Access Travel Pass

Information and application form

ptv.vic.gov.au

Who is the Access Travel Pass for?

The Victorian Government recognises that some Victorians who use public transport services may have a permanent physical disability, cognitive condition or mental illness that prevents them from using an electronic, or smartcard based, ticketing system. The Access Travel Pass has been developed to assist this group of passengers to access public transport services. This allows them to have a valid ticket at all times when using public transport services. People who always require a companion/carer to travel on public transport are not eligible for the Access Travel Pass, but may be eligible for the: >> Companion Card www.vic.companioncard.org.au, or the >> Multi-Purpose Taxi Program www.transport.vic.gov.au If you require a scooter or wheelchair for mobility outside your home, you may be eligible for the Scooter and Wheelchair Travel Pass. Application forms are available from ptv.vic.gov.au

Access Travel Pass Information and application form

Access Travel Pass the application form

There are two parts to the application form. The rst must be completed by the applicant or guardian and the second by the applicants health care professional. One passport colour photo will need to be supplied signed by the health care professional. By signing this form, the health care professional is verifying that the applicant successfully meets the criteria for the Access Travel Pass. To assist with the assessment, general information is provided below to outline the requirements of passengers when using the myki ticketing system. The Access Travel Pass is not available to every person with a disability.

What is myki?
myki is the ticketing system used on metropolitan public transport, V/Line interurban trains and major regional town bus services. When a passenger boards a train, tram or bus they must touch on their myki at a myki reader, located at railway station entrances and doorways of trams and buses. Touching on ensures the holder has a valid ticket for travel. When leaving the station, tram or bus, the passenger must touch off. Touching on and off public transport is important to ensure that: >> the holder has a valid ticket for travel >> railway station gates are opened for entry or exit at gated stations >> data is collected to assist with transport planning.

Access Travel Pass Information and application form

How does the Access Travel Pass work?

The Access Travel Pass is a registered myki that has the applicants photograph and name printed on the card. The pass holder is required to carry the Access Travel Pass with them at all times when travelling on public transport services. It authorises free travel on public transport services within Victoria at all times, regardless of whether it has been touched on or off. Where possible, the pass holder is encouraged to touch on or touch off their Access Travel Pass, so that their journeys can be included in the number of passenger trips and used to improve services. Alternatively, the Access Travel Pass may be used as a ash pass to provide entry and exit at gated stations and to show to an Authorised Ofcer (ticket inspector) if requested. A lanyard is provided with each Access Travel Pass to assist with card retention and ease of access when travelling. The Access Travel Pass entitles the pass holder to free travel on: >> train, tram and bus passenger services operating in metropolitan Melbourne >> V/Line train and coach services >> regional town bus services >> regional services that have a contract or service agreement with Public Transport Victoria. It is not valid on NSW TrainLink, Great Southern Railway, airport services and tourist railways. The pass holder should check with the relevant operator before booking or travelling.
Access Travel Pass Information and application form

How much does the Access Travel Pass cost?

The Access Travel Pass is provided free of charge.

Replacement cards
If the Access Travel Pass is lost, stolen, damaged or non-operational, including if the name or photograph becomes illegible, please contact Public Transport Victoria on 1800 800 007 as soon as possible. A free replacement Access Travel Pass will be issued. If lost or stolen, a Statutory Declaration must be completed and submitted to Public Transport Victoria before a replacement Access Travel Pass can be issued.

How to travel while waiting for your replacement Access Travel Pass
Once you have reported your Access Travel Pass lost or stolen, a new one will be posted within ve to ten working days. If you need to travel in the meantime, the PTV Hub at 750Collins Street, Docklands can provide you with atemporary pass for travel until your new myki Access TravelPass arrives.

Why do I have to provide so much information?

Information requested will assist Public Transport Victoria toassess your eligibility to the Access Travel Pass. Information with an * is not mandatory, but please note that if you choose not to provide this information, Public Transport Victoria may not be able to process your application form.

Access Travel Pass Information and application form

How is my medical information used?

Public Transport Victoria uses your medical information only for assessment of your eligibility for the Access Travel Pass. Medical information provided to Public Transport Victoria is stored securely and is not linked to the travel history of the Access Travel Pass.

Access Travel Pass Information and application form

Access Travel Pass Application Form Process

Step 1 Before completing this application form it is important that the applicant or guardian and the certifying health care professional read and understand the information contained in this form. Step 2 Obtain one colour passport photograph of the applicant. Step 3 Applicant or guardian to complete Section 1 of this application form. Step 4 The applicants health care professional to complete Section2 of this form and ensure both the application form and the reverse of one passport photograph is signed by the applicants health care professional. Step 5 submit form to: Public Transport Victoria Access Travel Pass applications PO Box 4724 Melbourne VIC 3001 Incomplete applications, including those without signatures or signed photographs, will be returned to the applicant for completion before resubmitting to Public Transport Victoria.

