Application No. 
		
Transfer application 
pursuant to the Housing Act 2003.

Transfer Application

Social housing transfers are available to help Queenslanders with their housing needs. This application collects essential information to assess your eligibility for a transfer to alternative social housing. Submission of this application does not guarantee an offer for transfer.

Important information
Your eligibility for a transfer will be assessed based on the information and the supporting documentation you provide with this application. If your circumstances change at any time, please advise your local Housing Service Centre within 28 days of the changes.

Completing this application – have you:
Answered all the questions with a tick where there are       Yes/No boxes?
Collected supporting evidence including proof of income and assets for new household member/s in this application?
Read and signed the declaration and consent on the last page?
Had this application signed by a witness on the last page?
A Housing Service Centre officer can witness this application if you are submitting it in person.
Got identification ready for any new household member/s for when you submit this application?
Alternatively, you can attach witnessed copies of identification evidence if you are returning this application via post.

For more information on housing assistance, please call or visit your local Housing Service Centre. You can also find information at www.qld.gov.au/housing or download our ‘Housing Assist Qld’ mobile app from the Google Play, Microsoft or Apple App stores.

We can also help you to find a place to rent in Queensland using RentConnect or help you with a bond loan to cover the rental bond when you move into private rental accommodation. For more information, call or visit your local Housing Service Centre or visit www.qld.gov.au/housing. 

For office use only	
This application is not required to be completed if the transfer is due to portfolio management reasons.	

Application Assistance
What is your first spoken language?
Do you need an interpreter? If you speak in a language other than English, or have hearing difficulties, we can arrange for an interpreter to assist you.
Which interpreter do you require?           Language, provide details:
                                                                Signing
Do you need assistance when	            Yes            No 

This may be a person that helps you to make decisions, or someone who makes decisions on your behalf about your personal, lifestyle or financial matters.

making decisions?                                           
                                                         If yes, which of the following:

                                                                 Public Trustee                                         Family, Friend or Advocate

                                                                 Office of the Public Guardian                  Power of Attorney
                                                                 Other, provide details:
Tenant Details
Full name/s:
Address:
Telephone:           Home:                                                              Mobile: 
            Work:
Email:
Tenancy reference number:
Centrelink reference number (CRN):

(swapping a public housing property with another public housing tenant – eligibility criteria apply)

   

.

Type of transfer:               Social Housing           Mutual exchange   

Reason for transfer: 

Who are your current household
members and what are their                                                                                                                            dates of birth?

Attach information on a separate page if needed.

Will everybody listed on your
current tenancy agreement               Yes           No 
be transferring with you?           If no, who will not transfer to the new tenancy?                            

Note: No people can remain at the property once the transfer is complete.

Is any household member
expecting a child?                              Yes           No
                                                      If yes, expected due date:

  0

What type of transport do
you use?                                             Public            Own            Other (family and friends)

Your need to move

Tick all that apply.

Does your household need to move for any of the following reasons?

   

	You are experiencing domestic and family violence	

	The safety of a child in your care is at risk	

	You have a history of homelessness	

	You are experiencing safety concerns related to violence, stalking, abuse (physical, emotional, financial), or harassment (other than domestic, family or sexual violence) from another person in your household or community	

	You are experiencing a family or relationship breakdown	

	Your housing has been impacted by a natural disaster	

	You are experiencing sexual violence 

(outside of domestic and family violence)		You are a victim of a major crime that was committed in Queensland	

	You need to meet your or a household member’s disability support needs			

Tick all that apply.

Is your current housing location unsuitable for any of the following reasons?

   

	Too close in proximity to the perpetrator of domestic, family, or sexual violence against you	

	Distance does not allow you to accept a firm offer of employment – minimum 20 hours per week	

	Does not enable you to gain or maintain regular access or custody to shared care of children	

	Does not meet the conditions of a Court Order, Parole or Probation Order, Family Court Order, Domestic Violence Order, Child Protection Order	

	Too far away from frequently required essential services – transport, medical, disability support for daily activities, transport to meet mobility requirements	

 

	You wish to enable family reunification	

	Too far away from family and community support which impacts on the wellbeing of the household	

	Too far away from education or training services		You are an Aboriginal or Torres Strait Islander person and need to move for cultural reasons	

Tick all that apply.

