English Dictionary $120.00 Oxford Beginner's Japanese Dictionary ISBN 9780199298525 $30.00 Whiteboard & whiteboard markers $15.00 Worksheets/booklets $20.00 Consumables $20.00 Cost to purchase $255.00

MATHEMATICS

Maths Text $55.00

Coloured paper, sticky tape, scissors $10.00 Protractor and compass $15.00

Worksheets/booklets $10.00

Cost to purchase $90.00

SCIENCE

Pearson Science 7 $58.70 Reference Books (various) $25.00 Audio/visual resources $25.00 Chemicals & consumables $30.00 Worksheets/booklets $10.00 Cost to purchase $148.70

HUMANITIES

Geography Alive 7 $50.00 Excursion/ Field Studies/ Practical Applications Workbooks $15.00 History Alive 7 $50.00

Printed Resources Worksheets/booklets $40.00 Colour Printed Historical/Geographical sources $40.00 Cost to purchase $195.00

SPECIAL EDUCATION PROGRAM

Creating programs for students with significant learning needs requires access to online programs, creating individualised work booklets and utilising many hands on materials to consolidate educational experiences. These resources are developed based on the individual needs of each student & as such, costs can be quite high. Participation in the Resource Scheme covers these costs.

$500.00

Page 8: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

 

CENTREPAY DEDUCTION FORM 

Please complete this form in full and return it to the Finance Window 

 

PART A – PARENT/GUARDIAN DETAILS 

FAMILY NAME:   

GIVEN NAME/S:   

YOUR DATE OF BIRTH:   

PHONE NUMBER:   

CENTRELINK REFERENCE NUMBER:        ‐        ‐        ‐   

CENTRELINK PAYMENT TYPE:   

 

PART B – STUDENT DETAILS 

NAME:    STUDENT ID:   

NAME:    STUDENT ID:   

NAME:    STUDENT ID:   

NAME:    STUDENT ID:   

 

PART C – TYPE OF REQUEST 

  START –  a new deduction for Student Resource Scheme (Complete Part E and H) 

  CHANGE – a current deduction for Student Resource Scheme (Complete Part F and H) 

  CANCEL – a current deduction for Student Resource Scheme (Complete Part G and H) 

 

PART D – SERVICE PROVIDERS DETAILS 

NAME:  Pacific Pines State High School 

ADDRESS:  PO Box 380, Helensvale  4212 

PHONE NUMBER:  (07) 5502 5111 

CENTREPAY REFERENCE NUMBER   

 

PART E – CHANGE A CURRENT DEDUCTION FOR STUDENT RESOURCE SCHEME 

FORTNIGHTLY AMOUNT:   

START DATE:   

ONGOING :    OR   TARGET AMOUNT:         $  OR  END BY:         /          /       

Once Part E is completed, please complete Part H 

     

Page 9: FINANCE CHECKLIST - Pacific Pines State High School · 3. The school is not responsible for providing textbooks, in-class consumables and personal resources for students. 4.The SRS

PART F ‐  CHANGE A CURRENT DEDUCTION FOR STUDENT RESOURCE SCHEME  

FORTNIGHTLY AMOUNT:  $ 

START DATE:       /       / 

ONGOING PAYMENTS:    TARGET AMOUNT:         $ 

Once Part F  is completed, please complete Part H 

 

PART G – CANCEL A CURRENT DEDUCTION FOR STUDENT RESOURCE SCHEME  

CANCELLATION DATE:       /       /  

Once Part G  is completed, please complete Part H 

 

PART H – AUTHORISATION – Please read, sign and date the statement (Must be completed)  

 

 I authorise the Australian Government Department of Human Services to make the nominated deduction and pay the amount to the service provider (or as they direct).  I give permission for: 

The information I have provided on this form to be given by Human Services to the services provider (or their agent). 

The services provider I have nominated on this form to provide my correct account or billing number to Human Services if required. 

 I understand that: 

if my deduction has a target amount and the final deduction is set to pay less than $2, my second last deduction will be increased by up to $2 to cover the final amount. 

if I have a current Centrepay deduction and I lodge a new claim, that the existing deduction(s) will not be carried over to the new payment. 

if I have a current Centrepay deduction and I transfer to another eligible Centrelink payment in the future that my deductions will continue. 

it is my choice to have this amount deducted from my Centrelink payments, and I can change my Centrepay deduction at any time. 

if I stop using the service provider but do not stop my Centrepay deduction, the service provider may instruct Human Services to stop the deduction. 

if I change service providers, I may also need to advise Human Services to stop my previous deduction. 

when a payment has been made to a service provider after my deduction authority has been cancelled or suspended, Human Services may be able to assist me to recover the Centrepay deduction. 

PRIVACY AND YOUR PERSONAL INFORMATION Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government 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 department or given to other parties for the purposes of research, investigation or where you have agreed or it is required or authorised by law. You can get more information about the way in which the Department of Human Services will manage your personal information, including their privacy policy at humanservices.gov.au/privacy or by requesting a copy from the department.  

 

Your signature:   

Date:       /       / 

 


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