Government of Western Australia
Department of Transport
Last Updated: 01.12.2023
Application for the Taxi User
Subsidy Scheme
ODT47
When blank, this form is classed as OFFICIAL, when completed, this form is classed as OFFICIAL SENSITIVE
The Taxi User Subsidy Scheme (TUSS) provides taxi travel at a reduced rate for people who have a severe and permanent disability that will
always prevent them using conventional public transport. This application has two parts, Part A and Part B. Both parts must be fully completed for
your application to be assessed. Incomplete applications will be returned with an explanation letter and must be resubmitted for assessment.
APPLICANT INFORMATION
To be eligible for TUSS, you must:
• be an Australian citizen or permanent visa holder (i.e. be a
permanent resident of Australia);
• reside permanently in Western Australia;
• have a severe and permanent disability that will always prevent
you using conventional public transport (like a bus service); and
• have a disability that falls within the categories below.
MOBILITY DISABILITY
When considering eligibility for the scheme under this criterion,
factors such as the need to use a wheelchair, walking aid or mobility
scooter and how the person’s disability impacts on their functional
capacity to use public transport, such as a bus, will be taken into
account. All the functional questions on page 3 must be completed.
The person’s functional capabilities must also be supported by
medical evidence provided by their doctor.
VISION DISABILITY
To be eligible for the scheme under this criterion the applicant must
be diagnosed as legally blind. To support this, information such as
an Ophthalmologist’s report or documentation of their visual acuity
readings using the Snellen scale, supporting their legal blindness
diagnosis, must be included.
COGNITIVE / INTELLECTUAL DISABILITY
For the purposes of this scheme, a severe cognitive impairment/
function relates to the mental processes of comprehension,
judgement, memory and reasoning, which aect a person’s ability
to plan and
nd their way around independently in the community.
Generally, this criterion applies to a person who does not have the
cognitive ability to use public transport, such as a bus, by themself.
PLEASE NOTE:
People may apply for TUSS under more than one category. If there
are multiple disabilities, it is important to include information on
all medical conditions. Each application is considered individually,
based on the condition(s) severity and how a person’s functional
capacity to use public transport is aected. Children under the
age of 10 are not eligible, unless they require use of a wheelchair.
Temporary participation in TUSS may be granted for a specied
period of 12 months or more, after which re-assessment of eligibility
will be required.
FACTORS THAT WILL NOT BE CONSIDERED INCLUDE:
• Anti-social behaviour.
• Vision impairment, but not legally blind.
• Mobility problems that are episodic, whereby some days are
considered bad days.
• Availability of, or proximity to, public transport.
• Length of bus journey, having to catch two or more buses, or
inconvenient timetables.
• Social / employment factors.
• Climatic / environmental factors.
• Personal security issues.
• Income levels.
• Eligibility for other subsidy or pension schemes (including
Veterans’ Aairs).
HOW TO APPLY
If you believe you may be eligible from the criteria listed, please
follow these steps:
• Complete Part A of the application, and sign the Declaration.
• Attach proof that you reside in Western Australia such as:
◦ Current Australian Pensioner Concession Card displaying
current residential address; or
◦ Current WA driver’s licence displaying current residential
address; OR
◦ Current WA Photo Card displaying current residential
address.
A full list of acceptable documentation is available on the DoT
website: www.transport.wa.gov.au/tussapply
• Obtain a colour photograph of yourself. The image should show
the applicant facing the camera and be from the chest up, and not
be more than 12 months old.
• Book an appointment with your medical practitioner.
• Take the completed form and photograph to your appointment
with your medical practitioner, who must complete Part B of the
application form and certify the back of the photograph. The same
medical practitioner completing your application must also certify
the photograph.
• Send your completed application form, certied photograph, and
proof of residential address to:
On-demand Transport – TUSS
GPO Box R1290
PERTH WA 6844
PLEASE NOTE
• All phone numbers must have 10 digits. When completing your
application, please include the area code at the beginning of
landline numbers.
