Request for an explanation or application for a formal review 109-02000000

If a customer has:

• contacted the agency by phone or in person, or a Service Officer has contacted the customer to discuss an unfavourable decision, go to Step 2
• lodged the Explanation or formal review of a decision (SS351) form or ABSTUDY and Assistance for isolated Children (AIC) Explanation or formal review of decision (SY054) form, or Service Officer has been allocated a form work item, see Table 6

Make sure the decision has been discussed with the customer and internal review options provided before recording a request for an explanation or an application for a formal review.

See First contact about a decision and the internal review process for a contact guide to help Service Officers have a conversation with a customer about a decision.

Has the decision been discussed and internal review options (including time frames) provided to the customer?

• Yes, go to Step 3
• No, see First contact about a decision and the internal review process and follow the Service Officer contact guide

If the customer does not understand or does not agree with:

• a decision that led to a debt (for example, payment cancelled, rate reduced from a date in the past):
• Record the request for explanation or application for formal review of the decision that caused the debt
• A Subject Matter Expert (SME) in the team responsible for the decision that caused the debt will give the explanation
• An Authorised Review Officer (ARO) will complete the formal review
• a decision about a debt amount or recovery:
• Record the request for explanation or application for formal review of the debt decision
• If the debt was raised by Payment Assurance Operations (region codes HU1, HU2 or starting with X), the explanation will be provided by a SME in Payment Assurance Operations. Refer the request to region code XWA
• If the debt was not raised by Payment Assurance Operations, the SME in the team responsible for the debt decision will give the explanation
• An ARO will complete the formal review

If the customer has:

• provided new information or an error has been identified, go to Step 4
• requested an explanation of a decision, go to Step 5
• applied for a formal review of a decision, go to Step 6

If the customer:

• has requested an explanation or applied for a formal review of the decision, document and upload the information to the customer’s record. The SME or ARO will consider the information
• If the request for explanation or application for formal review has already been recorded, no more action is needed. Procedure ends here
• To record a request for an explanation, go to Step 5
• To record an application for a formal review, go to Step 6
• has not requested an explanation or applied for a formal review and does not want to request an explanation or apply for a formal review of the decision, staff should take action to process the information or correct the error. See First contact about a decision and the internal review process

Procedure ends here.

If the customer is requesting an explanation of a decision that has not been made or that has no operative effect:

• tell them that no action can be taken until a decision is made
• discuss any outstanding actions the customer needs to take to have the decision made (for example, lodge outstanding documents or make a claim)
• procedure ends here

If the customer is requesting an explanation of a decision that has been made which has an operative effect, check if the customer has previously applied for an explanation or formal review of the same decision:

• in Customer Record, go to the Case List (ACL) screen in the Appeals (APL) system
• select each APL system record and go to the Modify Reconsideration (MR) screen to determine if an explanation or formal review of the same decision has previously been recorded
• check DOCs in Customer Record for records of explanations or formal reviews previously requested for the same decision

If the customer has not previously applied for a formal review of the same decision:

• Run the Internal Review/Explanation script
• Customer Service Delivery Group (CSDG) staff only
  Select Document decision discussion to document the discussion with the customer and record the request for an explanation which will assign to a SME
• Non-CSDG staff
  Select Add new explanation or review to record the request for an explanation which will assign to a SME
• Run the script for each decision the customer wants explained. See the Resources page for examples
• Record the request for an explanation for the right decision
• Run the script on the correct record. For example, the Assistance for Isolated Children applicant’s record rather than the student’s record
• The script requests the logon details and Regional Office Code (ROC) of the original decision maker. If these are not available, for example, an automatic decision, the user should use their own logon and the customer’s local service centre ROC. If the request for explanation is about an assessment by a Complex Assessment Officer (CAO) or a compensation team, use the ROC of the CAO or compensation team
• The script will leave the explanation DOC open after it is created. Do not close the DOC
• Check contact details with the customer. Note in the DOC their preferred contact number and times
• Check subscription to Electronic Messaging and subscribe the customer if appropriate
• Tell the customer:
• an experienced officer will call from an unidentified number. They will identify as being from Services Australia. They must conduct a proof of identity check before they can discuss the request for explanation
• For debt decisions, pausing recovery of the debt must be discussed with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• If the customer has a partner who also wants to request an explanation, run the Internal Review/Explanation script to record the explanation
• For a social worker decision, go to the Worklist in Work Optimiser, unassign the work item and re-categorise it to ZIAM_ROD_EXP_SWO
• For a Fares Allowance (FAA) decision for Youth Allowance (YA), Austudy or Pensioner Education Supplement (PES) student, also create a Fares Allowance Appeal Fast Note after completing the script. See FAA for YA, Austudy and PES students
• For a Parenting Payment decision where an exemption from the activity test was not granted following the provision of a medical certificate, select these fields in the script:
• Service Reason: PPP or PPS
• Original Decision: Other
• Subtype (free text field): Med Cert Not Acceptable
• Reason for Original Decision: Insufficient Evidence (GIS)

Procedure ends here.

