June 2020 | Version: 1
To be eligible for the Taxi Transport Subsidy Scheme you must:
Be a permanent resident of Australia;
Reside in NSW;
Not be a member of a similar scheme in another Australian state or territory;
Be over school age (preschool aged children, regardless of disability, are ineligible for inclusion
in the scheme); and
Have a severe and permanent disability in one of the specified categories listed below.
Criteria – Ambulatory / Mobility / Functional
(a) Unable to walk or stand. Mobile only with a wheelchair due to a physical disability; or
(b) Restricted to walking inside the home. Mobile outside of home only with a wheelchair due to a
physical disability; or
(c) Severe and permanent ambulatory problem that cannot functionally be improved which limits
walking to a distance of 20 metres or less without rest and also:
necessitates permanent use of a walking aid for all mobility; or
necessitates the constant assistance of another person for all mobility; or
is unable to independently ascend or descend three or more consecutive steps of 350mm
height; or
(d) Total and permanent functional loss of both upper limbs which renders the person incapable of
travelling on public transport without the constant assistance of another person.
Criteria – Visual Impairment
(a) Total loss of vision in both eyes or severe permanent impairment of 6/60 or less in each eye; or
(b) Field of vision reduced to 10
o
or less all round; or
(c) Total loss of lower half field of vision which cannot functionally be improved by corrective
lenses or other treatment; or
(d) Homonymous hemianopia with significant mobility limitations.
Criteria – Epilepsy
(a) Severe and controllable epilepsy
Must experience more than 12 episodes a year;
Longest period between consecutive seizures must be 2 months or less;
Approved applications are subject to review every 2 years.
Criteria – Intellectual Disability (Cognitive Impairment)
(a) Severe permanent intellectual disability which renders the person incapable of travelling on
public transport without the constant assistance of another person.
(b) Severe cognitive or memory impairment such that the applicant:
Is unable to be aware of or communicate destination; or
Is unable to manage the payment of fares; or
Exhibits socially unacceptable behaviour.
Criteria – Speech and / or Hearing
(a) Severe and permanent communication difficulties necessitating the constant assistance of
another person to use public transport.
3 ER ORMATIO
1. Eligibility check list
a)
Read, or have explained to you, the Terms and Conditions of the Taxi Transport Subsidy
Scheme. You are required to download the full information booklet prior to completing
your application either from the website or request it to be mailed out.
https://transportnsw.info/taxi-subsidy-scheme
b)
If you agree to the Terms and Conditions of the Scheme, complete PART A of this
application form;
c)
Take the application form to your medical practitioner who will complete the remaining
questions on the form (PARTS B & C); and
d)
Submit the completed application form along with a passport sized photo to:
Taxi Transport Subsidy Scheme
PO BOX K659
Haymarket NSW 1240
Or
Online: https://transportnsw.info/concessions-application
Please note it is essential we receive your passport sized
photo. If your application is approved your photo will be
used on the front of your TTSS Smartcard. Should your
application be declined we will remove your photo from
our systems in line with our Privacy Policy. If we do not
receive a photo with your application it will be declined.
Please complete the photo submission form with this application and attach your photo to it or
follow the instructions to submit online.
Please note: Your eligibility in a similar scheme in another State or Territory does not make
you automatically eligible in the NSW Scheme. Conversely, your eligibility in the NSW Scheme
does not make you automatically eligible in a Scheme administered by another State or
Territory.
For further information relating to the Taxi Transport Subsidy Scheme, visit
Website: www.transportnsw.info/taxi-subsidy-scheme
To contact Transport for New South Wales in relation to the Scheme, visit
Website: http://transportnsw.info/concessions-application or
Phone:
131500 and select option 5
3. Further information
2. How to apply
As a participant of the TTSS we require a personal photo of you to be printed on your
new Smartcard for security and identification purposes. Please follow the below
instructions for submitting your personal photo and sign this form. Please return the
signed form with your two passport sized personal photos back to TfNSW. This can be
done either by post or online.