Access Travel Pass Information and application form

Section 1: Applicant information

The Access Travel Pass will only be issued to the passenger with the cognitive or physical disability or mental illness. Please tick all relevant boxes where applicable. 1.1 Applicants details Title: Mr Mrs Miss Ms

Surname or family name: First or given name: Date of birth: Postal address: Suburb: State: *Phone home: *Phone mobile: *Email (if available): *Note: if you chose not to provide some or all of the optional information requested, your Access Travel Pass may not be able to processed. 1.2 Are you a permanent resident of Victoria?

Postcode:

Yes No Y  ou are not eligible for issue of the Access Travel Pass.

Access Travel Pass Information and application form

1.3  Have you previously applied for the Access Travel pass?

Yes No

1.4  Are you able to travel independently, without the assistance of a constant carer/companion on Victorias public transport services? (Please tick one)

Yes No Y  ou are not eligible for issue of the Access Travel Pass. However, you may be eligible for: >> Companion Card vic.companioncard.org.au >> Multi-Purpose Taxi Program transport.vic.gov.au

1.6  Describe how your condition impacts on your ability to touch on and off (use) the myki system (eg limited hand movement, ability to reach scanners, balance, mental illness/condition).

Access Travel Pass Information and application form

Section 2: Applicant/Guardian/Agent declaration

2.1  I conrm that the signature on the next page veries that the applicant: >> has a permanent physical disability, cognitive condition or mental illness and is unable to touch on or touch off a myki at the myki readers independently and/or consistently in all cases; >> can travel independently on Victorias public transport network; and that the applicant/guardian/agent: >> authorises public transport authorities to verify the information contained in this form, and to obtain and disclose any information relating to this application for the purpose of assessing the applicants eligibility for a registered myki loaded with an Access Travel Pass; >> agrees that the health professional in Section 3 may disclose information about the applicant to Public Transport Victoria to assist with the assessment of this application; >> declares that the information in this application is correct; >> accepts the Access Travel Pass terms of use Section 5; and >> has read the Access Travel Pass privacy notice.

Access Travel Pass Information and application form

10

2.2 Please provide the following signatures: Applicant signature (must be 16 years and over): OR Guardian/Agent signature if applicant unable to sign or under 16 years old). Signature:

Date:

2.3 Guardian/Agent details (if applicable) Guardian/Agent name (and relationship to the applicant)

Guardian/Agent phone number

Access Travel Pass Information and application form

11

Section 3: Health professional declaration

Your complete answers to questions are critical in the assessment of the applicants eligibility. Before completing the application form it is important that you read and understand the information contained in this form. 3.1  I am currently a:

Registered Medical Practitioner Registered Psychologist Clinical Psychologist Registered Psychiatrist Clinical Psychiatrist Registered Physiotherapist  ccupational Therapist eligible for membership of O Occupational Therapy Australia (Victoria).

3.2 The applicant has been in my professional care for: Years months

3.3  Is the condition/s permanent? (permanent means: the condition is not likely to improve with time or medical treatment, such as further surgery)

Yes No

Access Travel Pass Information and application form

12

3.4  Is the applicant able to travel independently using the public transport network? (independent means: no assistance is required to board or alight public transport or to determine the appropriate train, tram or bus route or stop)

Yes No

3.5  Can the applicant independently touch on and off their myki?

Yes No

3.6  Please describe the impact of the applicants condition on their ability to touch on/off using the myki ticketing system as per the legal requirements.

Access Travel Pass Information and application form

13

3.7  Health professional details My signature conrms, in my professional opinion, that all of the following are true: >> I have read all the information provided by the applicant on this form and verify that it is correct to the best of my knowledge. >> The applicant is able to travel independently on Victorias public transport network. >> The applicant has a signicant and permanent disability and is unable to touch on or touch off a myki at the myki readers independently and/or consistently. >> I am not the applicant, or an immediate family member of the applicant. >> I agree to offer all reasonable information to assist in the assessment of the applicants eligibility for the Access Travel Pass. >> I have signed the reverse of the applicants photograph and conrm it is a true likeness of the applicant.

Access Travel Pass Information and application form

14

Name: Employer/Business name: Business address: Suburb: State: Business phone number: Signature: Postcode:

Date:

Australian Health Practitioner Regulation Agency (AHPRA) registration number: Please provide the following information on the back of the applicants passport photograph: This photograph is a true likeness of (applicants name) Your name Your provider number Your signature Date of signature

Access Travel Pass Information and application form

15

Section 4: Photograph
35mm

45mm

Attach signed photograph here with a paper clip

A photograph is NECESSARY for ALL applicants. It is recommended that the passport photographs be taken before the appointment with the healthcare professional, so they can sign the back of the photo at the same time as completing Section 3 of this form. Afx the recent (within 3 months) colour passport photograph to the form for the health care professional to sign with the application. The colour passport-size photograph: >> must be 35mm x 45mm and a clear head shot with the applicant facing forward >> must have the applicants full name printed on the reverse of the photograph and be signed and dated by the healthcare professional completing this form. Please note: >> Photocopies or black and white photographs will not be accepted. >> The photograph will be scanned and kept on le to make it easier to get a replacement Access Travel Pass if it is lost, stolen or becomes non-operational.
Access Travel Pass Information and application form