A customer can apply for a formal review:

• without requesting an explanation, or
• before an explanation has been completed, or
• after a SME has finalised an explanation

The exceptions are COVID-19 Disaster Payment, Pandemic Leave Disaster Payment and High-Risk Settings Pandemic Payment decisions, where the customer cannot apply for a formal review at any time. See Reviews of grants and ex-gratia payments.

An application for a formal review does not have to be recorded by a SME. Anyone can record it.

If the customer applies for a formal review of a decision, check if the customer has previously applied for an explanation or formal review of the same decision:

• in Customer Record, go to the ACL screen in the APL system
• select each APL system record and go to the MR screen to determine if an explanation or formal review of the same decision has previously been recorded
• check DOCs in Customer Record for records of explanations or formal reviews previously requested for the same decision

If the customer applies for a formal review of a decision:

• before a request for an explanation of the same decision has been completed, go to Step 7
• and has never requested an explanation of the same decision, go to Step 8
• after an explanation has been finalised for the same decision, go to Step 9

The request for an explanation must be finalised before recording the application for a formal review.

• Run the Internal Review/Explanation script
• Finalise the explanation by selecting the outcome Customer has applied for formal review (no explanation provided)
• Continue the script to record the application for a formal review which will be referred to an ARO
• Check contact details with the customer. Note in the DOC their preferred contact number and times
• Check subscription to Electronic Messaging and subscribe the customer if appropriate
• Tell the customer the ARO:
• will call from an unidentified number
• will identify as being from Services Australia
• must conduct a proof of identity check before they can discuss the application for a formal review

Procedure ends here.

If the customer requests a formal review of a decision that has not been made or that has no operative effect:

• tell them that no action can be taken until a decision is made
• discuss any outstanding actions the customer needs to take to have the decision made (for example, lodge outstanding documents or make a claim)
• procedure ends here

If a decision has been made which has an operative effect, and the customer applies for a formal review of the decision:

• Run the Internal Review/Explanation script
• Customer Service Delivery Group (CSDG) staff
  Select Document decision discussion to document the discussion with the customer and record the application for a formal review. This will assign to an ARO
• Non-CSDG staff
  Select Add new explanation or review to record the application for a formal review. This will assign to an ARO
• The script will close the formal review DOC once it is created
• The script will create a Q449 letter to notify the customer their application for a formal review has been referred to an ARO. The Q449 letter will print centrally and be mailed to the customer
• Run the script for each decision the customer wants reviewed. See the Resources page for examples
• Record the application for a formal review for the right decision
• Run the script on the correct record. For example, the Assistance for Isolated Children applicant’s record rather than the student’s record
• For a Parenting Payment decision where an exemption from the activity test was not granted following the provision of a medical certificate, select these fields in the script:
• Service Reason: PPP or PPS
• Original Decision: Other
• Subtype (free text field): Med Cert Not Acceptable
• Reason for Original Decision: Insufficient Evidence (GIS)
• Check contact details with the customer. Note in the DOC their preferred contact number and times
• Check subscription to Electronic Messaging and subscribe the customer if appropriate
• Tell the customer the ARO:
• will call from an unidentified number
• will identify as being from Services Australia
• must conduct a proof of identity check before they can discuss the review
• Tell the customer of their case reference number
• For debt decisions, pausing recovery of the debt must be discussed with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• Consider any other appropriate actions. For example, payment pending review
• If the customer has a partner who also wants to apply for a formal review, run the Internal Review/Explanation script to record the review

Note: if a customer applies for a formal review of a decision without first requesting an explanation, the Internal Review/Explanation script will record an outcome of BYPASSED AT CUS REQ on the MR screen in the APL system.

Procedure ends here.

• Run the Internal Review/Explanation script and select:
• Select existing case
• the relevant Appeal number
• Refer explanation to ARO
• The script will create a Q449 letter to notify the customer their application for a formal review has been referred to an ARO. The Q449 letter will print centrally and be mailed to the customer
• Run the script for each decision the customer wants reviewed. See the Resources page for examples
• Record the application for a formal review for the right decision
• Run the script on the correct record. For example, the Assistance for Isolated Children applicant’s record rather than the student’s record
• Check contact details with the customer. Note in the DOC their preferred contact number and times
• Check subscription to Electronic Messaging and subscribe the customer if appropriate
• Tell the customer the ARO:
• will call from an unidentified number
• will identify as being from Services Australia
• must conduct a proof of identity check before they can discuss the application for review
• Tell the customer their case reference number
• For debt decisions, pausing recovery of the debt must be discussed with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• Consider any other appropriate actions. For example, payment pending review
• If the customer has a partner who also wants to apply for a formal review, run the Internal Review/Explanation script to record the review

Procedure ends here.

If the customer is contacting:

• about a decision after an explanation has been finalised, check if a SME has spoken to them or if they are responding to a letter (Q449)
• after SME explanation, go to Step 2
• responding to Q449 inviting contact after a SME was unable to contact them to explain the decision, go to Step 3
• about a request for an explanation and they have not been contacted or received a Q449, go to Step 4

Do not record a new request for an explanation of the same decision using the Internal Review/Explanation script.

