This document outlines what to do when a customer requests a SME explanation or applies for a formal review of a decision. It explains how to record a request or an application. It also covers enquiries about the progress or withdrawal of a request or application. There are separate processes for requests made before 15 May 2021.
Requests or applications on or after 15 May 2021
On this page:
Customer requests a SME explanation or applies for a formal review of a decision
Customer contacts about the progress or outcome of a request for a SME explanation
Customer contacts about the progress or outcome of an application for a formal review
Customer wants to withdraw their request for a SME explanation or application for a formal review
Actioning APL withdraw work item created by Appeals Branch Tactical Planning and Performance staff
Customer requests a SME explanation or applies for a formal review after withdrawing a request or application for the same decision
Customer has lodged an explanation or formal review of a decision form (SS351 or SY054)
ZDMS AROACT or ZDMS AROREF work item has been allocated for action via Workload Manager (WLM)
Open Explanation of decision DOC preventing updates to a customer’s record
Customer requests a SME explanation or applies for a formal review of a decision
Table 1
Expand tableStep | Action |
1 | Customer contacts about a decision that has been made
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 7
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2 | Customer contact by phone or in person
See First contact about a decision and the internal review process and make sure every attempt has been made to resolve the customer’s enquiry and explain the decision, applying First Contact Resolution principles. Decisions must be reassessed where an error is identified or new information is received that would change the decision. Customers must be offered the opportunity to submit a new claim if appropriate. If this is not done, there can be adverse date of effect issues for the customer if the decision is later changed under the internal review process. Do not record a request for a SME explanation or an application for a formal review: - if the customer has not requested a SME explanation or applied for a formal review
- to manage a challenging, complex, or lengthy enquiry
- to manage a customer complaint
Has the decision been explained, reassessed to correct errors and take into account any new information that would change the decision, and internal review options (including time frames) provided to the customer? |
3 | Check the decision
If the customer has requested a SME explanation or a formal review of a decision about a debt or recovery: - Record the request for SME explanation or application for formal review of the debt decision. If a SME explanation has been requested for
- a debt raised by Payment Assurance Operations (region codes HU1, HU2 or starting with X), a SME in Payment Assurance Operations will provide the explanation. Refer the request to region code XWA
- a debt that was not raised by Payment Assurance Operations, a SME in the team responsible for the debt decision will give the explanation
- a decision other than a debt decision (for example, payment cancelled, rate reduced from a date in the past):
- Record the request for a SME explanation or application for formal review of the decision the customer wants explained or reviewed
- A SME in the team responsible for the decision will give the explanation
If the customer has: |
4 | New information provided or error identified
If the customer: - has requested a SME 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 SME explanation or application for formal review has already been recorded, no more action is needed. Procedure ends here
- To record a request for a SME explanation, go to Step 5
- To record an application for a formal review, go to Step 6
- has not requested a SME explanation or applied for a formal review, process the information or correct the error. See First contact about a decision and the internal review process
Procedure ends here. |
5 | Customer requests a SME explanation of a decision
If the customer is requesting a SME 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)
- apply First Contact Resolution principles to assist the customer. For example, make the outstanding decision or make a referral for the decision to be made
- procedure ends here
If the customer is requesting a SME explanation of a decision that has been made which has an operative effect, check if the customer has previously applied for a SME 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
- Staff must follow the Document decision discussion process in Run the Internal Review/Explanation script to make sure the reasons for the customer’s request are clear for the assigned 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 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. |
6 | Customer applies for a formal review of a decision
A customer can apply for a formal review: - without requesting a SME explanation, or
- before a SME explanation has been completed, or
- after a SME explanation has been finalised
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. Tell the customer the agency: - has a high volume of formal review applications
- might take longer than usual to contact them
- will contact them about their formal review as soon as possible
If the customer applies for a formal review of a decision, check if the customer has previously applied for a SME 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 a SME explanation of the same decision has been completed, go to Step 7
- and has never requested a SME explanation of the same decision, go to Step 8
- after a SME explanation has been finalised for the same decision, go to Step 9
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7 | Customer applies for a formal review before a request for a SME explanation of the same decision has been completed
The request for a SME 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. |
8 | Customer applies for a formal review and has never requested a SME explanation of the same decision
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)
- apply First Contact Resolution principles to assist the customer. For example, make the outstanding decision or make a referral for the decision to be made
