INCOME CONFIRMATION SERVICE CONSENT AUTHORITY

APPLICATION OR TENANCY REFERENCE NUMBER:
The Department of Housing determines eligibility for its services using a number of factors including the amount of your household income and assets. Household income is also assessed to calculate the amount of rent the department will charge its tenants.
The Income Confirmation Service allows the department to obtain income and asset details for housing assistance applicants and occupants directly from Services Australia (the agency). If you are in receipt of a Centrelink income, your consent on this form will allow the Housing Services to obtain your income and assets details directly from Services Australia (the agency) and use these to assess your eligibility for housing assistance or to calculate your rent payable.
Income Confirmation Service Consent
I/we the undersigned authorise the Department of Housing (Housing and Homelessness Services) to use Centrelink Confirmation eServices to perform a Centrelink enquiry of my customer details and concession card status in order to enable Housing and Homelessness Services to assess my entitlement to services. I authorise Services Australia (the agency) to provide the results of that enquiry to Housing and Homelessness Services.
I understand Services Australia (the agency) will disclose personal information to Housing and Homelessness Services including, where relevant, current and historical details of name, address, concession card status, payment type, payment status, one off payment, income, assets, deductions, shared care arrangements and partner status to confirm my eligibility for services from Housing and Homelessness Services.
I understand that this consent, once signed, remains valid only for the period I am a customer of Housing and Homelessness Services. I understand that this authority, which is ongoing, can be revoked at any time by contacting Housing and Homelessness Services or Services Australia (the agency).
I can get proof of my circumstances/details from Services Australia (the agency) and provide it to Housing and Homelessness Services so that eligibility for services can be determined. If I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the services provided by Housing and Homelessness Services.

Surname		
First name/s		
Date of birth		
Centrelink Customer Reference Number (CRN)		
Signature		
Date		
A fact sheet is available from your nearest Housing Service Centre and information is available from Services Australia (the agency) on their website at www.servicesaustralia.gov.au.

Please return completed form to your nearest Housing Service Centre.

Privacy Notice
The Department of Housing is collecting your personal information so we may provide you with housing assistance. To assist you with your housing needs and services, your personal information may be disclosed to partner agencies, service providers, local governments and non-governmental agencies that now, or will, provide you with housing and/or support services. Unless authorised or required by law, your personal information will not be disclosed to any other third party without your consent.
More information about the Department’s privacy obligations is available on our website at www.housing.qld.gov.au.

Department of Housing
www.housing.qld.gov.au

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PH064 ICS (27/07/2023)