If a SME has explained the decision, tell the customer their review and appeal rights. Check if they want to apply for a formal review of the decision.

Does the customer want to apply for a formal review?

• Yes, see Table 1 > Step 9
• No, check what the customer wants and follow the relevant process to resolve their enquiry. Procedure ends here

Check what the customer wants:

• an explanation of the decision, go to Step 5
• to apply for a formal review of the decision, see Table 1 > Step 9
• something else, follow the relevant Operational Blueprint procedure to resolve their enquiry. Procedure ends here

Check the Activity List (AL) screen in Customer First or Customer Record.

Is there an open explanation DOC?

• Yes, check and add a priority indicator if the customer is eligible, tell them that their request for an explanation will be allocated to an experienced officer who will try to contact them as soon as possible
• Do not commit to a time frame for this contact
• Procedure ends here
• No, check the MR screen in the APL system in Customer Record. If the Outcome field:
• has an outcome, the request for explanation has been finalised.
  If the customer still wants an explanation, go to Step 5.
  If the customer wants a formal review, see Table 1 > Step 9.
• does not have an outcome, the request for explanation has not been finalised.
  Recreate the explanation DOC, see the Creating or recreating a request for explanation DOC table on the Troubleshooting tab. Tell the customer that their request for an explanation will be allocated to an experienced officer who will try to contact them.
  Note: do not commit to a time frame for this contact

Procedure ends here

Do not record a new request for an explanation of the same decision using the Internal Review/Explanation script.

Explain the decision to the customer using the information in the explanation DOC. Tell the customer their review and appeal rights.

Is the customer satisfied with the information provided?

• Yes, procedure ends here
• No, and the customer:
• still wants an explanation of the decision, Request Appeals Policy and Program advice webform and select Reopen existing explanation, to request that the existing APL record be reopened. Check and add a priority indicator if the customer is eligible
• wants to apply for a formal review of the decision, see Table 1 > Step 9
• does not want to apply for a formal review, check what they want. Follow the relevant Operational Blueprint procedure to resolve their enquiry
• Note: if the customer wants an explanation or formal review of a debt decision, pausing recovery of the debt must be discussed with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• Procedure ends here

Upon receipt, an application for a formal review is placed in a national allocation queue awaiting allocation to an ARO. A DOC with subject line ARO Review Apl No: Xnnnnnn or Formal Review APL No Xnnnnnn shows on the customer's record stating that the application has been received by the ARO Network.

When an application is allocated to an ARO from the national queue, a DOC with the subject line Progress of ARO APL Xnnnnnn or Review Progress APL Xnnnnnn shows on the customer’s record. Workload Manager is not used to allocate reviews to AROs, so no work item will exist.

For customers identified as needing a priority formal review, the application will be placed in the national queue from the date the application is made.

Does the customer have a DOC with the subject line Progress of ARO APL Xnnnnnn or Review Progress APL Xnnnnnn?

• Yes, go to Step 2
• No:
• Check and add a priority indicator if the customer is eligible
• Tell the customer their application has been received by the Authorised Review Officer Network, and
• Once allocated, an Authorised Review Officer will try to contact them (if needed) to discuss the review before making a decision
• Check the customer's contact details are up to date. In a new DOC, note any instructions from the customer about the best time or number to contact them. Procedure ends here

Important information for priority reviews

If a customer is in hardship and there are sensitivities other than those listed in Priority explanation or formal review of a decision that warrant urgent prioritisation of a formal review, email the Appeals Allocation team with the details. The team will consider each case on its merits.

When an application is allocated to an ARO from the national queue, a DOC with the subject line Progress of ARO APL Xnnnnnn or Review Progress APL Xnnnnnn shows on the customer’s record.

Check if the formal review the customer has contacted about has been finalised:

• Check for a DOC with the subject line ARO Decision Re: Xnnnnnn. The DOC will contain details of the formal review outcome
• If there is no ARO Decision DOC, in Customer Record, go to the ACL screen in the Appeals (APL) system
• Select the APL system record the customer has contacted about
• Go to the CH screen and check if the formal review has been finalised

Has the formal review been finalised?

• Yes, go to Step 3
• No, apologise for the delay and tell the customer:
• their application has been allocated to an Authorised Review Officer, and
• the Authorised Review Officer will try to contact them (if needed) to discuss the review before making a decision. Do not commit to a timeframe for this contact. Check the customer’s contact details are up to date and, in a new DOC, note any instructions from the customer about the best time or number to contact them. Procedure ends here

If a customer contacts about a formal review after the formal review has been finalised, tell them:

• their formal review has been finalised by an Authorised Review Officer (ARO)
• the outcome of the formal review
• they have been sent a letter outlining the reasons for the decision
• they can contact the ARO directly if they would like to discuss the formal review outcome
• their further appeal rights

Procedure ends here.

If the customer wants to:

• withdraw their request for an explanation, go to Step 2
• withdraw their application for a formal review, go to Step 3

The customer may do this at any time.

