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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

Source: http://www.originenergy.com.au/files/VIC_Life_Support_Concession.pdf