Aged Care forms
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Note: Forms are available as a web fillable PDF. All forms will still need to be printed to include an original signature and returned by post.
Aged Care Funding Instrument (ACFI) form
This form replaces the Resident Classification Scale (RCS) form.
Registration for Aged Care Online Claiming
The Registration for Aged Care Online Claiming forms are used to request access to Aged Care Online Claiming.
More information about choosing an online claiming channel for Residential and Community Care providers is available on this website by going to Aged Care Online Claiming.
Forms used to request access for Residential and Community Care providers:
- Registration for Aged Care Online Claiming using File Upload or Business to Business (B2B) [PDF, 605Kb]
- Registration for Aged Care Online Claiming using Web Forms [PDF, 444Kb]
If you are already registered for Aged Care Online Claiming, key personnel can complete the Change of nominated user's details form to register, amend access or deactivate users to the Aged Care Online Claiming website.
Note: If you are only deactivating users from the Aged Care Online Claiming website, key personnel can send an email to Medicare - Aged Care
with the user's name, A or RA number and deactivation date.
Form used to request access for Flexible Care providers:
Flexible Care providers that register for Aged Care Online Claiming will only have the ability to view ACCR data on the ACOC website. Flexible Care providers will not be able to perform any other actions within the ACOC website.
Forms must be completed and signed by key personnel within your organisation. Key personnel are the nominated persons who are registered with the Department of Health and Ageing.
Aged Care approved provider statement
The Aged Care approved provider statement is signed by key personnel of an approved provider to advise that appropriate business and security controls are in place. It ensures all aged care forms, claims and other relevant documentation to claim payments of subsidy under the Aged Care Act 1997 are appropriately authorised.
The provider statement only needs to be completed if you are a provider with services not registered for Aged Care Online Claiming.
The provider statement must be submitted every three years. The current provider statement is valid for the period 1 July 2011 to 30 June 2014. The next statement is due 30 June 2014 and will be sent to providers with services not registered for Aged Care Online Claiming in April 2014.
For providers with services registered for Aged Care Online Claiming, the Aged Care Online Claiming terms and conditions have been amended to include the provider statement’s terms and conditions. You do not need to re-sign a new Registration for Aged Care Online Claiming as the terms and conditions in your original application remains valid.
View the current terms and conditions for Aged Care Online Claiming
Note: If your organisation operates more than one aged care service you can complete one statement, attaching a list of services. Each page must be signed by the key personnel.
Banking details for the direct deposit of payments
The banking details form is for approved providers to formally notify the Department of Human Services of the banking details for:
- Australian Government-funded residential aged care services
- Community Aged Care Package (CACP) services
- Extended Aged Care at Home (EACH) services, and
- Transition care services
This form can be used to either add banking details for a new service or change the details for an existing service.
The form should be completed and signed by the approved provider (for a sole provider) or two key personnel (for a service administered by a board on behalf of the approved provider).
Note: Authorised signatories can only sign this form if they are key personnel.
When you have completed the form, make a copy for your records and send the original to the Department of Human Services.
Application for eligible oxygen treatment and/or enteral feeding supplement
Approval for higher-level funding for oxygen treatment is generally for a six-month period. This is because costs often fluctuate considerably for most residents' individual oxygen needs. Residential aged care services must advise the Department of Human Services of any changes that result in a variation of the amount being claimed and also any changes affecting payment of the benefit to the service.
Appointment of a nominee
This form is for residents in Australian Government-funded residential aged care services who wish to authorise another person to deal with the Department of Health and Ageing (DoHA) on their behalf. This form is also to be used for residents who are mentally impaired and are therefore unable to administer their own affairs.
If a resident is in a residential aged care service, they can authorise another person (a 'nominee') to act of their behalf with DoHA. The nominee may receive information from DoHA about their care costs and may give DoHA information about their income and assets. If it’s decided not to appoint a nominee, DoHA will contact the resident directly about these matters. You may vary or cancel the appointment of a nominee at any time by writing to DoHA
For more information, contact the Aged and Community Care Information line on 1800 500 853*.
Resident Entry Record (RER)
- RER for permanent care form [PDF, 1.5Mb]
- Guide for aged care providers: RER for permanent care [PDF, 143Kb]
- Completed RER contact sheet (where to send your completed RER form) [PDF, 80Kb]
- Questions and answers about the RER form [PDF, 123Kb]
- Guide to pensioner cards [PDF, 337Kb]
Some documents on this page may require the free Adobe PDF reader.
Last updated: 4 February, 2013