NT Health Freedom of Information (FOI) Online Application Form

Information Act 2002, Section 18

Please complete this online form to apply under the NT Information Act 2002 to access records and information held by NT Health.

Privacy Statement: The Information Act 2002 (the Act) requires you to supply your name and address and sufficient details to identify the information you require. Your personal information will be collected, used and may be disclosed only in accordance with the Act to assist with your request.

Application fee

Application fee is dependent on what information you are seeking to access:

For your own information no application fee is required.
For government information and/or information that is not about you a $30 fee is required.
For a combination of personal and government information a $30 fee is required.

As per the above criteria, if an application fee is required, payment can be made with the Receiver of Territory Monies (RTM). Once payment is made, the RTM will provide you with a receipt number which you will need to enter when completing this form.

Please note your application will not be accepted until the application fee is paid and proof of receipt provided.

In some cases the application fee may be reduced or waived, however, you must request this via the Application for Reduction or Waiver form.

Proof of identification

Your proof of identification is required before your application will be accepted.

You will need to upload your identification document (e.g. either current passport, birth certificate, basics card or drivers licence is sufficient).
Please ensure the photo or scan of your ID is clearly readable.
File size must be under 2MB.

Detailed description of information sought

Your application should include sufficient details to identify the information sought, such as relevant date range, subject matter, people involved, hospital or health centre attended.

You will be able to directly type or paste this information into the below online form, or upload it as a one separate document, if necessary (limit one file of maximum 2MB).

Before you start your application

This online application form cannot be saved, therefore it is recommended you follow the above steps regarding the application fee, identification and description required before starting your online application.

For all queries regarding this application, please phone 08 8999 2880 or email foi@nt.gov.au

Start your FOI application

Applicant's details

Title *

First name *

Surname *

Phone number * Please include the area code for landlines:

Email *

Postal address *

Preferred contact method *

Date of birth If you are applying to access your information, please provide your date of birth (day/month/year).

Application details

Application type and fee * Please select the type of information you would like to access.

My own personal information only. No application fee required.
Government information and/or information that is not about me. $30 fee required, unless applied for reduction/waiver. (See above Application fee section for more details.)
Combination of my personal information and government information. $30 fee required unless applied for reduction/waiver. (See above Application fee section for more details.)

RTM receipt number for payment of application fee If a fee is due with your application (see above Application Fee section for more details), you must provide the RTM receipt number, otherwise your application will not be accepted until proof of receipt is provided.

Description of requested information * Provide as much detail below as possible about the information you seek. Eg: subject matter (what information you are requesting), dates created, people involved, hospital or health centre attended. Attach an additional document if necessary (in attachments section).

Preferred delivery method of requested information * Note: Processing fees may apply.

Electronic copy sent by email.
Hard copy sent by mail.
Examine record in person.

Processing fee * Once application is processed the Information & Privacy Unit will contact you to advise of the processing fee which may include costs for searching for and retrieving information, copying information and packaging materials for delivery. In some cases the processing fee may be reduced or waived, however you must request this for consideration via completing the Application for Reduction or Waiver form and attach it to your application.

I understand that I may have to pay a processing fee in relation to the application.

Attachments

Photo ID (required) *

Additional description (optional)

Fee reduction/waiver form (optional)

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