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Providers registered in any registration category must use this form to notify the Commission of this type of change in circumstances.

The guidance for this smart form does not cover questions, such as those relating to identification or contact details, which are self-explanatory.

Complete this form for each responsible person where there is a change that relates to a suitability matter about a responsible person of the provider.
If you‘re removing the individual as a responsible person due to a suitability matter, you need to also complete the Removing a person as a responsible person form.

Section 1: Aware of change

This question relates to sections 13, s109(d) and 167(3)(b) of the Aged Care Act 2024

Question 1.2 

Explanatory Note
  • Describe the circumstances or event(s) through which you became aware of the change

  • Providers are required, as set out in Part 6 of the Aged Care Rules 2025, to take reasonable measures to require each responsible person to notify them if any of the following applies to the responsible person:

    • an NDIS exclusion decision is in force

    • an NDIS clearance decision is suspended

    • certain convictions.

Section 3: Change in suitability details

These questions relate to sections 13, s109(d) and 167(3)(b) of the Aged Care Act 2024

Questions 3.1 to 3.5

Explanatory Note
  • Select the relevant change(s) being notified and ensure question 3.2 is completed for each selection

  • For Question 3.2, provide details of the change of circumstance, including: 

    • Date of the change

    • Circumstances surrounding the change

    • If any enforcement action was taken against the individual, the reasons for the enforcement, including reference to relevant legislation 

  • If ‘no’ to Question 3.3, take time to consider the suitability matters in relation to the individual

  • For Question 3.5:

    • If the individual will cease to be a responsible person of your organisation, complete Question 4.1, and the ‘Removing a Person as a Responsible Person’ smart form

    • If the individual will continue to be a responsible person, detail any actions taken, or proposed to be taken, in relation to the individual. This may include any adjustments or limitations to their position in your organisation, or in the delivery of aged care services.

Evidence
  • Notice of any enforcement actions
  • Any other documents to support your response

Section 4: Removal details

This question relates to sections 13 and 167(3)(c) of the Aged Care Act 2024

Question 4.1

Explanatory Note
  • If ‘no’, this is the end of the form 

  • If ‘yes’, complete the ‘Removing a responsible person’ form