- procedure ends here
If a decision has been made which has an operative effect: - 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 - Staff must follow the Document decision discussion process in Run the Internal Review/Explanation script to make sure the reasons for the customer’s application are clear for the assigned 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 a SME 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. |
9 | Customer applies for a formal review after a SME explanation has been finalised for the same decision
- 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
- Staff must follow the Document decision discussion process in Run the Internal Review/Explanation script to make sure the reasons for the customer’s application are clear for the assigned 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 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. |
Customer contacts about the progress or outcome of a request for a SME explanation
Table 2
Expand tableStep | Action |
1 | Customer contact
If the customer is contacting: - about a decision after a SME 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
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2 | Customer has received a SME explanation
Do not record a new request for a SME explanation of the same decision using the Internal Review/Explanation script. If a SME explanation has been provided, apply First Contact Resolution principles to assist the customer. This includes checking the decision for errors, checking for new information, and reassessing the decision. Offer the customer the opportunity to submit a new claim, if appropriate. 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
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3 | Customer has received a Q449
Check what the customer wants: - a SME 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
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4 | Customer has not been contacted or received a Q449
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 a SME explanation will be allocated to an experienced officer who will try to contact them as soon as possible and to provide any additional information or evidence they have in support of their request for a SME explanation
- 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 SME explanation has been finalised.
If the customer still wants a SME 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 SME 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 a SME 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 |
5 | Customer still wants a SME explanation of the decision
Do not record a new request for a SME explanation of the same decision using the Internal Review/Explanation script. Apply First Contact Resolution principles to explain the decision, check for errors and new information, and reassess the decision if appropriate. Tell the customer their review and appeal rights. Is the customer satisfied with the information provided? - Yes, procedure ends here
- No, and the customer:
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Customer contacts about the progress or outcome of an application for a formal review
Table 3
Expand tableStep | Action |
1 | Customer contacts while an application for a formal review is awaiting allocation to an ARO
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. Is there a DOC with the subject line ARO Review APLNo: Xnnnnnn or Formal Review APL No Xnnnnnn? - Yes, go to Step 2
- No: check if a SME explanation of decision or formal review exists for the decision the customer wants reviewed:
- 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 a SME explanation or formal review of the same decision has previously been recorded
- check DOCs in Customer Record for records of SME explanations or formal reviews previously requested for the same decision
- if a SME explanation of decision or formal review does not exist, go to Table 2 > Step 2. Otherwise, go to Step 2
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2 | Allocation to an ARO
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. The order of allocation is based on the application date and whether any priority indicators impact the review. Does the customer’s record have a DOC with the subject line Progress of ARO APL Xnnnnnn or Review Progress APL Xnnnnnn? Yes, go to Step 3 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
- once allocated, an Authorised Review Officer will try to contact them to discuss the review before making a decision
- It may take longer to contact them as the agency currently has a high volume of formal review applications
- to provide any additional information or evidence they have in support of their application for review
- if the review relates to a claim rejection decision, tell the customer they can submit a new claim at any time
- 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 the formal review, email the Appeals Allocation team with the details. The team will consider the customer’s circumstances. |
3 | Customer contacts after an application for a formal review has been allocated to an ARO
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 4
- 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 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
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4 | Customer contacts after a formal review has been finalised by an ARO
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. |
Customer wants to withdraw their request for a SME explanation or application for a formal review
Table 4
Expand tableStep | Action |
1 | Check reason for customer contact
If the customer wants to: |
2 | Customer wants to withdraw their request for a SME explanation of a decision
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 a SME explanation or apply for a formal review of the decision later
- If the SME 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:
Procedure ends here. |
3 | Customer wants to withdraw their application for a formal review of a decision
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? |
4 | Withdraw application for a formal review of a decision
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: Procedure ends here. |
Actioning APL withdraw work item created by Appeals Branch Tactical Planning and Performance staff
Table 5: for Appeals Branch staff.
