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Dated factual snapshot · captured 2026-07-15

Departmental form summaries: a searchable copy of published facts from an earlier capture. Records are not rechecked for each release and may have changed or been withdrawn. Confirm the current record at the official source before relying on it.

Source: Australian Government Department of Home Affairs. Official source · Creative Commons Attribution 3.0 Australia.

About this copy

Original factual summaries describing what each official form is for and who lodges it. No form fields, layout or text are reproduced; the official PDF remains the only form.

Platform-authored navigation; no lawyer or registered migration agent reviewed this catalogue. It does not assess eligibility, points or suitability for any person.

Purpose

This form gives notice about how personal information is collected, used and disclosed under the Status Resolution Support Services (SRSS) Program and records the individual's consent to that handling so the Department can assess eligibility and deliver assistance.

Who lodges it

The individual receiving or applying for SRSS assistance; where the person cannot sign, a guardian may act, and a witness and interpreter may also sign as applicable.

When it is used

Used when a person enters or participates in the SRSS Program, as consent to the collection and disclosure of their personal and sensitive information is needed for the Department to offer assistance.

Official form

Open the Department's own PDF or instructions page.

Open official form 1450