Before you begin

You can use this form to apply for registration as a provider of disability services for:

TAC clients with a disability and/or
WorkSafe injured workers with a disability for attendant care.

You must have a current TAC client or WorkSafe injured worker you intend to work with before you complete this form.

The Victorian Social Services Regulator

If you are not already registered with the Victorian Social Services Regulator (the Regulator), the TAC will use the information collected in this form to decide whether we can fund disability services for your TAC client or WorkSafe injured worker.

If approved for funding, the TAC will contact the Regulator and confirm our intention to approve funding for your services for your client or injured worker.

You will then need to register with the Regulator.

When the TAC receives confirmation that you are registered with the Regulator, we will finalise your TAC registration.

Your registration as a TAC disability services provider is complete when you have written confirmation from the TAC that you are authorised to deliver disability services.

Before completing this form, you should familiarise yourself with the TAC's:

Continue

*

Where will you deliver disability services *

In Victoria onlyOutside of Victoria onlyBoth in and out of Victoria

Where is your head office located? *

In VictoriaOutside of Victoria

This application to register as a disability provider is available for providers operating in Victoria.

Providers intending to deliver disability services outside of Victoria for TAC or WorkSafe clients (attendant care) can contact us at sectors@tac.vic.gov.au

Are you currently registered with the Social Service Regulator for disability services? *

YesNo

Have you applied for registration with the Regulator for disability services and are awaiting an outcome? *

YesNo

What date did you submit your registration request? *

Under the Social Services Regulations Act 2021 (Vic), all providers of disability services for TAC clients and Worksafe injured workers with disability must register with the Social Services Regulator (the Regulator).

The TAC and/or Worksafe Victoria will not be able to fund disability service providers who are not registered with the Regulator.

Please visit the Social Services Regulator webpage for more detail.

Agree and continue

By continuing with this application, you agree to register with the Victorian Social Services Regulator if the TAC approves your TAC client or WorkSafe injured worker for disability services. *

Please upload your Notice of decision letter from the Regulator *

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Do you have a current TAC client or WorkSafe Victoria injured worker you intend to provide disability services for? *

YesNo

The TAC is unable to register disability services providers who do not have a TAC client or WorkSafe injured worker they intend to work with.

Please complete this application form when you have a client or injured worker you intend to work with.

Have you been in contact with a TAC or WorkSafe claims manager or representative regarding this application? *

YesNo

TAC or WorkSafe Victoria contact person's name *

Disability service type

You can only register for a service if you have a client or injured worker for that service.

For each service you select below, you need to supply the details of one TAC client or WorkSafe injured worker you intend to work with.

Choose your service type(s) *You can select more than one service type

Is this registration related to an application for Shared Supported Accommodation (SSA) property enrolment? *

YesNo

Is the property enrolled for Specialist Disability Accommodation (SDA)? *

YesNo

Please select the building class for the property enrolment *

Other building class *

Please provide the address for the SSA property enrolment *

Street address *

City *

State *

Postcode *

Att care for WorkSafe only

WorkSafe attendant care declaration

Service providers who only service WorkSafe Victoria injured workers can be registered for attendant care by the TAC.

Please provide the details of one WorkSafe injured worker you intend to work with:

WorkSafe injured worker full name *Please enter your injured worker's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this injured worker? *

WorkSafe injured worker claim number *

WorkSafe injured worker date of birth *

I have read and accepted the information provided in the WorkSafe policies for attendant care.

Attendant care policy

https://www.worksafe.vic.gov.au/attendant-care-services-policy

*

Att care for TAC

TAC attendant care declaration

Please provide the details of one TAC client you intend to work with:

Client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

Client claim number *

Client date of birth *

I have read and accepted the information provided in the TAC policies and provider guidelines for attendant care.

TAC attendant care policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/attendant-care

TAC attendant care provider guidelines

https://www.tac.vic.gov.au/providers/working-with-tac-clients/guidelines/provider-guidelines/attendant-care-provider-guideline

*

Case management declaration

Please provide the details of one TAC client you intend to work with:

TAC client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

TAC client claim number *

TAC client date of birth *

I have read and accepted the information provided in the TAC policies and provider guidelines for case management.

Case management policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/supporting/schedule-2-authorised-disability-services

Case management provider guidelines

https://www.tac.vic.gov.au/providers/working-with-tac-clients/guidelines/provider-guidelines/case-management-guidelines

*

Client Independent Skills Services declaration

Please provide the details of one TAC client you intend to work with:

TAC client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

TAC client claim number *

TAC client date of birth *

I have read and accepted the information in the TAC policies and provider guidelines for attendant care, which covers Client Independent Skills Services information.

Attendant care policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/attendant-care

Attendant care provider guidelines

https://www.tac.vic.gov.au/providers/working-with-tac-clients/guidelines/provider-guidelines/attendant-care-provider-guideline

*

Community access planning declaration

Please provide the details of one TAC client you intend to work with:

TAC client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

TAC client claim number *

TAC client date of birth *

I have read and accepted the information in the TAC policies for community access support services.

Community access support services policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/community-access-support-services

*

Community group programs declaration

Please provide the details of one TAC client you intend to work with:

TAC client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

TAC client claim number *

TAC client date of birth *

I have read and accepted the information in the TAC policies and provider guidelines that relate to community group programs.