Expand tableStep | Action |
1 | Appeals Branch triage staff allocated APL XNNNNNN withdraw ARO rev DOC
Workload Manager allocates work items. Staff must: - Use Customer First or Customer Record to access the customer's record and find the APL XNNNNNN withdraw ARO rev DOC
- Note the appeal number
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2 | Check if the work item needs to be reallocated
Appeals Triage Officers may need to reallocate a work item if: - they were involved in the original decision
- there is a conflict of interest
Note: before requesting reallocation of a work item, a Quality Development Officer (QDO) or Team Leader must give approval to reallocate the work item. Does the work item need reallocating? |
3 | Reallocate work item
Unassign the work item in Work Optimiser using the reason Conflict of Interest if the work item must be reallocated because: - there is a conflict of interest, including where the Appeals Triage Officer was involved in the original decision, and
- a QDO or Team Leader has given approval for reallocation
To reallocate a work item for any other reason, if the QDO or Team Leader has given approval for reallocation: - correct the APL record on the Modify Reconsideration (MR) screen if necessary. Enter '?' into each field for a list of appropriate codes to use
- annotate the APL XNNNNNN withdraw ARO rev DOC with the appropriate text based on the reason for reallocation
- the Team Leader of the Appeals Triage Officer will send an email to the Appeals Allocation team to request recategorisation of the work item
Procedure ends here. |
4 | Customer does not want to proceed with their application for review
Record the withdrawal of the application for formal review: - Run the ARO Finalise Review Case script in Customer Record and record all relevant details. On the Final Result of the Appeal dialog box, record:
- What was your decision? WITHDRAWN
- Please provide the explanation for your decision: AUTOMATIC DECISION
- What date was the formal advice sent to customer? Today's date
- When the script pauses on the DOC:
- change the content of the Ext Detail: field of the DOC to: ’APL XXXXXXX Withdrawn' (replace ‘XXXXXXX’ in DOC with the APL number that was withdrawn)
- delete the body content of the DOC, then add: ‘This DOC was created by a Triage Officer. The customer withdrew their application for formal review. Please see the APL XNNNNNN withdraw ARO rev DOC for more information'
- select OK on the script to finish it
- After the script has finished:
- go to the Add ARO Decision (ARD) screen and change the code in the Explanation field from AUTOMATIC DECISION to WDS (Withdrawn/dismissed)
- do not remove or add any Special Case Identifiers (SCIs)
- If the formal review relates to a debt decision and a debt amount is still owing, check if recovery of the debt was paused pending the outcome of the formal review. If recovery was paused, the Appeals Triage Officer must request that debt recovery be restarted. See Recovery of debts pending a reassessment, explanation or review of decision
- Create Withdrawal letter, go to Formal review triage > Table 1 > Step 15.
Procedure ends here. |
Customer requests a SME explanation or applies for a formal review after withdrawing a request or application for the same decision
Table 6
Expand tableStep | Action |
1 | Check details
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 a SME explanation of the same decision, go to Step 2
- request a SME 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
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2 | Customer applies for a formal review after withdrawing request for a SME explanation
Procedure ends here. |
3 | Customer requests a SME explanation after withdrawing a request, or applies for a formal review after withdrawing an application
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 support from Tactical Planning and Performance 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:
- the APL number
- that the customer has requested a SME explanation or applied for a formal review of the decision again
- that the Request support from Tactical Planning and Performance webform has been submitted
Appeals Tactical Planning and Performance 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. |
Customer has lodged an explanation or formal review of a decision form (SS351 or SY054)
Table 7
Expand tableStep | Action |
1 | Customer has lodged an explanation or formal review of a decision form
To request a SME 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:
- 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 a SME 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
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2 | Process the SS351/SY054 form
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 SME explanation or formal review, check if the: - SS351/SY054 has already been processed, or
- customer has already requested a SME 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 a SME explanation or applied for a formal review of the same decision, record the request or application, go to Step 3
- previously requested a SME explanation or applied for a formal review of the same decision, go to Step 4
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3 | Record the request for a SME explanation or application for a formal review
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 a SME 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?
