Application for External Review by the Information Commissioner

Section 1: Details
Do you require special assistance when communicating with us? If so, please select:
One file only.
2 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx.
Does this person know you have submitted this application on their behalf?
Please tick which of the following describes your application (you may tick more than one option):
We must receive this application within 40 working days of the date the agency made a formal decision or we may not be able to help you. If we cannot help you, we will let you know what your other options are.
How did you receive the decision?
Note: If you have sought a review with NCAT, the IPC cannot review the same decision. You must seek an internal review before coming to us unless you are the person who asked for the information.
The following section of this form will be removed and a copy provided to the Agency as part of the IPC’s notification of an application for external review. This is to assist the Agency in responding to the IPC’s external review.
It will assist the Information Commissioner to have your consent for this section of your application for external review to be provided to the agency so that the Commissioner can collect all of the information required to deal with your application.
Please confirm:

From June 2017, the IPC will be conducting a client satisfaction survey to find out how we can further improve our services. We may also report on the results of this survey.
After your external review has concluded, you may be randomly selected to be part of this voluntary survey. The survey will be sent to participants via an email from the IPC. Your personal details, and contact information provided in this form will be used to contact you for the IPC client satisfaction survey. Should you choose to complete the survey, we assure you that all comments you make will be completely confidential.
Should you prefer NOT to take part in the survey, you may be assured that your decision will in no way affect the services you receive from the IPC. You can choose to opt-out of participating in the survey by advising us via return email.

Section 2: Footnotes

It is not a requirement under the GIPA Act that you complete an application form when making an application for external review. This form is designed to assist you in providing the key information we might need to with application for external review.

Please refer to our fact sheet on external reviews here: http://ipc.nsw.gov.au/gipa-reviews.

Section 3: Other information
Maximum 3 files.
2 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx.

You can print and send this form and any attachments to us:
By email: ipcinfo@ipc.nsw.gov.au
By fax: (02) 8114 3756
By mail: GPO Box 7011, Sydney, NSW 2001
In person: Level 17, 201 Elizabeth Street, Sydney NSW 2000
Electronically: by selecting SUBMIT
Please keep a copy for your records.
For more information about the GIPA Act visit our website: www.ipc.nsw.gov.au

If you are deaf or you have a hearing or speech impairment, you can call us through the National Relay Service on 133 677, or if you would like the assistance of an interpreter, call us through the Translating and Interpreting Service on 131 450.
To assist us with processing your application the IPC requires that you include a copy of your original access application to the agency as well as a copy of the agency's notice of decision on your application with this application for external review by the IPC.
Please select upload to add supporting documents. This may include a copy of correspondence between you and the agency, your access application, the agency’s decision, your internal review application, and the agency’s decision on your internal review request.
We prefer to receive electronic copies of all documents wherever possible.

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