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Home and Community Care Program for younger people

If you are under 65 (under 50 Aboriginal or Torres Strait Islander) and currently have a disability and are not eligible for the NDIS, or you are carer of such a person complete a request for a Home and Community Care assessment below or phone 1300 367 700.

 Paper form - HACC referral/request for younger people (PYP)(PDF, 53KB)

Client Details
Is a carer in place?
Supporting Information
One file only.
256 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.
One file only.
256 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.
One file only.
256 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.
Emergency Contact Details
GP Details
Referral (if applicable, agency use only)
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