Application for Higher Accommodation Supplement for Significantly Refurbished
Service
Application Type
Is this an application for pre-approval or final approval? Pre-Approval / Final
If an application for a final approval, did you receive pre-approval? Yes / No. If Yes, enter
approval reference number.
If application for pre-approval, complete remainder of form on basis of expected responses once refurbishment is
completed.
If you are a newly built service completed on or after 20 April 2012, you automatically qualify for the higher
accommodation supplement and do not need to complete this form. See Guidelines for further information.
Giving false or misleading information is a serious offence - S137.1 Criminal Code Act 1995
Applicant Information / Details
Name of Residential Care Service
RACS ID
Address for Correspondence
Approved Provider and ABN
Contact Person
Contact Phone and Email
Key Personnel Signature / Details
Name of Applicant:
Position:
Signature:
Date:
Assessment against criteria specified in 22A.8(3) of the Subsidy Principles 2013
The criteria that must be met for a refurbishment to qualify as a ‘significant refurbishment’ are set
out in 22A.8(3) of the Subsidy Principles 2013. Please refer to the Significant Refurbishment
Guidelines if necessary for assistance in completing this application.
Criteria / Provider Self- Assessment
1. When did the refurbishment commence? Enter date
2. When was the refurbishment you are claiming suitable for occupancy? Enter date
3. Is the refurbished service significantly different in form, quality or
functionality? Yes / No
4. Are a significant proportion of the refurbished areas for the use of residents?
5. Does the refurbishment provide significant benefits to supported* residents? Yes / No
6. What is the cost of the refurbishment that has been completed? Yes / No
7. a) Does the cost include an amount relating to upgrading the facility to meet
safety requirements of a Commonwealth, State or Territory law?
b) If yes, what is the actual or estimated cost of that safety work? Enter amount
8. Is the eligible* cost of the refurbishment at least equal to the amount worked out by
multiplying 40% of the number of operational places (the lower of the before or after
refurbishment number) by $25,000
9. Do you confirm that relevant costs have been, or will be, capitalised in accordance with
Australian Accounting Standards?
10. Have at least 40% of residents benefited from a significantly refurbished room?
or
b) If ‘a’ above does not apply, does the refurbishment otherwise provide significant benefit
to at least 40% of residents?
or
Does the refurbishment consist of an extension increasing the number of operational places
by at least 25%?
11. Is the proportion of the number of places available for supported* residents after the
refurbishment at least equal to that number before the refurbishment?
12. Does the refurbishment consist only of routine repairs, maintenance or furniture
replacement?
Note:
1) Where the refurbishment includes any work (eg: installation of fire sprinklers) undertaken to upgrade the facility to
meet safety requirements of a Commonwealth, State or Territory law (a ‘safety law’) that work cannot be used to meet
the significant refurbishment criteria in questions 3, 4, 5, 10 or 11. Instead other ‘significant refurbishment’ work must
be undertaken that meets those criteria. However, in determining the ‘eligible cost’ for whether a refurbishment has
met the minimum monetary threshold (question 8) an amount relating to such costs may be included not exceeding 1/3
of those estimated costs. For example, where a refurbishment costs $1,200,000 including
$300,000 for required sprinkler installation the ‘eligible cost’ for Question 8 is reduced to $1,000,000 as only $100,000
(1/3 of $300,000) is counted as eligible).
2) *supported resident includes concessional and assisted residents – refer Guidelines for further information.
Supporting Statement
Describe in general terms the refurbishment work that has been undertaken, noting work
undertaken to resident rooms (including number of rooms affected), to common areas for
residents and to areas not used by residents. Describe how the refurbishment has benefited
supported* residents. (Please attach typed description. As a guide description would normally
be 1-2 pages in length and follow the following format)




Work undertaken to resident rooms and number of beds/rooms affected
Work undertaken to common areas
Work undertaken to areas not used by residents
How do supported* residents benefit from the refurbishment? Describe any aspects or
parts of the refurbishment that are not for the benefit of supported* residents.
Note: If you have already provided this information in a pre-approval request it need not be supplied again for a final
approval but information explaining any material differences in the completed work must be attached (see below).
Supporting Information
Have you attached the following documents?
Relevant project plans and site, floor and building plans: Yes / No
If you previously received a pre-approval, a statement explaining any material differences
between the originally proposed refurbishment and the final refurbishment: Yes / No
Forward the completed application (pages 1 to 3), and any supporting documentation to:
Department of Social Services
MDP 454
GPO Box 9848
CANBERRA ACT 2601
Enquiries
Should you require additional information concerning this application form, please contact the Department
of Social Services by:
Telephone: (02) 6289 xxxx or E-mail at: TBA