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This service agreement is for a participant in the National Disability Insurance Scheme
participant's NDIS no:
Date of Birth:
This agreement is made between: Participant/Participant’s representative
Provider The NDIS and this Service Agreement This Service Agreement is made for the purpose of providing supports under the Participant’s National Disability Insurance Scheme (NDIS) plan. A copy of the Participant’s NDIS plan may be attached to this Service Agreement. The Parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to; • Support the independence and social and economic participation of people with disability, And • Enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports. Responsibilities of Provider The Provider agrees to: • Review the provision of supports with the Participant regularly as required • Communicate openly and honestly in a timely manner • Treat the participant with courtesy and respect • Consul the Participant on decisions about how supports are provided • Give the Participant information about managing any complains or disagreements and details of the provider’s cancellation policy. • Listen to the Participant’s feedback and resolve problems appropriately. • Give the Participant a minimum of 24 hours’ notice if the Provider has to change a scheduled appointment to provide supports except in the instance of sudden illness of the worker. • Give the Participant the required notice if the Provider needs to end the Service Agreement (see Cancellation Policy below for more information) • Protect the Participant’s privacy and confidential information. • Provide supports in a manner consistent with all relevant laws, including the National Disability Insurance Scheme Act 2013 and rules and the Australian Consumer Law; keep accurate records of supports provided to the Participant, and • For self-managing participants issue regular invoices and statements of the supports delivered to the Participants Responsibilities of Participants / Participant’s representative The Participant/ Participant’s representative agrees to: • Inform the Provider about how they wish the supports to be delivered to meet the Participant’s needs • Treat the Provider with courtesy and respect • Talk to the Provider if the Participant has any concerns about the supports being provided • Give the Provider a minimum of 24 hour’s notice if the Participant cannot make a scheduled appointment; and if the notice is not provided by then, the Provider’s cancellation policy will apply. • Give the Provider the required notice if the Participant needs to end the Service Agreement (see cancellation Policy below for more information), and • Let the Provider know immediately if the Participant’s NDIS plan is suspended or replaced by a new NDIS plan of the being a participant in the NDIS.
Payments The Provider will seek payment for their provision of supports after the delivery. (One or more of the below paragraphs may apply. Cross – out those that do not apply.) Funding managed by Participant/ Nominee – The Participant has chosen to self-manage the funding for NDIS supports provided under this Service Agreement. Please list Name and Address for payment of invoices: Name : Email Address: Funding managed by the NDIA – the Participant has nominated the NDIA to manage the funding. After providing support the Provider will claim payment for those supports from the NDIA. Funding managed by a Registered Plan Management Provider – the Participant has nominated Registered Plan Management provider to manage funding under this Service Agreement. Please list Name and Address for payment of invoices: Name : Email Address: Changes to this Service Agreement If changes to the supports or their delivery are required, the Parties agree to discuss and review this Service Agreement. The Parties agree that any changes to this Service Agreement will be in writing, signed, and dated by the Parties. Ending this Service Agreement Should either Party wish to end this Service Agreement they must give 1 month notice in writing. If either Party seriously breaches this Service Agreement the requirement of notice will be waived. Cancellations and ‘no shows’ scheduled supports Ability Matters will work hard to minimise the risk of cancellation, no show or late change to a scheduled support but acknowledges that this may happen. When this occurs Ability Matters will work in conjunction with you to see if the supports can be rescheduled safely. Both Ability Matters and the participant agree to provide as much advance notice of changes as possible. Ability Matters is able to claim 100% of the agreed fee associated with he support from the NDIS participant’s plan, provided that all the following conditions are met: If a participant, or their family or carer on their behalf , agree there was an unforeseen circumstances that resulted in a short-notice cancellation, such as: - doesn’t show up for a scheduled support within a reasonable time or; - is not present at the agreed place within a reasonable time when Ability Matters’ staff is travelling to deliver the support and or; - has given less than 2 (two) days’ notice for a support. No fee is payable by NDIS, or the participant, for cancellation by Ability Matters or any failure to deliver the agreed supports. Hours of work At Ability Matters, we require a minimum 2 hours of work per shift. Provider travel to provide a support Where the participant’s support is likely to be delivered by a support worker who needs to travel to a participant (either from the providers place of business or between one participant and the next) to deliver a support of less than four hours, the first hour of support will include an allowance for travel with forty minutes being for direct service delivery and the first twenty minutes of the hour allowed as travel.