• Run the Internal Review/Explanation script
• Finalise the explanation by selecting the outcome Explanation request withdrawn by customer
• Include details of the discussion with the customer in the explanation DOC
• Tell the customer they can request an explanation or apply for a formal review of the decision later
• If the explanation was of a debt decision, and an amount is still owing, recovery of the debt/s must recommence as the customer has withdrawn their request:
• Create a Fast Note requesting debt recovery be restarted, see Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• Tell the customer that recovery of the debt will restart

Procedure ends here.

Explain to the customer:

• If they withdraw their application for a formal review of a decision, it is taken to have never been made
• If they apply for a formal review of the same decision later, back payment may be limited if the review outcome is in their favour. See Dates of effect for review of decision outcomes

Does the customer want to withdraw their application for a formal review of the decision?

• Yes, go to Step 4
• No, procedure ends here

Has the application for a formal review been allocated?

If it has, there will either be a ‘Progress of ARO APL AXXXXXX’ or 'Review Progress APL AXXXXXX' DOC on the record.

• Yes:
• Request action using a Fast Note - select Auto Text, use Appeals > Withdraw Formal Review
• Record the relevant information in the body of the Fast Note, including that the customer has asked to withdraw their formal review request
• Do not complete the work item created by the Fast Note
• Use Work Optimiser to reassign the work item to the logon found in the text of the ‘Progress of ARO APL AXXXXXX’ or 'Review Progress APL AXXXXXX' DOC and on the ARO screen in the APL system record
• No:
• Complete the Formal Review - Customer initiated withdrawal webform
• Include in the webform
  - customer’s CRN
  - APL number
  - the customer has asked to withdraw their ARO formal review request
  - it has been explained that the application for a formal review will be taken to have never been made
  - the customer has confirmed they want to withdraw their application for a formal review
• Create a DOC and include
  - the customer has withdrawn their application for a formal review of a decision
  - it has been explained that the application for a formal review will be taken to have never been made
  - the Formal Review - Customer initiated withdrawal webform has been submitted

Note: if the formal review was of a debt decision, and a debt amount is still owing, recovery of the debt/s must recommence as the customer has withdrawn their formal review application:

• Create a Fast Note requesting debt recovery be restarted, see Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• Tell the customer that recovery of the debt will restart

Procedure ends here.

A withdrawn request or application has an outcome of WITHDRAWN on the MR or ARD screen in the APL system.

If the customer wants to:

• apply for a formal review after withdrawing a request for an explanation of the same decision, go to Step 2
• request an explanation after withdrawing a request for an explanation of the same decision, go to Step 3
• apply for a formal review after withdrawing an application for a formal review of the same decision, go to Step 3

• Run the Internal Review/Explanation script
• Choose options Select existing case and Refer explanation to ARO
• The script will create a Q449 letter to be sent to the customer to acknowledge their application for a formal review of the decision. The Q449 letter will print centrally and be mailed to the customer
• Tell the customer their application will be forwarded to an ARO. They will try to contact them (if needed) to discuss the review
• Check the customer’s contact details. Note on the DOC their preferred contact number and times
• Check subscription to Electronic Messaging and subscribe the customer if appropriate
• For debt decisions, pausing recovery of a debt must be discussed with the customer, see Table 1 in Recovery of debts pending a reassessment, explanation or review of decision

Procedure ends here.

Do not run the Internal Review/Explanation script

• Tell the customer the matter will be forwarded to an appropriate officer who will contact them
• Complete the Request Appeals Policy and Program advice webform and note:
• withdrawn APL number shown on the ACL screen
• date the customer re-contacted to request an explanation or apply for a formal review of the decision
• Create a DOC and include:
• APL number
• the customer has requested an explanation or applied for a formal review of the decision again
• the Request Appeals Policy and Program advice webform has been submitted

Appeals Policy and Program will reset the original APL system record to reflect the new request for an explanation or application for a formal review. They will issue any further instructions.

Note: for debt decisions, pausing recovery of a debt must be discussed with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision

Procedure ends here.

To request an explanation or apply for a formal review of a decision, a customer may upload or lodge an Explanation or formal review of a decision (SS351) form or ABSTUDY and Assistance for isolated Children (AIC) Explanation or formal review of decision (SY054) form.

• If a form has been lodged and the customer is not present:
• search for the customer’s record using the information on the form
• if the customer cannot be identified, make attempts to contact using the phone number provided on the form
• make sure the form is scanned and attached to the customer’s record. See Scanning Centrelink documents using an MFD
• if the request/application relates to a debt decision and recovery is not paused, contact the customer to discuss the pause. See Recovery of debts pending a reassessment, explanation or review of decision
• To process the SS351/SY054 form, including if the customer is present or if a form work item has been allocated, go to Step 2
• If a customer contacts about an SS351/SY054 form that has already been processed and:
• they requested an explanation of decision which is in progress, tell the customer that their request has been received and will be allocated to an experienced officer to be completed. Procedure ends here
• they applied for a formal review which is in progress, tell the customer that their application has been received and will be allocated to an ARO to be completed
• for explanations/reviews of a debt decision, check if recovery of the debt has been paused and, if not, discuss the pause with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision. Procedure ends here
• If the request/application has been finalised, tell the customer about the outcome of their request/application based on the information recorded on the customer’s record. Procedure ends here

After the SS351/SY054 form has been scanned or uploaded to the customer’s record, a form work item will be created:

• ZDMS_SS351 for an SS351 form
• ZIAM_EIR_ABY_EXP for an SY054 form (ABSTUDY)
• ZIAM_EIR_AIC_EXP for an SY054 form (Assistance for Isolated Children)

To view the form, See Viewing Centrelink customers’ digital images.