16

Section 5: Terms of use

1.  The Access Travel Pass entitles the pass holder to free travel on Victorias public transport network. As at the date of issue of these Terms of use, this means: >> train, tram and bus passenger services operating in metropolitan Melbourne; >> train and coach passenger services operated by V/Line throughout regional Victoria; >> urban bus services in regional cities; and >> other public transport services operated under contract orservice agreement with Public Transport Victoria. 2.  Access Travel Pass does not apply to NSW TrainLink, Great Southern Railway, airport services, tourist railways, privately run bus services and chartered trains, trams and buses. 3.  The contents of the information provided in this application form part of the Terms of use. 4. The Access Travel Pass holder will: >> be issued with a registered myki with their photograph and name printed on the card; >> carry their registered myki at all times when travelling on Victorias public transport services; >> not alter, tamper or interfere with the registered myki; >> keep their contact details up to date with Public Transport Victoria; >> advise Public Transport Victoria as soon as possible if the registered myki is lost, stolen, damaged or non-operational, including if they become aware that the name or photograph is illegible;

Access Travel Pass Information and application form

17

>> complete and submit a Statutory Declaration to Public Transport Victoria if their registered myki is lost or stolen; >> upon request, show the Access Travel Pass to any Authorised Ofcer (transport inspector); and >> not lend or loan the Access Travel Pass to any other person. 5.  The registered myki remains the property of the Public Transport Victoria. 6.  Representatives of public transport authorities may inspect, deactivate, suspend, hotlist or take possession of the registered myki or require its return at any time if the pass holder is in breach of the terms of use. 7.  A free replacement registered myki with a loaded Access Travel Pass will be issued if it becomes damaged and non-operational and when conrmed via a Statutory Declaration that the Access Travel Pass was lost or stolen. 8.  Public Transport Victoria may change these terms of use from time to time. The current version of the terms of use may be obtained by contacting Public Transport Victoria on 1800 800 007 or by visiting ptv.vic.gov.au 9.  Where Public Transport Victoria reasonably considers that any such change will have more than a minor detrimental effect on travel for pass holders generally, the change will be notied by Public Transport Victoria to pass holders in advance in writing. 10. Public Transport Victoria has the right to revoke, refuse to issue or reissue an Access Travel Pass to any applicant. 11. The entitlement enforced by the Access Travel Pass and established in the Victorian Fares and Ticketing Manual (myki) continues as long as the disability exists; therefore there is no need to reapply periodically for an Access Travel Pass. However, this is subject to any subsequent changes to the conditions governing the use of public transport. 18

Access Travel Pass Information and application form

Section 6: Privacy notice

Some Personal Information or Health Information is collected from you to facilitate the issuing and administration of your myki and relevant entitlements. Where necessary, Public Transport Victoria may disclose Personal Information or Health Information to a Victorian public transport operator, the Department of Transport Planning and Local Infrastructure or another entity for the purpose of issuing or administering your myki. Any Personal Information or Health Information collected by Public Transport Victoria will only be otherwise used or disclosed if required by law or permitted by privacy laws. If you choose not to provide certain information (such as your name and address, or other contact details) when requested, Public Transport Victoria may not be able to process your application form. You are entitled to contact the Public Transport Victoria Information Privacy Ofcer (contact details are set out below) and request access to any Personal Information or Health Information about you that is held by Public Transport Victoria. Public Transport Victoria will take reasonable steps to correct and update any Personal Information or Health Information that is established to be inaccurate, incomplete or not up to date or provide you with a written statement if such a request is refused. For more information please visit ptv.vic.gov.au or contact Public Transport Victorias Information Privacy Ofcer: Public Transport Victoria Information Privacy Ofcer PO Box 4725 Melbourne VIC 3000 Phone: 1800 800 007 Email: ptvprivacy@ptv.vic.gov.au

Access Travel Pass Information and application form

19

Section 7: Contacts for more information

For all Access Travel Pass enquires, contact Public Transport Victoria for assistance: Phone: 1800 800 007 Website: ptv.vic.gov.au National Relay Service: 13 36 77 Speech-to-Speech Relay Service: 1300 555 727 Multilingual information For all Access Travel Pass telephone enquiries in languages other than English, please use the following phone numbers: Arabic Cantonese Croatian Dinka Greek Italian Macedonian 9321 5440 9321 5441 9321 5442 9321 5452 9321 5443 9321 5444 9321 5445 Mandarin Somali Spanish Sudanese Turkish Vietnamese 9321 5454 9321 5446 9321 5447 9321 5453 9321 5448 9321 5449

All other foreign languages 9321 5450 Submit completed form to: Public Transport Victoria Access Travel Pass applications PO Box 4724 Melbourne VIC 3001

PTVH0114

Access Travel Pass Information and application form

20