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Emergency housing assistance request form

This form is used to request emergency housing assistance through the Department of Housing and Public Works when your home has been damaged and you cannot live in it due to a cyclone, storm or other event.

An asterisk * indicates a required field.

Personal Details

Other Details



Personal Information Privacy Notice

The Department of Housing and Public Works is collecting personal information on this form to provide you with housing assistance.

To assist you with your housing needs and services, your personal information may be disclosed to partner agencies, service providers, local governments and non-governmental agencies that may be able to provide you with housing and/or support services.

To assist you with your housing needs and services, they may pass on the information to other partner agencies, service providers, local governments and non-government organisations that may be able to provide you with housing or support services.

Limited personal information may be used for housing related research, policy or planning functions.

Unless authorised or required by law, your personal information will not otherwise be disclosed to any other third party without your consent.

More information about the department’s privacy policy is available on our website at http://www.qld.gov.au/legal/privacy/ .

Declaration

To the best of my knowledge, the information provided on and in conjunction with this form is true and correct.

I understand that I will commit an offence and be liable to a penalty under the Housing Act 2003 if I knowingly provide to the Department of Housing and Public Works false or misleading information that may influence decisions about my eligibility for housing services and may make my application invalid.

I also declare that I have read, understood and agree to the terms of the Personal Information Privacy Notice above mentioned.

Disclaimer

While the department will make every effort to provide assistance, completing this form does not guarantee that the department will be able to provide the assistance you require.

Licence
Creative Commons Attribution-NoDerivs 3.0 Australia (CC BY-ND 3.0)

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