Is your current housing unsuitable for any of the following reasons?

   

	Design restricts daily living activities – bathing, mobility, or seriously aggravates a medical condition or disability	

	Size is too small resulting in overcrowding			
Your financial wellbeing

Tick all that apply.

Are you or another tenant experiencing any of the following situations?

	Unable to work and have high levels of living expenses beyond normal living costs related to a long-term or serious medical condition or permanent and/or significant disability	

 

	Multiple periods of unemployment 
Long-term unemployment	

	Currently employed –

Part-time

Full-time

Casual	
Your wellbeing

Tick all that apply.

Have any of the following affected you or your household’s ability to access stable housing?

   

	You or a household member have a permanent and significant disability	

	You are experiencing safety concerns related to risk of violence, stalking, abuse, or harassment (other than domestic, family or sexual violence) from another person in your household or community

	There are a limited number of or no suitable properties to meet needs - size, location or features	

	You or a household member have a long-term or serious medical condition			

	Your safety is at risk from domestic, family, or sexual violence 	

	There is an immediate and ongoing risk to the safety of a child in your care	

	You are a young person at risk who requires a tailored response on your path to independence	

	History of homelessness	
Your future housing

You may be offered housing from any of the areas listed below.

Where do you want to live?

Area 1:		Area 4:		
Area 2:		Area 5:		
Area 3:		Area 6:		

More than one housing type can be applied for. We will make every effort to offer the type of housing that you have chosen and are eligible for. However, this cannot be guaranteed. Housing with four or more bedrooms are limited.

What types of housing do you want to apply for?

   

 

Townhouses have three or more units next to each other with one to four bedrooms each, divided by common walls. These can be single or double storey and usually have small fenced yards.		Cluster housing is several separate homes with two to four bedrooms each, located within a housing development.	

	Apartments/flats/units are usually a complex of two or more storeys, may be studio style or have up to three bedrooms. These do not have a separate yard.	

	Seniors’ units are only available to applicants over 55 years of age and are usually in a complex of one or two storeys with one to two bedrooms.	

	Detached houses are one house with two or more bedrooms on its own block of land.

		Dual Occupancy are two detached houses that are on one block of land, sometimes with a shared driveway.	

	Duplexes are usually two units with one to three bedrooms, each on a block of land, divided by a common wall. These may be in groups of two to four.			
Do you need modifications to your home to help with daily living activities due to a disability or medical condition?                                Yes           No
                    If yes, provide details:
Will you accept housing with

Living, bathroom or kitchen facilities may be shared. If you accept an offer, you can choose to remain on the housing register for housing which has its own facilities.

shared facilities?                                   Yes           No

Do you have any pets?                          Yes           No

                                                          If yes, provide details:

Attach a page if necessary.

Is there any additional information you would like to provide?

Note: If more than four new household members, complete and attach ‘Additional household member’ forms before submitting this application.

New household member details
What is your relationship with the tenant/s? 
Full name:

Any other name you may be known as.

Alias: 

Gender:                                Date of birth:           /         /               Country of birth:

  0   

Tick all that apply.

Do you identify as:           Aboriginal                                Australian South Sea Islander
                                           Torres Strait Islander              Other cultural or linguistic background             None
Centrelink reference number (CRN):
Department of Veteran Affairs reference number (DVA):
Citizenship/Residency details:         Australian citizen                    Permanent resident
                                                             Not permanent resident         Visa - what type?
Are you expecting a child?               Yes           No
                                                      If yes, expected due date:
Do you have a medical
condition or disability?                      Yes           No
                                                      If yes, provide details:

Attach information on a separate page if needed.

Gross amount and type (wages, pension, allowances, family payments, interest, superannuation).

What is your income?              $                       Frequency:                        Type:
                                                   $                       Frequency:                        Type:

Savings, investments, cash deposits, property trusts, shares, bonds, debentures, superannuation - allocated pension or lump sum payments, share from property sale or settlement.

What are your assets?             $                       Type:
                                                   $                        Type:

Do you own/part own property

This includes residential property, vacant land, industrial property, commercial property, a live-aboard boat, cabin, donga, caravan, or manufactured/ transportable home.

in Australia or overseas?                 Yes            No
                                                      If yes, what type:
                                                      Address:
                                                                          % of property owned:
                                                                       Current property value:
                                                                                  Ownership date:
What type of transport do 

  0

you use?                                             Public            Own            Other (family and friends)

Evidence for your application
All evidence to support your application must be provided before an assessment can be completed.