• For the purpose of determining your eligibility for TUSS, the health
information provided in your application may be disclosed on a
condential basis to an Occupational Therapist contracted by DoT
for that purpose.
MORE INFORMATION
For any queries or if you are having diculty completing this form,
please contact On-demand Transport by email
or by telephone 13 11 56.
TTY: If you are hard of hearing, or have a speech impediment,
please contact the National Relay Service on 13 36 77 and quote the
telephone number (08) 9216 8000.
Information is also available on the Department of Transport website
www.transport.wa.gov.au/TUSS
PART A: To be completed by the applicant and / or Next of kin / Carer
APPLICANT DETAILS
MR MRS MS MISS OTHER
IF OTHER, PLEASE SPECIFY
SURNAME
FIRST NAME
OTHER GIVEN NAMES
DATE OF BIRTH
/ /
GENDER
Male Female X*
* For details about the documents required when X is selected visit:
www.transport.wa.gov.au/licensing/change-my-gender.asp
RESIDENTIAL ADDRESS
SUBURB
STATE
W A
POST CODE
Postal address is the same as residential address.
POSTAL ADDRESS (IF APPLICABLE)
SUBURB
STATE
W A
POST CODE
PHONE NUMBER MOBILE NUMBER
EMAIL ADDRESS
NAME OF RESIDENTIAL CARE FACILITY (IF APPLICABLE)
NATIONAL DISABILITY INSURANCE SCHEME (NDIS)
NUMBER (IF APPLICABLE)
Are you a permanent resident of Western Australia?
Yes No
You must attach proof that you are currently residing in WA.
These documents will also be used to validate your identity for
TUSS purposes.
For a list of acceptable forms of proof of residence, visit
www.transport.wa.gov.au/tussapply
NEXT OF KIN DETAILS
SURNAME
OTHER GIVEN NAMES
HOME / WORK PHONE NUMBER
MOBILE NUMBER
EMAIL ADDRESS
RELATIONSHIP TO THE APPLICANT
CARER / OTHER CONTACT DETAILS
SURNAME
FIRST NAME
OTHER GIVEN NAMES
HOME / WORK PHONE NUMBER
MOBILE NUMBER
EMAIL ADDRESS
RELATIONSHIP TO THE APPLICANT
PREFERRED CONTACT
FIRST NAME
Who is your preferred contact for TUSS-related matters?
Participant Next of kin Carer / other contact
2
ABOUT THE APPLICANT
Do you hold / have you ever held a WA driver’s licence?
Yes No
If yes, what is / was your current or previous driver’s licence number?
Are you able to independently use public transport (without
assistance from another person)?
Always Usually Sometimes
It depends Never
If you selected sometimes, it depends or never, please explain why
you have diculty.
What is your approximate independent walking distance in metres
(without assistance from another person, rest breaks allowable)?
Do you use a walking / mobility aid?
Yes No
Can you manage vertical steps independently?
Yes
No
What functional / health problems limit your ability to manage steps
and why?
Can you move independently from sitting to standing and vice versa?
Yes No
Please attach a colour photograph of the applicant.
The back of the photo must be certied by the medical practitioner
that completes Part B of application (example shown below, right).
APPLICANT PHOTO
Please attach a
COLOUR, signed
and certied photo of
applicant.
DO NOT USE GLUE,
TAPE OR PUT A
STAPLE OVER THE
FACE.
BACK OF PHOTO
EXAMPLE
I certify that this is a
true photograph of:
APPLICANT’S FULL
NAME
[Medical practitioner’s
signature]
Date __ / __ / ____
Ensure the photograph is of high quality, showing the applicant
facing the camera and from the chest up. The photo will be
scanned and used on the TUSS participant card if the application is
successful.
APPLICANT PHOTOGRAPH
COMMUNICATION METHODS
If your application is successful, DoT will communicate important
information about your TUSS participation via mail and email.