Concessions Scheme collection of personal photos Privacy Statement
To ensure you understand TfNSW’s obligations when managing your personal information, please
read the Privacy Statement below and sign this form. Once the form is signed and TfNSW has
received your personal photo, we will proceed with the production of your TTSS Smartcard.
print your name and sign on the
Please send both photos and this form signed
overleaf back to Transport for NSW.
Postal
and online address details are overleaf.
Photo #2
(Please print your
name and signature
on the back)
PRIVACY STATEMENT: Transport for NSW (TfNSW) is collecting your personal photo in connection with
the Taxi Transport Subsidy Scheme for identification purposes. TfNSW may also use your personal photo
in connection with other TfNSW Concessions Schemes. For example, Vision Impaired Pass. While
providing your personal photo is voluntary, you may not be able to have a TTSS Smartcard unless you
provide it.
TfNSW will use your personal information, including your photo, to administer and manage the Scheme.
In administering and managing the Scheme, TfNSW may use your personal information, including your
photo, to produce and issue the Smartcard and investigate and handle non-compliance according to the
Scheme Terms and Conditions.
Otherwise, TfNSW will not disclose your personal photo without your consent unless authorised by law.
Your personal photo will be managed by TfNSW in accordance with the Privacy and Personal Information
Protection Act 1998 and the Health Records and Information Privacy Act 2002. For more information
about how TfNSW manages personal information or to access or amend your personal information please
see the TTSS Privacy Statement at https://transportnsw.info/travel-info/ways-to-get-around/taxi-hire-
vehicle/taxi-subsidy-scheme.
TTSS Smartcard Photo Collection Form
Page 2 of 18
I certify that I have either read, or had read to me, this Privacy Statement.
TTSS Client ID (if you know it)
First Name
Middle/Other Name
Last Name
Concessions Scheme
Participant’s signature
Date (DD/MM/YYYY)
If you are unable to sign, the declaration is required to be signed by your carer.
Name of person signing on behalf of
the TTSS Participant
Signature of person signing
Date (DD/MM/YYYY)
To post please send this completed and signed form with your two personal photos to:
Taxi Transport
Subsidy Scheme PO
BOX K659
Haymarket NSW 1240
Or to submit this form and photos online
,
complete the following steps:
1. Complete this form and save to your computer
2. Take a photo of yourself and save as a JPEG on your computer
3. Go to https://transportnsw.info/concessions-application
4. You will be presented with the Concessions Application and Enquiries page
5. For each of the fields below, please select from the drop down menu as follows:
-
'Type of application' field select Enquiry
-
'Your Application is for' field select Taxi transport subsidy scheme
-
'Related To' field select Taxi transport subsidy scheme – Smartcard enquiry
6. In the Comments supporting your application add “Completed TTSS Smartcard Photo Collection form”
7. Click the Add attachment and you will be presented with a file explorer window
8. Navigate to the TTSS Smartcard Photo Collection form on your computer and select the form
9. To attach your photo click Add attachment again navigate to your JPEG photo and select the photo
10. You will be able to see your attached form and photo just above the Add attachment button.
11. Once you have attached the completed form and photo scroll to the bottom of the page and click Send.
If you have any questions about this form or TTSS, please call Transport Info on 131500
or submit an enquiry at http://transportnsw.info/concessions-application.
More information about the TTSS Smartcard is available here
https://transportnsw.info/taxi-subsidy-scheme
Page 3 of 18
Office Use Only
Application ID:
Client ID:
Section 1: Applicant’s details – please use BLOCK LETTERS
Title
(please tick)
Mr
Mrs
Miss
Ms
Other
(please specify)
First name
Middle / other name
Last name
Date of birth
(DD/MM/YYYY)
/ /
Gender
(please circle)
Male / Female
Medicare No.
Sequence / reference
number (next to your
name on your
Medicare card)
Residential address
Must not be a post office box
Enter the Property / Care facility / Retirement Home / Aged Care Home name plus the full address,
including unit number
Suburb
State
Postcode
Postal address or “As above” if the same as your residential address
Suburb
State
Postcode
Contact Details
Home
Mobile
Work
Email
Preferred Contact Method (please circle)
POST / PHONE / EMAIL
Part A: To be completed by the applicant / carer
Page 4 of 18
Full Name
Contact Details
Home
Mobile
Work
Email
Relationship to Applicant Please tick ()
Spouse / Partner
Parent / Guardian
Carer
Son / Daughter
Friend / Neighbour
Brother / Sister
Other Family Member
Other
(Please circle below)
(a) Does the alternate contact know they may be contacted by Transport for NSW?