Please attach evidence about your need to move and your housing needs: 
•	Documentation supporting your reasons for needing to move
•	For anyone who has a medical condition or disability – completed ‘Medical Report’ form (PH068) (unless we already have this information)
•	A completed ‘Support Statement’ form (PH076)
•	Decision-making – Public Trustee, Guardian, Power of Attorney documentation (unless we already have this) 

Some income, medical and referral forms are available at www.qld.gov.au/housing. Or please call or visit your local Housing Service Centre for forms or advice.

Attach information about any new household members living with you 

All evidence to support your application must be provided before it can be completely assessed. Please tick all that apply.

What identification evidence can the new household member/s provide?

	Primary		Secondary	

 

 

Australian Birth Certificate or extract		Bank, credit or ATM card with your signature	

	Australian Naturalisation or Citizenship Certificate	

	Bank, credit union or building society statements	

Australian Permanent Residency Certificate or stamp		Centrelink correspondence with CRN	

	Immicard, Immigration or sponsorship papers	

	Medicare Card	

	Temporary Protection Visa or stamp	

	Health Care Card	

	Australian Passport	

	Seniors/Pensioner Card	

Australian Driver licence	

	Taxation Assessment Notice	

	Photograph identification car

d (Queensland Transport)		Australian Marriage Certificate	

	Adult Proof of Age Card until expiry (Queensland Transport)	

	Australian divorce papers	

	18+ card until expiry (Queensland Transport)	

	Life Insurance policies	

	Keypass Card	

	Other photographic identification such as
security identification, cash converters card	

	Queensland Corrective Services verification			

Below are examples of other types of evidence new household members will need to provide, where applicable. Existing household members must also provide up-to-date income, assets and property ownership evidence as detailed below.

Further evidence required

•	Income – Centrelink income statements, payslips, employer’s declaration/s
	Household members over 16 years receiving Centrelink payments can give consent to the department to obtain income and assets details electronically from Centrelink.
•	Assets – quarterly bank statements and documentation showing details of other assets and their current valuation
•	Property ownership – title deed, mortgage documents, contract of sale

Declaration and consent
Personal Information Privacy Notice
The Department of Housing and Public Works is collecting personal information on this form to provide you with housing assistance or assess grant funding applications. This is authorised by the Housing Act 2003. To assist you with your housing needs and services, relevant personal information may, in very limited and specific circumstances, be disclosed to partner agencies, service providers, agencies authorised by legislative provisions, and local governments and non-governmental agencies that now, or will provide you with housing and/or support services. Limited personal information may be used for housing related research, policy or planning functions. Unless authorised or required by law, your personal information will not be passed on to any other third party without your consent. More information about the department’s privacy policy is available on our website at www.housing.qld.gov.au.

I understand:
•	the instructions given on this form and agree to the above Privacy Notice above
•	the information on this form will be used by the Department of Housing and Public Works to register my application for a transfer, providing I am eligible
•	my personal information may be given to government and non-government organisations to provide me with housing and/or support services
•	that as tenant/s, I must advise the department if any circumstances change regarding current or new household members 
•	that I may become ineligible for housing assistance if changes occur to my or my household’s circumstances, incomes and/or assets
•	upon submitting this application, each new household member/s must provide at least one item from the above list of primary and secondary identification as proof of identity. One proof of identity, must show a Queensland address, signature and date of birth.

To the best of my knowledge, the information provided on and in conjunction with this application is true and correct. I understand that I will commit an offence and be liable to a penalty under the Housing Act 2003 if I knowingly provide to the Department of Housing and Public Works false or misleading information that may influence decisions about my eligibility for housing assistance and may make my application invalid.

Applicant name:                                                            Applicant name:
              Signed:                                            /     /                         Signed:                                           /     /

     Date:						    Date:

I am a Department of Housing and Public Works employee / registered community housing provider employee / Corrective Services officer / Justice of the Peace / Commissioner for Declarations / Solicitor.

I have witnessed the above signatures and sighted two of the listed forms of identification for each applicant.

 Witness name:                                                          Position:
             Signed:                                           /     /        Organisation: