Brisbane City Council (TransLink) Bus Travel Assistance Safety
Contents
1. refer to point 4 under Eligibility section on tear off page for details on measuring E Government assistance details Please provide details of the assistance type held by the applicant Each student s individual reference number must be provided as well as the applicant s card number If the student has a card in their own name and the parent guardian has a card that also lists that student please submit the application under the parent guardian s concession card You MUST supply a photocopy of current documentary evidence with your application refer to section B If you don t it may delay approval of your assistance Assistance type HCC Health Care Card PCC Pensioner Concession Card VA Veterans Affairs Pensioner Concession Card CPO Child Protection Order Cardholder s name Assistance type CRN Entitlement number as shown on card please tick v Not needed P Expiry date HCC PCC VA CPO Student s name Assistance type CRN Entitlement number f F Not needed for Child Expiry date as shown on card please tick v Protection Order piry 1 HCC PCC VA CPO 2 HCC PCC VA CPO 3 HCC PCC VA CPO 4 HCC PCC VA CPO Cardholder certification Must be signed by the cardholder authorise Centrelink to confirm with the Department of Transport and Main2. Queensland Brisbane City Council TransLink Bus Government Travel Assistance Safety Net Application School Transport Assistance Scheme DTMR Code The information on TNR use only the tear off page stims B T must be read before completing this form Section A to be completed by parent guardian El Parent guardian details Application must be in the name of the concession card holder Where the student has a card in their own name the parent guardian should apply as the applicant but the person whose signature appears on the card must sign the cardholder certification at question 5 Only the parent guardian shown here will be able to alter or amend details for students listed in this application Title Family name Given name s Your principal place of residence include property name if applicable Postcode Postal address Please tick if the same as above Home telephone number Work telephone number Mobile telephone number Email address IMPORTANT For fast processing these details should be the same as those held by the student s school B Reason for making this application New application Change of school Name of previous school attended Last date of enrolment Change of address Previous residential address Last date at that address Change of government Pr
3. s MOT transferabte issued by the Australian Government Department of Human Services on behat of DEPENDENT 5 the Department of ferrites Movsing Community Services and indigenous Allens CARD START 22 JUL 201X LI Pensioner Concession Card You are required to supply your CRN number and the CRN of each dependant you are wanting assistance for This information is obtained from your Pensioner Concession Card issued by the Department of Human Services 4s Australian Government CUSTOMER NAME 31 AUG Department of Human Ser CUSTOMER ADDRESS 201X Signature of cardholder WY K cen 111 111 KX PARTNER NAME aw W1t 111 111A CHLDONE 11 A This card is NOT transferable humanservices gov su peesionercard CHLD TWO mIa bussed by the Australian Geverament Deparinert of Homan Services os behal of CHLD THREE 111 111 I1A fhe Department of Famdies Houung Community Services ssd Indgeroes Afters Card start 01 Jan 201X DSP Veterans Affairs Pensioner Concession Card You are required to supply your entitlement number and the entitlement number of each dependant you are wanting assistance for This information is obtained from your Veterans Affairs Card oft Ha Australian Government PENSIONER X Department of Veterans Affairs CONCESSION CARD Signature of a N Child Protection Order You are required to supply a copy of the Authority to Care For a Child document issued by the Department of Communities Child Safety
4. and Disability Services No additional supporting documentation will be required Page 4 of 6 TRB Forms Area Form F3068 CFD V01 Aug 2014 Please read and remove this tear off page not to be returned with this application WE Queensland Brisbane City Council TransLink Bus Ne f P A Government Travel Assistance Safety Net Application School Transport Assistance Scheme The instructions must be read before completing this form Please keep these pages for your records Applying for safety net assistance Complete this form if you wish to apply for safety net assistance on Brisbane City Council TransLink buses Fill in all questions on the form and attach your documentary evidence If you do not it may delay the processing of your form Post the completed form to the Department of Transport and Main Roads office nearest you Addresses are shown overleaf Parents guardians will be required to pay the full cost of travel until approval is granted by the department These fares are not refundable Applications can only be accepted for the current school year You will be advised of the outcome of your application in writing TransLink will also be advised of the start date of assistance Students will have to call in person to a Brisbane City Council Regional Business Centre for the issue of a photographic bus pass Proof of identity that is current student ID card or birth certificate or current passpor
5. the level of assistance granted Officer s signature Date Input officer s certification have reviewed travel details on this application with details recorded in STIMS and confirm the student s is are not receiving assistance for the same journey s approved on this application Appropriate details have been accurately recorded in accordance with the STIMS user manual Officer s signature Date entered Page 3 of 6 TRB Forms Area Form F3068 CFD V01 Aug 2014 Section B what supporting documentation do I need to supply NOTE A copy of supporting documentary evidence must accompany this application If you do not supply current documentary evidence processing of this application will be delayed If the student has a card in their own name and the parent guardian has a card that also lists that student please submit the application under the parent guardian s concession card Health Care Card You are required to supply your CRN number and the CRN of each dependant you are wanting assistance for This information is obtained from your Health Care Card issued by the Department of Human Services Australian Gorrrament oe ae Deperement of Human Services CUSTOMER NAME 21 J ADORESS 1 Y 201X R ADORESS 2 Signature of cardholder QV Q 111 111 111A PARTNER NAME DEPENDENT 1 DEPENDENT 2 DEPENDENT 3 humae services gos au healthtarecard DEPENDENT 4 This card
6. Roads the current status of my Commonwealth Benefit and other details as they pertain to my concessional entitlement This involves electronically matching details have provided to the Participant with Centrelink or Department of Veterans Affairs DVA records to confirm whether or not am currently receiving a Centrelink or DVA benefit understand that this consent once signed is effective only for the period am a customer of the department also understand that this consent which is ongoing can be revoked any time by giving notice to the department understand if withdraw my consent will not be eligible for the assistance provided by the department A brochure is available from Centrelink that provides more details about the Centrelink Confirmation eServices or on the website humanservices gov au Signature of cardholder Date Fal On what days will the service be used Please tick v the days travelled specifying am pm actual times are not needed Student s given First date of Monday Tuesday Wednesday Thursday Friday Bea ere e name as travel on this of days of days used to get shown above bus this year am pm am pm am pm am pm am pm am pm school All l 2 3 4 ho Page 2 of 6 TRB Forms Area Form F3068 CFD V01 Aug 2014 Names of other students already receiving or applying for tra
7. e Date Ensure that the certification at question 5 has also been signed by the cardholder Privacy statement The department collects the information on this form as authorised under the Transport Operations Passenger Transport Act to assess eligibility for bus safety net assistance These details are accessible by authorised department staff and may also be provided to the bus operator local conveyance committee and Department of Education Training and Employment staff as required Details on this form may also be given to Centrelink the Department of Veterans Affairs and Child Safety as required Your and the student s personal details will not be disclosed by the department to any other third party without your consent unless required to do so by law or for the purpose of Information Privacy Act 2009 Some of the student s personal information including name school and current year level may appear on a bus pass created and issued at the request and discretion of the relevant bus operator Please send completed form to your nearest departmental office Approval TransLink Top Up Code Student s name Data entry details Initials Notes Yes No Level Application ID 1 2 3 4 Approving officer s certification have assessed this application in accordance with the approved school transport policies and procedures and certify that the student s is entitled to
8. evious assistance type for example Health Care Card Date of change assistance Other gt Please provide details Date of change It is important to advise the school of any change of address If you don t it may affect your assistance Distance to nearest school by the shortest trafficable route Please tick Vv what type of school s the student s attend and complete the appropriate section s below State primary gt Please complete section A below Non state primary gt Please complete section A and B below State secondary gt Please complete section C below include any state senior colleges Non state secondary gt Please complete section C and D below Section Type of school Name of nearest school to your house cents Verification Date Initials A Nearest state primar km eels km 7 B Nearest non state primary km km l C Nearest state secondary km km d D Nearest non state secondary km km l of the type attended Page 1 of 6 TRB Forms Area Form F3068 CFD V01 Aug 2014 El Names of students applying for bus travel assistance IMPORTANT Student details must match records held by the school attended Other Male Year Date of N Distance Famil f ame of the school amily name Given name initials Female grade birth they attend to this M F school 2 S km 3 l km 4 l km
9. f Education Training and Employment is responsible for transport assistance for students with a disability Please discuss eligibility requirements and assistance types for these students with the school attended Note The above is a brief summary of eligibility and should only be used as a guide Please contact your nearest departmental office for full details or log onto www translink com au schooltransport Levels of assistance Students travelling on Brisbane City Council buses may be eligible to receive a bus pass for travel based on the distance criteria that is 3 2km for primary students and 4 8km for secondary students The department will pay a maximum amount for eligible students travelling on Brisbane City Council bus services Parents guardians are responsible for the payment of any excess fares that apply above this amount Page 5of 6 TRB Forms Area Form F3068 CFD V01 Aug 2014 Please read and remove this tear off page not to be returned with this application Bus passes Passes must be produced to the driver when boarding a bus Any excess fare above the level of assistance is to be paid directly to the bus operator Passes are issued for travel to and from school Monday to Friday on school days only Passes are not valid for travel at other times or for school excursions outings vacations etc Passes are not valid on special or tour bus services Passes will not be accepted in a mutilated condition If
10. he Yeerongpilly Railway Centre East Carindale Shopping Centre 1151 Creek Road Carindale West 70 Station Road Indooroopilly Business lounge Library and Customer Centre 266 George Street Brisbane Change of circumstances A new application form needs to be completed within seven days when a student changes school address or government assistance The department reserves the right to withdraw travel assistance and recover monies paid if investigations show the student to be ineligible Persons who intentionally provide false information to obtain a benefit may be liable to a 6600 fine under Section 149 3 of the Transport Operations Passenger Transport Act 1994 Departmental offices Further information on the School Transport Assistance Scheme can be obtained from the following offices or online at www translink com au schooltransport TransLink SEQ South TransLink SEQ North Southport Carseldine PO Box 10420 PO Box 156 Southport BC Qld 4215 Zillmere Qld 4034 Phone 5585 1857 Phone 3863 9849 Ipswich PO Box 631 Ipswich Qld 4305 Phone 3813 8613 Page 6 of 6 TRB Forms Area Form F3068 CFD V01 Aug 2014