- Staff must follow the Document decision discussion process in Run the Internal Review/Explanation script to make sure the reasons for the customer’s request or application are clear for the assigned SME or ARO
Close the form work item. The explanation or review will be allocated to a SME or ARO to be completed. Procedure ends here. |
4 | Customer has previously requested a SME explanation or applied for a formal review of the same decision
- If the customer is requesting a SME explanation of a decision, and a request for SME explanation of the same decision has already been recorded:
- If the previous request for explanation has been completed, contact the customer and apply First Contact Resolution principles to assist them. Explain the decision, check for errors and new information, and reassess the decision if appropriate. Advise the customer of the option to submit a new claim, if appropriate. Tell the customer their review and appeal rights. Close the form work item. Procedure ends here
- If the previous request for a SME 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 a SME explanation of the same decision has previously been requested, record the application for a formal review. If the request for explanation has:
- 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
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ZDMS AROACT or ZDMS AROREF work item has been allocated for action via Workload Manager (WLM)
Table 8
Expand tableStep | Action |
1 | ZDMS_AROACT or ZDMS_AROREF work item has been allocated for action via Workload Manager (WLM)
For: |
2 | ZDMS_AROACT work item has been allocated
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. |
3 | ZDMS_AROREF work item has been allocated
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 7
- 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. |
Open Explanation of decision DOC preventing updates to a customer’s record
Table 9
Expand tableStep | Action |
1 | Open Explanation of decision DOC preventing updates being made to a customer’s record
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:
Procedure ends here. |
Customer requested an explanation, quality check or review before 15 May 2021
On this page:
Request for an explanation, quality check or ARO review made before 15 May 2021
Customer contacts about the progress or outcome of a quality check or ARO review
Withdrawing a request for a quality check or ARO review made before 15 May 2021
Open SME quality check DOC preventing updates to a customer’s record
Request for an explanation, quality check or ARO review made before 15 May 2021
Table 1
Expand tableStep | Action |
1 | Check details
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
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2 | Customer requested a quality check or ARO review before 15 May 2021
If their request relates to: Procedure ends here. |
3 | New information provided or error identified
- 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
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4 | Customer asked for an explanation of a decision before 15 May 2021
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) - Staff must follow the Document decision discussion process in Run the Internal Review/Explanation script to make sure the reasons for the customer’s request are clear for the assigned officer
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5 | Action 'request for explanation only' DOC
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 |
6 | Request for a quality check
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) - Staff must follow the Document decision discussion process in Run the Internal Review/Explanation script to make sure the reasons for the customer’s application are clear for the assigned ARO
- No, record a DOC outlining the conversation with the customer
Procedure ends here. |
7 | Customer asks for a formal review after requesting a SME quality check
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 Table 1 > Step 9 in 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
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Customer contacts about the progress or outcome of a quality check or ARO review
Table 2
Expand tableStep | Action |
1 | Customer contact
If the customer is contacting about the progress of: |
2 | Customer contacts about the progress of a quality check
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: |
3 | Quality check has been finalised
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:
- No, check what the customer wants and follow the relevant Operational Blueprint procedure to resolve their enquiry. Procedure ends here
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4 | Quality check has not been finalised
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? |
5 | Customer contacts about the progress or outcome of an ARO review
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. |
6 | Customer contacts after an ARO review has been allocated
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
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7 | Customer contacts after a review has been finalised by an ARO
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 |
Withdrawing a request for a quality check or ARO review made before 15 May 2021
Table 3
Expand tableStep | Action |
1 | If the customer requests:
- 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
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2 | Customer withdraws their quality check request
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. |
3 | Customer asks to withdraw their ARO review request
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? |
4 | Withdraw ARO request
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
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5 | Customer wants an explanation or formal review after withdrawing a request
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
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6 | Customer requests a SME explanation or ARO review
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. Complete the Request support from Tactical Planning and Performance 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 support from Tactical Planning and Performance webform has been submitted
Appeals Tactical Planning and Performance 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 explanation if decision, ARO referrals and implementing ARO decisions. Procedure ends here. |
7 | Customer requests a review after withdrawing a request at Administrative Review Tribunal (ART) level
Tell the customer to contact the ART. See the Resources page for contact information. |
Open SME quality check DOC preventing updates to a customer’s record
Table 4
Expand tableStep | Action |
1 | Open SME quality check DOC preventing updates being made to a customer’s record
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:
Procedure ends here. |
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