YES / NO
(b) Are they primary / secondary contact?
Primary / Secondary
(c) Have they helped you complete this application form?
YES / NO
(d) Do you consent for us Transport for NSW to contact this person?
YES / NO
(Please circle below)
The NSW Taxi Transport Subsidy Scheme is only available to permanent residents of Australia who must reside
in NSW and who have a severe and permanent disability.
(a) Are you a permanent resident of Australia?
YES / NO
(b) Do you reside in New South Wales?
YES / NO
Section 2: Alternate contact details (must be a parent or guardian if applicant is a minor)
Section 3: Residency
Page 5 of 18
Please ensure you have read or had explained to you, the Terms and Conditions of the Taxi
Transport Subsidy Scheme on Transport for New South Wales.
I have read or had explained to me, the Terms and Conditions of the Taxi Transport Subsidy
Scheme on Transport for New South Wales.
https://transportnsw.info/taxi-subsidy-scheme
I accept the Terms and Conditions of the Taxi Transport Subsidy Scheme.
I certify that the information provided for this application is true and correct.
I authorise my doctor / specialist to provide (at my own expense) all relevant medical information
required for the Taxi Transport Subsidy Scheme to assess this application.
If approved, I agree to follow the Terms and Conditions of the Taxi Transport Subsidy Scheme. I
acknowledge that misuse of travel entitlements will lead to the removal from the Scheme and
could result in prosecution.
I authorise Transport for New South Wales to manage all my information in this application in accordance
with the Privacy and Personal Information Protection Act 1998 (NSW) and the Health Records and
Information Privacy Act 2002 (NSW). Please read the Privacy of personal and health information in the
enclosed TTSS Booklet or on the website https://transportnsw.info/ttss-information-booklet to fully
understand how your personal information will be handled by Transport for NSW. The Privacy Notice
explains what information is collected, how you may access and amend your personal information, and
how Transport for New South Wales may use and disclose your personal information for the purposes of
the Taxi Transport Subsidy Scheme.
Applications will be processed within 30 business days of receipt. If further information is required,
the assessment process may be delayed. Unsuccessful applicants will be notified in writing by
Transport for New South Wales.
Transport for New South Wales reserves the right to decline the application if you have previously
been suspended or removed from the NSW Scheme or a similar scheme in another State or
Territory.
I certify, that I have either read or had read to me the Terms and Conditions of the scheme and
agree to the statements in the declaration above.
Applicant’s signature
Date
(DD/MM/YYYY)
/ /
If the applicant is not capable of signing, the declaration is required to be signed by the alternate
contact.
Name of person signing on
behalf of the applicant
Signature of person signing
Date
(DD/MM/YYYY)
/ /
Section 4: Applicant’s or carer / agent’s declaration
Page 6 of 18
PLEASE HAVE YOUR DOCTOR COMPLETE THE FPLEASEUR
Important information for medical practitioners
Please read carefully before completing Parts B & C of the application
A person's eligibility is based on their medical /
physical disability.
There are five categories for criteria eligibility to
qualify for the scheme:
Ambulatory / Mobility / Functional
Visual Impairment
Epilepsy
Intellectual Disability
Speech and / or Hearing
The subsidy is not available to individuals
whose medical condition will improve. The
scheme is in place to assist those with a
permanent disability.
The following conditions do not automatically
qualify you for the scheme:
Ageing symptoms e.g. senility, frailty,
dementia, functional weakness (unless
accompanied by socially unacceptable
behaviour); or
The inability to use public transport; or
Financial status; or
Remoteness to public transport itself
All questions need to be completed to
determine eligibility.
Incomplete applications will delay in receiving
the benefits of the Scheme and the form will be
returned for completion.
Further information may be requested from a
specialist to support the application.
