Time In Care Information Access Service Complete This

Time In Care Information Access Service Complete This

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Time in Care Information Access Service
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Complete this form to apply for information through the Time in Care
Information Access Service (TICIAS). Information that may be obtained
through this service includes:
*
Time in care reports providing information about:
*
why you came into care
*
your placement history
*
information about milestones
*
education/medical information
*
details of your family constellation
*
other relevant information about your family and your experiences
in out of home care.
*
Documents held in departmental records including:
*
birth certificates
*
school reports
*
medical reports
*
awards
*
photographs.
This service is only available to relevant persons or their authorised
representative. Relevant persons are people who are or were in care
under the Child Protection Act 1999 or the Children’s Services Act
1965 as well people who were State children under the State Children
Act 1911. However, if you are a young person who is currently in care
or transitioning from care you are encouraged to approach your child
safety service centre before applying for this service. Your child
safety officer will often be able to provide information without
requiring a formal application.
Privacy notice: The Department of Children, Youth Justice and
Multicultural Affairs is collecting your personal information to
assess and manage your application for information under the Time in
Care Information Access Service. The department will manage your
personal information in accordance with the Information Privacy Act
2009.
Applicant’s details
First name:
Middle name/s:
Family name:
Date of birth:
Other names used while in care:
Dates in care (if known):
Other relevant information:
E.g. institutions in which you were placed, mother’s maiden name,
names of siblings
Contact details
Please provide your contact details:
Email
Email address:
Phone
Contact number:
Mail (if applicable)
Postal address:
How would you like to receive the information provided under this
service?
Please select one option only
Email
Registered post
Collect from Brisbane CBD (111 George Street)
Collect from local area office:
Please specify which office/ locality:
Authorised representative
If you are authorised to represent the applicant please provide your
details below.
First name:
Family name:
Organisation:
Address:
In what capacity are you authorised to act for the applicant?
Legal representative
Community organisation
Appointed statutory guardian
Other (please specify): ______________________________
Evidence of the representative’s authority to act, as well as evidence
of the representative’s identity, must be forwarded along with this
form. Identity requirements are the same as for the applicant as
detailed overleaf.
Verification of identity
Identity requirements
Please note below which form of identity is attached
Evidence of identity:
Contact us on (07) 3097 5605 or freecall 1800 809 078 if you have
questions about identity requirements
Original certified copy of identity document enclosed
Post a certified copy of your driver’s licence, passport, birth
certificate, proof of age card or other identity document along with
this completed form to:
Right to Information, Information Privacy and Redress
Department of Children, Youth Justice and Multicultural Affair
Locked Bag 3405
BRISBANE QLD 4001
Certified means certified by a justice of the peace, commissioner for
declarations, lawyer, police officer or health professional as a true
copy of the original document. Send the copy which has the original
stamp or signature of the person who certified the document.
Statutory declaration
A statutory declaration completed by someone who has known you for one
or more years, which says that you are the person named as the
applicant.
Evidence of identity sighted by departmental officer
Date:
Signature:
Position title:
Region/business area:
Applicant’s signature
(or signature of authorised representative)
Date:
Time in Care Information Access Service
Right to Information, Information Privacy and Redress
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