Life Support Concession & Machine Notification
The Life Support Concession assists Victorian Households who hold a valid concession card with electricity costs where a member of the household uses an eligible life support machine. Non-concession households where a member of the household uses a life support machine should complete this form to notify their electricity retailer and/or water corporation that they have the machine present in their home. Please see the back of this form for eligibility criteria.
I have the following type of machine (please )
Eligible for an electricity and water concession
Continuous positive airways pressure (CPAP) machine
If you pay a caravan park or retirement village for your electricity, please contact the Concessions Information Line on 1800 658 521
Ventolin nebuliserOthers (please specify)
Water details (haemodialysis machines only)
I certify that the machine indicated is/will be installed in the
Pensioner Concession Card (Centrelink or Veterans' Affairs)
(NB: Commonwealth Seniors Health Cards, Child Disability and
Foster Care Health Care Cards, and Veterans’ cards marked ‘Dependent’ are not eligible)
Application form return details Please return this form to your electricity retailer and/or water corporation. Addresses are located on the back of this form. Please notify the electricity retailer and/or water corporation when the machine has been removed.
other details as they pertain to my concessional entitlement. This
This information is collected by the DHS Concessions Unit and your
involves electronically matching details I have provided to DHS and my
electricity retailer/distributor and/or water corporation for the purpose
electricity retailer/distributor and/or water corporation with Centrelink or
of administering your concessions. Without this information, we are
Department of Veterans’ Affairs (DVA) records to confirm whether or not I
am currently receiving a Centrelink or DVA benefit.
Your information will be disclosed to your electricity retailer/distributor
I understand that this consent, once signed, is effective only for the
and/or water corporation to enable them to process your concession.
period I am a customer of my electricity retailer/distributor and/or water corporation. I also understand that this consent, which is ongoing,
You are able to request access to the personal information that we
can be revoked any time by giving notice to my electricity retailer/
hold about you, and to request that it be corrected if necessary. Please
contact the Concessions Information Line on 1800 658 521 with any queries about this statement.
I understand that if I withdraw my consent, I may not be eligible for the concession provided by DHS and my electricity retailer/distributor
I authorise Centrelink to confirm with the Department of Human Services (DHS) and my electricity retailer/distributor and/or water
corporation the current status of my Commonwealth Benefit and
at least 1,880 kilowatt hours of electricity
• If you or someone in your household uses
a life support machine, this form is used
to notify your electricity retailer and/or water
corporation of the presence of the machine, to
The discount is equal to the cost of 1,880
ensure you are notified prior to any withdrawal
electricity used each year, calculated using the
general domestic tariff of your electricity retailer.
For haemodialysis machines a discount is
• If the electricity/water account holder has an
available on both your electricity and water bills.
eligible concession card, and the life support
The discount on your water bil is equal to the
machine used is an eligible machine, you can
cost of 168 kilolitres (42 kilolitres per quarter)
also claim a concession on your electricity
Please send your form to your electricity
retailer or water corporation. Addresses for
• Pensioner Concession Card – issued
• Department of Veterans’ Affairs Gold Card
(cards marked ‘Dependent’ are not eligible)
Red Energy Medical Cooling Administrator
Commonwealth Seniors Health Cards, Victorian
Seniors Card, Child Disability and Foster Care
Health Care Cards and Medicare Cards are not
medical practitioner to complete the doctor’s/hospital section.
What machines are eligible for a concession?
For further information, please contact your
Your hospital social worker or doctor must
electricity retailer and/or water corporation,
or call the Concessions Information Line on
confirm the installation of the machine.
For multilingual information, please call
the Translating and Interpreting Service
• Intermittent peritoneal dialysis machine
Eligible machines are those that consume
Ark Pharm, Inc. MATERIAL SAFETY DATA SHEET 1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION MSDS Name: Tretinoin CAS Number: 302-79-4 Catalog Numbers: AK-73126 Company Identification: 2. COMPOSITION, INFORMATION ON INGREDIENTS Molecular Formula: Molecular Weight: Component Concentration CAS Number 3. HAZARDS IDENTIFICATIONEMERGENCY OVERVIEW 3.1 Cla
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