Separately to this, we may also email you tips, reminders and other
educational messaging related to being a TUSS participant. Please
read the DoT Privacy Policy at
https://www.transport.wa.gov.au/aboutus/our-website.asp and
indicate your agreement with the statements below.
I agree to receive educational messaging via email.
I have read and agree to the terms and conditions in the DoT
Privacy Policy.
DECLARATION
If you are unable to sign this document, your carer / next of kin can
sign on your behalf. If this is not a suitable option for you, you may
tick the box at the bottom of the page to indicate your agreement with
the declaration.
• I certify that the information I have provided is true and correct.
• I consent for the Department of Transport (DoT) to use the
contact details I have provided on this form for all DoT dealings.*
• I authorise my medical practitioner(s) to provide the relevant
medical, psychiatric or allied health information required by DoT
for the assessment of this application.
• If this application is approved, I undertake to observe the
conditions of participation in the Scheme and acknowledge that
any misuse of the concession provided may lead to cancellation
of membership and/or legal action or other penalties imposed by
DoT.
• I hereby authorise DoT and/or its employees to contact my
medical practitioner(s) in regards to this application for the
purpose of obtaining information to support this application.
• I consent to DoT disclosing the health information provided in my
application to a third party Occupational Therapist contracted by
DoT for the purpose of determining my eligibility for TUSS.
• I understand that my application will be returned to me if
incomplete.
* DoT administers a range of licences and services, including driver’s
licences; vehicle licences; the Taxi User Subsidy Scheme; WA photo
cards; o-road vehicle registration; learner’s permits; extraordinary
licences; recreational skippers tickets; and boat registration.
TUSS APPLICANT’S SIGNATURE
(or other person authorised to sign if applicant is unable to sign)
DATE SIGNED
/ /
If signed by other person, please print your full name.
FULL NAME OF AUTHORISED OTHER PERSON
SOURCE OF AUTHORITY IF SIGNED ON APPLICANT’S BEHALF:
Power of Attorney Guardianship Order
Other (please specify)
I am unable to sign this form. By ticking this box, I agree with
the declaration above.
Note: if you tick this box, DoT may need to contact you to conrm
your declaration and any changes to your details.
Signature alternative
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PART B: To be completed by your medical practitioner
The Taxi User Subsidy Scheme (TUSS) is available to people who have a severe and permanent disability that will always prevent them from using
conventional public transport. Please complete all sections relevant to the applicant and certify the back of the applicant’s photograph as shown.
APPLICANT DETAILS
NAME OF APPLICANT
CURRENT AGE OF APPLICANT
MOBILITY DISABILITY
DIAGNOSIS ONE: CURRENT CONDITION AFFECTING MOBILITY
CONDITION
DATE OF ONSET
/ /
What are the functional mobility issues relating to this diagnosis that
aect the applicant’s use of public transport?
Is the applicant undergoing any treatment or rehabilitation to
improve their functional mobility?
Yes No
If yes, please give details of the current treatment or rehabilitation.
The condition is likely to
Deteriorate Improve Stay the same
If the applicant’s condition is likely to improve, when do you expect
the person to have stabilised or regained enough function to use
conventional public transport?
months
DIAGNOSIS TWO: CURRENT CONDITION AFFECTING MOBILITY
CONDITION
DATE OF ONSET
/ /
MOBILITY DISABILITY
What are the functional mobility issues relating to this
diagnosis that aect the applicant’s use of public transport?
Is the applicant undergoing any treatment or rehabilitation to
improve their functional mobility?
Yes No
If yes, please give details of the current treatment or
rehabilitation.
The condition is likely to
Deteriorate Improve Stay the same
If the applicant’s condition is likely to improve, when do you expect
the person to have stabilised or regained enough function to use
conventional public transport?
months
DIAGNOSIS THREE: CURRENT CONDITION AFFECTING
MOBILITY
CONDITION
/ /
DATE OF ONSET
What are the functional mobility issues relating to this diagnosis that
aect the applicant’s use of public transport?
