Financial Improvement Agreements (FIA) 002-02070040

Item

Action

1

FIA Verbal Declaration to be read to the customer and copied into Case Notes:

I declare that:

• I will put this Financial Improvement Agreement into action to help me achieve my goal and improve my financial self-reliance by the end of my fourth year of receiving Farm Household Allowance
• After discussion with my Farm Household Case Officer, I am aware of the range of advice, counselling, study, and training available to me
• I will undertake reviews of progress with my Farm Household Case Officer when asked to do so
• I understand that failure to complete the agreed activities may result in a non-payment period being applied
• I will notify Services Australia within 14 days if I am unable to comply with the requirements in my Financial Improvement Agreement
• I understand that some activities may be eligible for the payment of the activity supplement
• I understand that the activity supplement can be accessed for approved reasonable travel and accommodation costs associated with undertaking the activity as agreed in the Financial Improvement Agreement

I consent to:

• The disclosure of information to other organisations which may assist me to meet some of or all activities in my Financial Improvement Agreement
• The disclosure of information I have provided on this form to relevant sections of the Australian Government for administering the Farm Household Allowance program, including analysis of, and reporting of its effectiveness

Customer's response: Yes

Farm Household Case Officer Declaration to be copied and pasted into Case Notes:

I declare that:

• the information in the Financial Improvement Agreement is an accurate reflection of the information provided to me by the customer
• the information is a fair an accurate report of my understanding of the customer's preferred activities
• the agreed advice and training referrals are within the purpose of the Financial Improvement Agreement
• the activities agreed are reasonable, measurable, and achievable
• I have read the declaration and consent text to the customer
• the customer has provided a verbal declaration and consent
• I have provided a copy of this Financial Improvement Agreement to the customer

2

FIA appointment Verbal Declaration to be read to the customer and copied into Case Notes.

I understand that:

It is important for you to attend the appointment we have arranged for you. If there are circumstances that make it difficult or unreasonable for you to attend, you need to talk to us about this. We will take your individual circumstances into account. However, if you do not attend without a good reason or if we do not hear from you, your payment may be stopped. You will then be required to contact us for your payment to be restarted.

If you cannot attend for any reason, you need to call your Farm Household Case Officer to make other arrangements.

Customer's response: Yes/No