Before recording a new explanation or formal review, check if the:

• SS351/SY054 has already been processed, or
• customer has already requested an explanation, or
• applied for a formal review of the same decision

Check the:

• DL screen for DOCs about the request or application
• ACL screen in the Appeals (APL) system to see if there is an APL record for the explanation or formal review

If the SS351/SY054 has already been processed, close the form work item. The explanation or review will be allocated to a SME or ARO to be completed. Procedure ends here.

If the SS351/SY054 has not been processed, and the customer has:

• not previously requested an explanation or applied for a formal review of the same decision, record the request or application, go to Step 3
• previously requested an explanation or applied for a formal review of the same decision, go to Step 4

Check the following information from the SS351 or SY054 form and record the customer’s request or application using the Internal Review/Explanation script:

• Is the customer requesting an explanation or applying for a formal review?
• The customer will indicate if they are requesting an explanation or applying for a formal review in Question 1 of the form
• If the customer does not answer the question or indicates they want an explanation and a formal review, an application for a formal review should be recorded
• What decision is the customer asking about?
• The customer should indicate the payment type, decision type and date of the decision
• If the decision cannot be identified, make attempts to contact the customer to identify the correct decision
• Why is the customer requesting an explanation or applying for a formal review?
• The customer may provide the reason on the form or attach a separate document
• What date did the customer request an explanation or apply for a formal review?
• This is the date the form was received by the agency
• If applicable, is the partner also requesting an explanation or formal review of the same decision in Question 7 of the form?

Close the form work item. The explanation or review will be allocated to a SME or ARO to be completed.

Procedure ends here.

• If the customer is requesting an explanation of a decision, and a request for explanation of the same decision has already been recorded:
• If the previous request for explanation has been completed, tell the customer their review and appeal rights. Close the form work item. Procedure ends here
• If the previous request for an explanation has not been completed, tell the customer their request for explanation has been received and will be allocated to an experienced officer to be completed. Close the form work item. Procedure ends here
• If the customer is applying for a formal review of a decision after an explanation of the same decision has previously been requested, record the application for a formal review. If the request for explanation has:
• not been completed, see Table 1 > Step 7
• been completed, see Table 1 > Step 9
• If the customer is applying for a formal review of a decision, and an application for a formal review of the same decision has previously been made:
• If the previous application for a formal review has been completed, tell the customer their review and appeal rights. Close the form work item. Procedure ends here
• If the previous application for a formal review has not been completed, tell the customer
• their application for a formal review has been received and will be allocated to an Authorised Review Officer to be completed. Close the form work item. Procedure ends here

For:

• ZDMS_AROACT, go to Step 2
• ZDMS_AROREF, go to Step 3

This work item is created when a document about an unfinalised formal review is scanned to the customer’s record.

When allocated the ZDMS_AROACT work item, find the scanned document. Check if the information relates to an unfinalised application for a formal review. See Viewing Centrelink customer’s digital images.

If the information:

• relates to an unfinalised application for a formal review, finalise the ZDMS_AROACT work item. The ARO will consider this information when undertaking the review
• does not relate to an unfinalised application for a formal review, re-categorise the ZDMS_AROACT work item. See Work Optimiser for staff

Procedure ends here.

This work item is created when a letter or statement requesting an explanation or applying for a formal review of a decision (other than an SS351 or SY054 form) is scanned to a customer’s record.

When allocating a ZDMS_AROREF work item, find the scanned document. Check if the document is a request for an explanation or an application for a formal review of a decision. See Viewing Centrelink customer’s digital images.

If the document is:

• a request for an explanation or an application for a formal review of a decision, see Table 6
• not a request for an explanation or an application for a formal review of a decision, re-categorise the work item. See Work Optimiser for staff

Procedure ends here.

An open Explanation of Decision DOC may prevent some activities from being finalised on a customer’s record, for example, death action.

Check the MR screen in the APL system in Customer Record. If the Outcome field:

• has an outcome, the explanation of decision has been finalised. Complete the DOC and finalise the required action on the customer’s record
• does not have an outcome, the explanation of decision has not been finalised:
• Complete the DOC
• Finalise the required action on the customer’s record
• Re-create the Explanation of Decision DOC. See the Creating or recreating a request for explanation DOC table on the Troubleshooting tab

Procedure ends here.