Part B must be completed by an approved
Medical Practitioner as listed by the Medical
Board of Australia, not limited to:
General Practitioner
Paediatrician
Orthopaedic
Prosthetist
Optometrist
Ophthalmologist
Neurologist
Neurosurgeon
Psychiatrist
Speech Therapist
Speech-Language Pathologist
Rheumatologist
Specialist Surgeon
Specialist Medical Oncologist
Please have your doctor complete the following relevant
questions on this application form.
Part B: To be completed by a medical practitioner
Page 7 of 18
1.1.
Patient’s full name:
1.2.
List all significant medical conditions:
Diagnosis
Date of
onset or
duration
Treatment (past, current and proposed)
1.3.
Is the status of the Applicant’s current overall condition: (please circle)
Improving / Deteriorating / Static
1.4.
Is the applicant under the management of a specialist for their disability?
If you tick ‘Yes’, a specialist report must be provided with this application.
Disability
Tick if yes
Type of specialist
(e.g. Orthopaedic, Ophthalmologist)
Ambulatory / Mobility disability?
Visual impairment?
Epilepsy?
Intellectual disability?
Speech, Hearing, Functional disability?
1.5.
Are current or planned rehabilitation and/or treatment efforts expected to improve the applicant’s ability
to use public transport (buses / trains / ferries)? (please circle)
YES / NO
Please ensure Part C: Medical Practitioner’s Endorsement (page 15) is also completed
Section 1: Medical background (Doctor to complete)
Page 8 of 18
2.1.
What are the main conditions affecting the applicant’s mobility and ability to use public transport
(buses, trains, ferries)?
2.2. Does the applicant use a wheelchair outside of home for all mobility at all times due to a physical
disability? (Note: An electric scooter is not considered a wheelchair) (please circle)
YES / NO
If YES you do not need to answer Question 2.3
2.3. How many metres can the applicant walk outside of home, using a walking aid if necessary or
oxygen tank, before needing to stop and rest?
Metres
(Please circle below)
(a) Does the applicant use a walking aid (stick, frame, walker, crutches) or oxygen tank
for mobility when away from home?
YES / NO
(b) Does the applicant require the constant assistance of another person for all
mobility?
YES / NO
(c) Does the applicant require assistance to ascend or descend three or more
consecutive steps of 350mm height?
YES / NO
2.4 Does the applicant have total and permanent functional loss of both upper limbs? (please circle)
Other Comments
Please ensure Part C: Medical Practitioner’s Endorsement (page 15) is also completed
YES / NO
Section 2a: Ambulatory / Mobility (Doctor to complete)
Section 2b: Functional (Doctor to complete)
Page 9 of 18
3.1.
What are the main conditions causing the visual impairment?
3.2.
Has the applicant been assessed as legally blind by an eye specialist? (please circle)
YES / NO
3.3.
If YES, a certificate or report from Ophthalmologist / Optometrist should be supplied. (please circle)
Is a report attached?
YES / NO
3.4.
What is the best - corrected visual acuity in each eye?
Right
Left
3.5.
Is there any loss of Visual Fields? (please circle)
Right
YES / NO
Left
YES / NO
3.6.
Degrees of reduction in field of vision?
Degrees
3.7.
Is the applicant’s condition treatable?
Please COMMENT
3.8.
In the event of any significant abnormality in the applicant’s visual acuity and / or field loss in both
eyes, a recent ophthalmologist or optometrist report is required. The report should include visual field
charts.
(Please circle below)
Is a report attached?
YES / NO
Please ensure Part C: Medical Practitioner’s endorsement (page 15) is also completed
Section 3: Visual impairment (Doctor to complete)
Page 10 of 18
4.1.
Does the applicant suffer from grand mal epilepsy? (please circle)
4.2.
Is the applicant fit to drive a motor vehicle? (please circle)
4.3.
When was the applicant’s last seizure that impaired consciousness AND was followed by confusion for
more than one minute?
Month
Year
4.4.
In the last 12 months, how many seizures has the applicant suffered that impaired consciousness and
were followed by confusion for more than one minute?
Number
4.5.
What is the longest period between consecutive seizures which occurred in the last 12 months
(meaning seizures with impaired consciousness and confusion lasting more than one minute)?
Months
4.6.