4
MOBILITY DISABILITY
Is the applicant undergoing any treatment or rehabilitation to
improve their functional mobility?
Yes No
If yes, please give details of the current treatment or rehabilitation.
The condition is likely to
Deteriorate Improve Stay the same
If the applicant’s condition is likely to improve, when do you expect
the person to have stabilised or regained enough function to use
conventional public transport?
months
OTHER RELEVANT MEDICAL HISTORY WHICH IMPACTS ON
PUBLIC TRANSPORT USE
CONDITION
DATE OF ONSET
/ /
IMPACT ON MOBILITY
CONDITION
DATE OF ONSET
/ /
IMPACT ON MOBILITY
CONDITION
DATE OF ONSET
/ /
IMPACT ON MOBILITY
MOBILITY DISABILITY
ASSISTANCE REQUIREMENTS
Does the applicant use a walking aid?
Yes No
If yes, please specify
Walking frame / rollator Tripod / quadcane
Crutches Walking stick
Other
Does the applicant require assistance from another person for all
mobility?
Yes No
If yes, please describe the type / level of assistance required.
Does the applicant use a wheelchair or mobility scooter?
Yes No
If yes, please specify
Manual wheelchair Electric wheelchair
Mobility scooter
How often is the wheelchair / mobility scooter used?
Always Occasional use
Outside use / long distance only
How does the applicant use the wheelchair / mobility scooter?
Independently (travels alone) With assistance
VISION DISABILITY
SPECIFIC DIAGNOSIS OF VISUAL IMPAIRMENT
What is the applicant’s best corrected visual acuity using the
Snellen scale?
LEFT EYE RIGHT EYE
Please give details of any visual loss (total diameter of eld
remaining) in degrees.
LEFT EYE RIGHT EYE
Does the applicant meet the eligibility criteria for legal blindness?
Yes No
If yes, please provide photocopies of documentation to support
legal blindness.
5
COGNITIVE / INTELLECTUAL DISABILITY
CONDITION
DATE OF ONSET
/ /
What are the cognitive impairments relating to this diagnosis that
aect the applicant’s use of public transport?
Is the applicant undergoing any treatment or rehabilitation to
improve their cognitive / intellectual disability??
Yes No
If yes, please give details of the current treatment or rehabilitation.
What is the applicant’s level of cognitive / intellectual disability?
Mild Moderate Severe
Would the applicant require the constant assistance of another
person to use a bus?
Yes No
Please supply relevant information to support the level of cognitive
disability, for example:
• Mini Mental State Examination (MMSE) score;
• NDIS report (or section);
• Aged Care Assessment Team report; or
• other relevant report / evidence, as determined by the medical
practitioner.
PUBLIC TRANSPORT USE
Does the applicant’s disability prevent them from independently
using a conventional public transport service?
Yes, always No it does not
Yes, sometimes /
mostly
Do not know, unsure of
impact
FURTHER INFORMATION
Please provide any other information which you feel will be of
assistance to our assessors in making a determination.
MEDICAL PRACTITIONER DETAILS
Please print clearly or use a practitioner’s stamp.
I have examined the applicant and certify that to the best of my
knowledge, the information provided is true and correct.
MEDICAL PRACTITIONER’S FULL NAME
ADDRESS
SUBURB
STATE
POST CODE
PHONE NUMBER
AUSTRALIAN HEALTH PRACTITIONER REGULATION
AGENCY REGISTRATION NUMBER
SIGNATURE
PLEASE ENSURE YOU HAVE CERTIFIED THE BACK OF THE
APPLICANT’S PHOTOGRAPH.
APPLICATION CHECKLIST
Part A: all required fields completed.
Part A: attach documentation proving your identity and that
you reside in Western Australia.
Part A: colour photograph and attached and signed by
medical practitioner.
Part A: declaration ticked or signed
Part B: all required fields completed.
Part B: Medical practitioner declaration signed.
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