If the customer:

• requested an explanation of a decision, go to Step 4
• requested a quality check or ARO review, go to Step 2
• asks about a formal review after requesting a SME quality check, go to Step 7
• wants to provide more information or an error is identified, go to Step 3
• wants to withdraw their request for a quality check or ARO review, see Table 2 > Step 1
• asks about an explanation or formal review after withdrawing a request for the same decision, see Table 2 > Step 5

If their request relates to:

• a decision made by Compliance Risk Branch (CRB) such as Online Compliance Intervention (OCI), Employment Income Confirmation (EIC) or Check and Update Past Income (CUPI), see Procedures for non-Compliance staff in CRB interventions
• a decision made by an investigation team, see Customer contacts non-investigation staff about an Intelligence and Investigations or MRT investigation
• a decision made under the Targeted Compliance Framework or Job Seeker Compliance Framework, see Non-compliance with compulsory requirements - review and appeals
• a decision about the changed or cancelled child care attendance data, See Customer queries Child Care Management System (CCMS) information. If the Families and Child Care - Business Process and Design Branch has finalised an enquiry referral, see Requests or applications on or after 15 May 2021 tab
• any other decision, see Table 2

Procedure ends here.

• For claim rejection decisions where new documents have been provided, see Request to reassess a rejected claim, otherwise
• Correct any errors
• Reassess the decision using the new information
• If unable to correct or reassess at the point of contact, use Operational Blueprint to find the relevant Fast Note or create a work item for an appropriately experienced officer. Make sure all documents have been added to the customer record
• Record all details on a DOC on the customer's record

If the customer is:

• satisfied with the reassessment outcome, record details of the reassessment and conversation on a DOC. Procedure ends here
• not satisfied with the reassessment outcome, go to Step 6

Can information on the customer record be used to explain the decision, for example, claim finalisation DOC or assessment DOC?

Get technical support if the matter is complex or if support is needed to provide a satisfactory explanation.

• Yes, and the customer is:
• satisfied with the explanation, record a DOC outlining the conversation with the customer. Procedure ends here
• not satisfied with the explanation, go to Step 6
• No:
• Run the Internal Review/Explanation script. Select request for explanation only to refer this work to an appropriately experienced officer. Run the script on the correct record, for example, the Assistance for Isolated Children applicant’s record rather than the student’s record
• For a Social Worker decision, also go to the Worklist in Work Optimiser, unassign the work item and re-categorise it to ZIAM_EIR_SWO_EXP
• For a Fares Allowance (FAA) decision for Youth Allowance (YA), Austudy or Pensioner Education Supplement (PES) student, also create a Fares Allowance Appeal Fast Note after completing the script. See FAA for YA, Austudy and PES students
• For a Parenting Payment decision where an exemption from the activity test was not granted following the provision of a medical certificate, select these fields in the script:
  - Service Reason: PPP or PPS
  - Original Decision: Other
  - Subtype (free text field): Med Cert Not Acceptable
  - Reason for Original Decision: Insufficient Evidence (GIS)

Make genuine attempts to contact the customer.

• If the customer is satisfied with the explanation, annotate the DOC outlining the conversation. Complete the DOC. Procedure ends here
• If the customer is not satisfied with the explanation, annotate the DOC outlining the conversation. Close the DOC. Go to Step 7
• If unable to contact the customer, issue a Q351 letter advising contact attempts were unsuccessful and to contact Services Australia if they would still like an explanation of the decision. Annotate the DOC with the contact attempt details and that a Q351 was sent. Complete the DOC

To issue a Q351 letter, see Creating a manual letter or Online Advice (OLA). When creating the Q351, code the following:

• select the Service Reason of the decision under review and letter code Q351
• select from letter issued to nominee or customer (1 = Nominee, 2 = Customer)
• select 2 = NULL for the Appeal paragraph
• enter the date the original decision was made
• select the appropriate decision type
• select from program (which will allow free text entry of program) or benefit (which will auto default from benefit type previously entered)
• select 3 = No Cust Cont
• do not give an explanation of the decision in this letter. There should be no need for free text paragraphs

Finalise the letter and check before sending to the customer.

Procedure ends here

Explain that the decision can be quality checked by a SME.

If no decision has been made, there can be no quality check. For example, the customer's claim has not been assessed, or the customer was overpaid but the debt has not been raised. In this case, tell the customer a decision must be made before they can request a quality check.

Does the customer want the decision quality checked?

• Yes:
• Run the Internal Review/Explanation script to refer the work to an appropriately experienced officer
• The script will need to be run more than once in some cases. See the Resources page
• Make sure the script is run on the correct record, for example, the Assistance for Isolated Children applicant’s record rather than the student’s record
• Tell the customer the SME will call from an unidentified number, will identify as being from Services Australia and must conduct a proof of identity check before being able to discuss the matter
• If the quality check relates to a debt decision, check if recovery of the debt has been paused and, if not, discuss the pause with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• For a Social Worker decision, also go to the Worklist in Work Optimiser, unassign the work item and re-categorise it to ZIAM_EIR_SWO_EXP
• For a Fares Allowance (FAA) decision for Youth Allowance (YA), Austudy or Pensioner Education Supplement (PES) student, also create a Fares Allowance Appeal Fast Note after completing the script. See FAA for YA, Austudy and PES students
• For a Parenting Payment decision where an exemption from the activity test was not granted following the provision of a medical certificate, select these fields in the script:
  - Service Reason: PPP or PPS
  - Original Decision: Other
  - Subtype (free text field): Med Cert Not Acceptable
  - Reason for Original Decision: Insufficient Evidence (GIS
• No, record a DOC outlining the conversation with the customer

Procedure ends here.

