Application for Compensation

Use this form to claim compensation from the Department of Social Services (the department) for financial loss or personal injury you allege to have suffered as a result of any alleged negligence or defective administration by the department.

Section 1: Personal details

Title

Residential address

Is your postal address the same as your residential address?

Postal address

Section 2: Application details

You should outline the events and circumstances which you consider contributed to your claim. Please attach any available supporting documents. Please ensure you only provide documents that are relevant to your claim. If there is insufficient space, please attach a separate document.
Please attach any available supporting documents. Please ensure you only provide documents relevant to your claim. If there is insufficient space, please attach a separate document.
Please list descriptions and amounts of claimed items.
For example, review by agency, Ombudsman, Courts, Tribunals. If you have not taken any action to resolve this matter, please move on to Section 3.

Section 3: Other details

If so, please provide details and attach any available supporting documents.

Supporting documents

If you are considering whether there is any additional information that may be relevant, you may wish to provide material that helps explain, support, or clarify matters relating to your CDDA claim, or that responds to issues identified in the preliminary decision documents. The type of material that may be relevant will depend on your individual circumstances, but could include:

  • Medical records or certificates from treating practitioners;
  • Correspondence, such as emails, letters, or other communications;
  • Personal records, notes, or journal entries;
  • Photographs or other visual records; or
  • Any other information or documents that you consider may assist the decision-maker in understanding the circumstances relevant to your claim.

If you are unable to upload your documents in full or in part, please indicate this in the box above and a member of our Discretionary Payments team will reach out to you.

Additional information

Please note that CDDA payments may be taxable. Please contact the Australian Taxation Office or seek independent financial advice to determine your own circumstances.

For more information on the CDDA Scheme, visit the Department of Finance’s website.

Please keep a copy of your completed claim form and any supporting documents for your records as we are unable to return them to you.

Maximum 5 files.
256 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Section 4: Privacy notice and declaration

Privacy notice

The Department of Social Services is collecting personal information about you to assist in the effective management of your CDDA application. We may use your personal and sensitive information to assess your application and verify your claim. Any information provided to the Department of Social Services in relation to the CDDA will be stored as a Commonwealth record.

Further, the Department may disclose your personal information (including sensitive information) to other Commonwealth agencies, including the Department of Finance, the Commonwealth Ombudsman, relevant Commonwealth Ministers and to contracted service providers as part of processing your compensation claim.

Your personal information may be disclosed to other parties where you have agreed, or where it is otherwise permitted, such as where it is required or authorised by or under an Australian law.

Your personal information (including sensitive information) may also be used or disclosed by the Department for quality assurance, auditing, investigation, reporting, research, evaluation and analysis purposes.

The Department’s Privacy Policy contains more information about the way in which we will manage your personal information, including information about how you may access or seek a correction of your personal information held by the Department. The Privacy Policy also contains information on how you can complain about a breach of the APPs and how the Department will deal with such a complaint. Please read our:

I declare that to the best of my knowledge and belief, the information that I have supplied in or attached to this application is accurate and true, and that all relevant information has been included.

Declaration and authorisation

I understand that giving false or misleading information is a serious offence under section 137 of the Criminal Code Act 1995 (Cth).
I acknowledge that I have read and understood the privacy collection notice above.
  • Print
  • Email

Was this page helpful?

Your feedback has been successfully submitted.
Thank you for providing feedback. Help us improve by telling us what you think.
DSS5301 | Permalink: www.dss.gov.au/node/5301