What is the prognosis for recovery in the long term?
4.7.
Is there concomitant intellectual disability? (please circle)
If YES, please provide details in Section 5 (Intellectual Disability)
Other Comments
Neurologist’s details
Full Name
AHPRA Registration no.
Qualification
Signature
Date
(DD/MM/YYYY)
/ /
YES / NO
YES / NO
YES / NO
Section 4: Epilepsy (Neurologist to complete)
Page 11 of 18
4.8 Is there ambulatory / mobility/ functional disability? (please circle)
If YES, please provide details in Section 2 (Ambulatory / Mobility / Functional)
Other Comments
Please ensure Part C: Medical Practitioner’s endorsement (page 15) is also completed
YES / NO
Page 12 of 18
5.1.
What are the main conditions causing the applicant’s intellectual disability?
5.2.
Does the intellectual disability prevent the applicant from travelling alone on public transport (buses,
trains, ferries) at all times? (please circle)
If YES, please provide details of why the intellectual disability prevents the applicant from travelling
alone?
5.3.
Can the applicant:
(Please circle below)
(a) Recognise the correct vehicles?
YES / NO
(b) Alight at the correct destination?
YES / NO
(c) Pay the correct fare?
YES / NO
(d) Communicate with transport staff?
YES / NO
5.4.
If able to travel on public transport, are there any associated behavioural problems which may be
considered socially unacceptable when travelling on public transport? (please circle)
If YES, please provide details of the behaviour considered socially unacceptable.
Please ensure Part C: Medical Practitioner’s endorsement (page 15) is also completed
YES / NO
YES / NO
Section 5: Intellectual disability (Doctor to complete)
Page 13 of 18
6.1.
What are the main conditions causing the speech and / or hearing impairment?
6.2.
Is the assistance of another person required by the applicant when using public transport owing to their
inability to communicate or to receive information for them? (please circle)
If YES, please provide details.
6.3.
Does the applicant suffer from any speech impediment which affects their ability to travel on public
transport? (please circle)
If YES, please provide details.
6.4.
Is the applicant able to communicate effectively with transport staff with or without hearing aids?
(please circle)
If NO, please attach a recent report of a speech discrimination test conducted by an audiologist.
(please circle)
Is a report attached?
YES / NO
Please ensure Part C: Medical Practitioner’s endorsement (page 15) is also completed
YES / NO
YES / NO
YES / NO
Section 6: Speech and/or hearing (Doctor to complete)
Page 14 of 18
All of the following information is mandatory
I declare that the information provided in this application is accurate, true and complete.
Under which category is the applicant applying to be admitted to the Scheme?
(one or more categories must be completed for this application to be assessed)
Please tick () if Yes
Ambulatory / mobility / functional disability?
Complete Section 1, 2 & Part C
Visual impairment?
Complete Section 1, 3 & Part C
Epilepsy?
Complete Section 1, 4 & Part C
Intellectual (cognitive impairment) disability?
Complete Section 1, 5 & Part C
Speech / hearing disability?
Complete Section 1, 6 & Part C
(Please circle below)
(a) Do you consider that your patient meets the medical eligibility criteria for one
or more of the categories for acceptance to the Scheme?
YES / NO
(b) Have you attached ALL supporting medical document(s)?
YES / NO
(a) Have you attached a specialist report from the last 12 months where
available?
Transport for NSW may ask for more information from a specialist if we require more
information to make an assessment.
YES / NO
Medical Practitioner’s Details
Full Name
AHPRA Registration no.
Qualification
Address
State
Postcode
Phone
Email
How long have you
treated this patient?
Years
Months
Signature
Date
(DD/MM/YYYY)
/ /
PART C: Medical Practitioner’s endorsement
Page 15 of 18
Outcome
Ambulatory
/ Mobility /
Functional
Vision
Epilepsy
Intellectual
Speech /
Hearing
Exceptional
Circumstances
Approved
Review in
months
More information
Not approved
Medical assessor’s name
Assessment date
(DD/MM/YYYY)
/ /
Form TTSS 02 06/20 ABN 18 804 239 602
Medical assessor’s
signature
Application ID
Client ID
PART D: Office use only