If a customer requested a quality check, it must be completed before they can apply for a formal review.

Sometimes a customer will decline an ARO review when speaking with a SME but decide later that they want an ARO review. An ARO review can only be actioned if a quality check has been completed.

Has the SME quality check been completed?

• Yes, record the customer's application for a formal review of the decision. See Step 9 in Table 1 on Request or application on or after 15 May 2021 tab
• No, tell the customer they will have the option to apply for a formal review when the quality check is completed. They can apply for a formal review after an experienced officer contacts them about the decision or they receive a letter. Procedure ends here

If the customer is contacting about the progress of:

• a quality check, go to Step 2
• an ARO review, go to Step 5

Check if the quality check has been completed. Check the MR screen in the APL system in Customer Record. If the Outcome field has an outcome recorded, the quality check has been finalised.

If the customer is contacting about a:

• decision after a quality check has been finalised, go to Step 3
• quality check that has not been finalised, go to Step 4

Do not record a new request for a quality check of the same decision using the Internal Review/Explanation script.

Tell the customer of the outcome of the quality check including their further review rights.

Does the customer want to apply for a formal review of the decision?

• Yes, run the Internal Review/Explanation script to refer the review to an ARO. If the quality check was of a debt decision, and an amount is still owing, check if recovery of the debt was restarted. If not:
• create a Fast Note requesting debt recovery be restarted. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• tell the customer that recovery of the debt will restart
• No, check what the customer wants and follow the relevant Operational Blueprint procedure to resolve their enquiry. Procedure ends here

If the quality check has not been finalised, check the Activity List (AL) screen in Customer First or Customer Record.

Is there an open quality check DOC with a summary line APL XNNNNN - Request Pending or APL XNNNNN - Priority Review?

• Yes, tell the customer that their request will be allocated to the next available experienced officer who will try to contact them as soon as possible. Do not commit to a timeframe for this contact.
• If the quality check relates to a debt decision, check if recovery of the debt has been paused and, if not, discuss the pause with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• Procedure ends here
• No, recreate the quality check DOC. See the Creating or recreating a request for quality check DOC (requests made before 15 May 2021) table on the Troubleshooting tab
• Tell the customer that their request for a quality check will be allocated to the next available experienced officer who will try to contact them as soon as possible. Do not commit to a timeframe for this contact
• Procedure ends here

Upon receipt, a request for an ARO review is placed in a national allocation queue awaiting allocation to an ARO. A DOC with subject line ARO Review Apl No: Xnnnnnn or Formal Review APL No Xnnnnnn shows on the customer's record stating that the request has been received by the ARO Network.

When a request is allocated to an ARO from the national queue, a DOC with the subject line Progress of ARO APL Xnnnnnn or Review Progress APL Xnnnnnn shows on the customer’s record. Workload Manager is not used to allocate reviews to AROs, so no work item will exist.

For customers identified as needing a priority review, the request will be placed in the national queue from the date of the request.

Does the customer have a DOC with the subject line Progress of ARO APL Xnnnnnn or Review Progress APL Xnnnnnn?

• Yes, go to Step 6
• No:
• tell the customer their request has been received by the Authorised Review Officer Network, and
• once allocated, an ARO will try to contact them (if needed) to discuss the review before making a decision
• check the customer's contact details are up to date. In a new DOC, note any instructions from the customer about the best time or number to contact them.
• check if the review relates to a debt decision and recovery of the debt has been paused. If not, discuss the pause with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision
• Procedure ends here

Important information for priority reviews

If a customer is in hardship and there are sensitivities other than those listed in Priority explanation or formal review of a decision that warrant urgent prioritisation of a formal review, email the Appeals Allocation team with the details. The team will consider each case on its merits.

When a request is allocated to an ARO from the national queue, a DOC with the subject line Progress of ARO APL Xnnnnnn or Review Progress APL Xnnnnnn shows on the customer’s record.

Check if the formal review the customer has contacted about has been finalised:

• Check for a DOC with the subject line ARO Decision Re: Xnnnnnn. The DOC will contain details of the formal review outcome
• If there is no ARO Decision DOC, in Customer Record, go to the ACL screen in the Appeals (APL) system
• Select the APL system record the customer has contacted about
• Go to the CH screen and check if the ARO review has been finalised

Has the ARO review been finalised?