Schedule 2 authorised disability services policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/supporting/schedule-2-authorised-disability-services

Community group program provider guidelines

https://www.tac.vic.gov.au/providers/working-with-tac-clients/guidelines/provider-guidelines/community-group-program-provider-guideline

*

NOT USEDMultiple and complex needs model declaration

Please provide the details of one TAC client you intend to work with:

TAC client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

TAC client claim number *

TAC client date of birth *

I have read and accepted the information in the TAC policy that relates to the multiple and complex needs model.

Schedule 2 authorised disability services policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/supporting/schedule-2-authorised-disability-services

*

Assertive outreach declaration

Please provide the details of one TAC client you intend to work with:

TAC client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

TAC client claim number *

TAC client date of birth *

I have read and accepted the information in the TAC policy and provider guidelines that relate to assertive outreach services.

Schedule 2 authorised disability services policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/supporting/schedule-2-authorised-disability-services

Outreach service provider guidelines

https://www.tac.vic.gov.au/providers/working-with-tac-clients/guidelines/provider-guidelines/outreach-service-provider-guidelines

*

Respite declaration

Please provide the details of one TAC client you intend to work with:

TAC client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

TAC client claim number *

TAC client date of birth *

I have read and accepted the information in the TAC policy that relates to respite services.

Schedule 2 authorised disability services policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/supporting/schedule-2-authorised-disability-services

*

Supported employment services declaration

Please provide the details of one TAC client you intend to work with:

TAC client full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client? *

TAC client claim number *

TAC client date of birth *

I have read and accepted the information provided in the TAC policies and provider guidelines for supported employment services.

Supported employment services policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/supported-employment-service

Supported employment services provider guidelines

https://www.tac.vic.gov.au/providers/working-with-tac-clients/guidelines/provider-guidelines/supported-employment-service-guidelines

*

Shared supported accommodation declaration

Is this shared supported accommodation for the same client/injured worker you entered for attendant care or respite? *

YesNo

Please provide the details of one TAC client or WorkSafe injured worker you intend to work with:

Client/injured worker full name *Please enter your client's name and at least one other point of ID (claim number or date of birth).

What other ID can you provide for this client/injured worker? *

Client/injured worker claim number *

Client/injured worker date of birth *

I have read and accepted the information provided in the TAC policies and provider guidelines for shared supported accommodation.

Shared supported accommodation policy

https://www.tac.vic.gov.au/clients/how-we-can-help/treatments-and-services/policies/supported-accommodation

Shared supported accommodation provider guidelines

https://www.tac.vic.gov.au/providers/working-with-tac-clients/guidelines/provider-guidelines/supported-accommodation-provider-guideline

*

Disability service provider details

Is this disability service provider a *

PersonOrganisationBoth

First name *

Last name *

Australian Business Number (ABN) *

Entity name linked to your ABN *

Trading name (if different to entity name)

Email *The TAC will use this email address to send you a copy of your completed form and for any further correspondence related to your application.

Phone number *

Website

Service provider address *

Street name and number *

City *

State *

Postcode *

Organisational head details

Title *

First name *

Last name *

Email *

Phone number *

Secondary contact details

Title

First name

Last name

Role

Email

Phone number

Service areas and specialties

Service areas (regions, towns etc.)

Languages spokenPlease indicate if you have support workers available that speak a language other than English, and which languages.

Specialty supports or services you provide (e.g. mental health, behaviours of concern etc.)

Your privacy

Any information the TAC collects in this form will be used in accordance with the Privacy and Data Protection Act 2014. We will use this information to begin the TAC provider registration process for providers of disability services for TAC clients and/or WorkSafe injured workers.

As a registered WorkSafe Victoria Agent, where required, we will collect information on behalf of WorkSafe Victoria to register a provider for attendant care and shared supported accommodation services.

Without this information, the TAC is unable to register a provider for disability services under the Victorian Social Services Regulator’s requirements.

We may use this information to contact you, provide general TAC news and information and for reasonable secondary purposes.

The TAC may also be required by law to disclose this information.

For more information, please see our Privacy policy.

Disability service provider declarations

Please declare any current or anticipated events, matters or circumstances that may impact the operations of your organisation or the delivery of disability services applied for (including financial and legal)For example, merger acquisitions

I agree to the TAC and WorkSafe Victoria disability service provider registration requirements. *

Name of person completing this form *

Position *

Before you begin

The Victorian Social Services Regulator

Disability service type

***Att care for WorkSafe only***

WorkSafe attendant care declaration

***Att care for TAC***

TAC attendant care declaration

Case management declaration

Client Independent Skills Services declaration

Community access planning declaration

Community group programs declaration

NOT USED***Multiple and complex needs model declaration***

Assertive outreach declaration

Respite declaration

Supported employment services declaration

Shared supported accommodation declaration

Disability service provider details

Organisational head details

Secondary contact details

Service areas and specialties

Your privacy

Disability service provider declarations

TAC and WorkSafe Victoria disability service provider registration requirements

Att care for WorkSafe only

Att care for TAC

NOT USEDMultiple and complex needs model declaration