Consent to Exchange Information Between Support Workers/Service Providers

DCJ0145

This form is to give permission for support agencies to share information to help you as best possible. 

For information or assistance with this form, phone 1800 422 322, 24 hours a day, seven days a week.

DCJ Privacy Notice 

This notice outlines how the Department of Communities and Justice (DCJ) collects, uses, stores and discloses yourpersonal and or health information in accordance with the Privacy and Personal Information Protection Act 1998 (NSW)(PPIP Act) and the Health Records and Information Privacy Act 2002 (NSW) (HRIP Act). 

DCJ collects personal and or health information from time to time in connection with your application for housingservices or during your tenancy for the purposes of assessing and processing your application for housing assistanceand or administering your tenancy. 

We may also collect information to provide you with support services, related to your tenancy or as a client of DCJ. Thisinformation may be collected from: 

• you directly

• individuals who are visiting or residing at the same residential address as you 

• members of the public

• Community Housing Providers 

• your authorised representatives 

• other third parties, for example, medical practitioners 

• other NSW or Commonwealth government agencies (as permitted by law). 

This information is held by DCJ, and where relevant, Community Housing Providers. The information held relates toservices provided to you, including the details you provide in this document and information in other documentationcompleted or provided by or on your behalf, and it also relates to information you provide to our staff or CommunityHousing Providers (for example, during the sign-up process for your public housing tenancy). 

DCJ may also use your information for data analytics, data matching and data integration on DCJ’s Federated AnalyticsPlatform (FAP). In addition to the use of your information on the FAP, this information will also support policymaking,program and service planning, delivery of targeted services for clients, program evaluation, monitoring and reporting,research and resource planning. We may also use your information within DCJ to plan, coordinate and improve the waywe provide services. This includes the use of information by companies contracted by DCJ, for example, for thepurposes of determining client satisfaction and related long-term service enhancement. 

Intended recipients of your personal and or health information include those involved in the above activities, as well asany others who may have a lawful interest in considering your application or tenancy, including where relevant: 

• DCJ 

• Aboriginal Housing Office 

• Community Housing Providers 

• Housing Appeals Committee 

• NSW Land and Housing Corporation 

• The Minister administering the Housing Act 2001. 

DCJ may also disclose your personal and or health information where required or permitted by law, for example: 

• for purposes relating to child protection, health reasons, protection of public revenue, and or law enforcement 

• to relevant statutory bodies 

• to other co-tenants, authorised occupants and or visitors of the subject residential address. 

The supply of your personal and or health information in this form is voluntary; however, if you do not supply us with theinformation we request, we may not be able to process your application, provide services to you or other individualsaffected by your tenancy, or provide other forms of assistance. 

You have a right of access to, and correction of, your personal and health information held by DCJ in accordance withthe PPIP Act and the HRIP Act. Further information about your privacy rights are available on the DCJ website at https://dcj.nsw.gov.au/statements/privacy.html.

• I have read and understand the above notice.

• I give permission for medical details affecting my need for housing to be released to the above named socialhousing provider and, if necessary, for my doctor/health care professional to discuss these details on my behalfwith the social housing provider.

• I give permission for my details to be released by my social housing provider to a third party support service forthe purposes of making a referral on my behalf.

If you are signing on behalf of another person as their legally appointed guardian such as the NSW Trustee and Guardian or privateenduring guardian, write your name here.