• Yes, go to Step 7
• No, apologise for the delay and tell the customer:
• their request has been allocated to an Authorised Review Officer, and
• the Authorised Review Officer will try to contact them (if needed) to discuss the review before making a decision. Do not commit to a time frame for this contact. Check the customer’s contact details are up to date and, in a new DOC, note any instructions from the customer about the best time or number to contact them
• Procedure ends here

If a customer contacts about an ARO review after the ARO review has been finalised, tell them:

• the review has been finalised by an Authorised Review Officer (ARO)
• the outcome of the formal review
• they have been sent a letter outlining the reasons for the decision
• they can contact the ARO directly if they would like to discuss the review outcome
• their further appeal rights

Procedure ends here

• to withdraw their quality check request, go to Step 2
• to withdraw their ARO review request, go to Step 3
• a quality check or ARO review after a withdrawing a request for a quality check or review, go to Step 5

Withdrawn quality check requests are taken to have never been made. If a customer withdraws their request for a quality check and then requests a formal review of the same decision at a later time, arrears may be limited if the review outcome is in their favour. Explain this to the customer.

If the customer chooses to withdraw their quality check request:

• Go to the ACL screen in the APL system
• ‘S’elect the relevant APL number
• Key today’s date in the Date Finalised field
• Key WDN in the Outcome field
• Key Y or N in the New Info Received field (if not already populated)
• Annotate the APL PENDING DOC to advise that the customer has asked to withdraw their request for a quality check on <date> and complete the DOC
• Tell the customer that recovery of the debt will restart
• If the quality check related to a debt decision, and an amount is still owing, recovery of the debt/s must recommence as the customer has withdrawn their request. See Table 3 in Recovery of debts pending a reassessment, explanation or review of decision

Procedure ends here.

Explain to the customer:

• Withdrawn review requests are taken to have never been made
• If they later request a formal review of the same decision, arrears may be limited if the outcome is in their favour
• If the review related to a debt decision, and an amount is still owing, recovery of the debt/s must recommence as the customer has withdrawn their request. See Table 3 in Recovery of debts pending a reassessment, explanation or review of decision
• Tell the customer that the recovery of the debt will restart

Does the customer want to withdraw their request for an ARO review?

• Yes, go to Step 4
• No, procedure ends here

If allocated to an ARO, there will either be a ‘Progress of ARO APL AXXXXXX’ or 'Review Progress APL AXXXXXX' DOC on the record.

Has the review been allocated?

• Yes:
• Request withdrawal using a Fast Note - select Auto Text, use Appeals > Withdraw Formal Review
• Update the relevant information in the body of the Fast Note, including that the customer has asked to withdraw their ARO review request
• Use Work Optimiser to reassign the work item to the logon found in the text of the ‘Progress of ARO APL AXXXXXX’ or 'Review Progress APL AXXXXXX' DOC as well as the ARO screen in the APL system record. Procedure ends here
• No:
• Complete the Formal Review - Customer initiated withdrawal webform
• Include in the webform:
  - customer’s CRN
  - APL number
  - the customer has asked to withdraw their ARO review request
  - it has been explained that the review request will be taken to have never been made
  - the customer has confirmed they want to withdraw their review request
• Create a DOC and include:
  - the customer has withdrawn their application for a formal review of a decision
  - it has been explained that the application for a formal review will be taken to have never been made
  - the Formal Review - Customer initiated withdrawal webform has been submitted

A customer can request an explanation or apply for a formal review after withdrawing a request for quality check or review of the same decision.

A withdrawn request shows in the APL system as WDN: Withdrawn.

Note: a withdrawn request is taken to have never been made.

To check the level of review withdrawn:

• get the withdrawn review number from the customer's Document List (DL) screen
• go to the APL system:
• go to the Case List (ACL) screen. All previous reviews will be listed on the ACL screen
• find the withdrawn review
• find the 'level' of review for the withdrawn review:
• ODM - Subject Matter Expert, go to Step 6
• ARO – Authorised Review Officer, go to Step 6
• ART1 - ART first review, go to Step 7
• ART2 - ART second review, go to Step 7

Do not run the Internal Review/Explanation script to record a new quality check or review.

Tell the customer the matter will be forwarded to an appropriate officer who will contact them.

Request Appeals Policy and Program advice using the webform and note the:

• withdrawn APL number shown in the ARO Decision DOC
• date the customer re-contacted to request an explanation or apply for a formal review of the decision

Create a DOC and include:

• the APL number
• that the customer has requested an explanation or formal review again
• that the Request Appeals Policy and Program advice webform has been submitted

Appeals Policy and Program will reset the original review record to reflect the new request or application and will issue any further instructions.

Check if the review relates to a debt decision and recovery of the debt has been paused. If not, discuss the pause with the customer. See Table 1 in Recovery of debts pending a reassessment, explanation or review of decision.

A SME or ARO will action the customer's review request. See SME explanations, ARO referrals and implementing ARO decisions.

Procedure ends here.

Tell the customer to contact the ART. See the Resources page for contact information.

An open SME quality check DOC may prevent some activities from being finalised on a customer’s record, for example, death action.

Check the MR screen in the APL system in Customer Record. If the Outcome field:

• has an outcome, the SME quality check has been finalised. Complete the DOC and finalise the required action on the customer’s record
• does not have an outcome, the SME quality check has not been finalised:
• Complete the DOC
• Finalise the required action on the customer’s record
• Re-create the SME quality check DOC. See the Creating or recreating a request for quality check DOC (requests made before 15 May 2021) table on the Troubleshooting tab

Procedure ends here.