Feedback, complaints and disputes If the Participant wishes to give the Provider feedback, the Participant can talk to Ability Matters’ Directors on Mobile no: 0426 747 292 or 0434 255 833 or email: admin@abilitymatters.info If the Participant is not happy with the provision of supports and wished to make a complaint, the Participant can talk to Ability Matters’ Directors on mobile no: 0426 747 292 or 0434 255 833 or email: admin@abilitymatters.info If the Participant is not satisfied or does not want to talk to this person, the Participant can contact the National Disability Insurance Agency by calling 1800 800 110, visiting one of their offices in person, or visiting www.ndis.gov.au for further information. You may also want to call the NDIS Quality and Safeguards Commission at 1800 035 544 or visiting www.ndiscommission.gov.au for further information. Goods and services tax (GST) For the purpose of GST legislation, the Parties confirm that: • A supply of supports under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the National Disability Insurance Scheme Act; • The Participant’s NDIS plan is expected to remain in effect during the period the supports are provided; and • The Participant / Participant’s representative will immediately notify the Provider if the Participant’s NDIS plan is replaced by a new plan or the Participant stops being a participant in the NDIS.
Contact details The Participant / the Participant’s representative can be contacted on:
Phone (B/H)
Phone (A/H)
Mobile
Phone (A/H)
Address
Alternative Contact Person/Mobile (A/H)
The Provider can be contacted on:
Phone (B/H)
Phone (A/H)
Mobile
Phone (A/H)
Address
Alternative Contact Person/Mobile (A/H)

Schedule of Supports The supports and their prices are set out in the attached Schedule of Supports. All prices are GST inclusive (if applicable) and include the cost of providing the supports. Additional expenses (i.e. things that are not included as part of a Participant’s NDIS supports) are the responsibility of the Participant/Participant’s representative and are not included in the cost of the supports. Examples include entrance fees, event tickets, meals, etc. Additional Expenses Cost Travel in Ability Matters’ or Ability Matter’s staff vehicle @ $1/km Cost of Activity @ cost Service Booking For support to commence and payment requests to be made a Service Booking needs to be created, please select one of the following: Participant/Participant’s representative nominate Ability Matters to create a Service Booking. Participant/Participant’s representative will create a Service Booking. Information collection and access (Consent form) We collect information about you for the primary purpose of providing quality supports and services to you. We need to collect some personal information from you to ensure our services meet your needs. If you do not provide this information, we may be unable to fully provide these services. This information will also be used for: a. administrative purposes for running our service b. billing you directly, through the NDIS, or other agency if required c. use within our service to ensure you are provided with quality supports and services d. disclosure of information to the NDIA, the NDIS Quality and Safeguards Commission, or other government agencies if needed e. disclosure of information to health professionals to ensure high quality health care for you if needed f. disclosure to other providers, with your consent, in order to provide appropriate services. We do not disclose your personal information to overseas recipients. We have a privacy policy that is available on request. That policy provides guidelines on the collection, use, disclosure and security of your information. To ensure the process of quality supports and services, information about you may be given to other service providers who also provide you services. I consent to provide my personal information to Ability Matters for the purposes outlined above. I give consent for my personal information to be shared with the following people/organisations:

Agreement signatures The Parties agrees to terms and conditions of this Service Agreement.
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Signature of Participant / Participant’s representative
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