11. metres or less by the shortest trafficable route from the nearest state secondary school or the nearest non state school of the type attended 4 Measuring The distance from your residential property to the school is measured by the shortest trafficable route over roads open for public use Distances are measured from the vehicle access point of your residential property alignment nearest to the school to the closest entrance to the school No measurements are made on private property In calculating this distance the single journey is used However in cases where the distance to and from school varies because of different routes that is one way roads the average distance is taken 5 Students must be enrolled at an approved school 6 School transport assistance is available from only one address This address must be the principal place of residence of the student s parent or guardian For students under shared guardianship parents must decide from which address they will apply for assistance 7 Students from overseas interstate or on student exchange programs are not eligible to receive travel assistance 8 Students attending TAFE colleges are not eligible to receive transport assistance 9 Travel assistance is not available for travel to alternative addresses or for travel to more than one school facility 10 In assessing eligibility of students the minimum frequency of travel is 20 that is two trips per week The Department o
12. nsport assistance including rail travel assistance bus travel assistance and conveyance allowance Note Do not include students listed at question 4 Type of assistance you Family name Given name amer Date of Name of the school they attend get for this student initials birth i or type applied for 1 ae 2 ae 3 4 L EJ Certification by parent guardian certify that the above information provided is true and correct and have read and agree to the conditions of travel as listed on the attachment of this application understand that am required to complete a new application within seven days should there be any change in the information contained in this application It is further understood that the department reserves the right to withdraw travel assistance and recover monies paid if investigations show the student s to be ineligible understand that persons who intentionally provide false information to obtain a benefit may be liable to a 6600 fine under Section 149 3 of the Transport Operations Passenger Transport Act 1994 In order to assess an applicant s ongoing entitlement to assistance the department will verify the student s personal details with the school attended and schools will disclose to the department updated information for that purpose By signing the certification below am authorising this exchange of information between the department and schools Signatur
13. t and the approval letter from the department must be presented before the pass will be issued If the student changes school or address during the year or if the government assistance you receive changes you will need to reapply for assistance within seven days of the change occurring You must also tell the department if the number of times the student catches the bus each week changes Eligibility This is only a brief summary Contact your nearest office or go to www translink com au schooltransport for full details To be eligible for safety net assistance the student must be listed as a dependant on the applicant s Health Care Card issued by the Department of Human Services Pensioner Concession Card issued by the Department of Human Services Department of Veterans Affairs Pensioner Concession Card Students who have a card issued in their own name as well as students under a Child Protection Order issued by the Department of Communities Child Safety and Disability Services may also qualify for safety net assistance The following conditions also apply 1 The student must not be in receipt of any other assistance from the School Transport Assistance Scheme 2 Primary school students years prep 6 must live 3 2 kilometres or less by the shortest trafficable route from the nearest state primary school or the nearest non state school of the type attended 3 Secondary school students years 7 12 must live 4 8 kilo
14. the pass is damaged lost or stolen a Statutory Declaration must be completed by the parent guardian stating the circumstances and signed by a Justice of the Peace A replacement fee will be charged and once again identification is required Damaged passes must also be returned at the time of replacement Noa WN gt Code of Conduct for school bus travel The department has in place a Code of Conduct for School Students Travelling on Buses The code applies to all students attending primary and secondary school in Queensland who use buses either to travel to and from school or for other school related activities such as excursions The code sets out prescribed standards of behaviour and examples of how your child can meet these standards Brochures outlining the code of conduct and detailing students and parents responsibilities are available from your local bus operator or nearest departmental office as listed below Brisbane City Council Regional Business Centres Passes are issued at Brisbane City Council Regional Business Centres only after a student has received approval in writing from the department The Regional Business Centres are pass issuing centres only and cannot provide information to applicants on the bus safety net scheme Please refer to the departmental offices listed at the bottom of this page for any general enquiries Region Location North 960 Gympie Road Chermside South 681 Fairfield Road Yeerongpilly opposite t
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