HCPA Checklist - NDIS

Section 1: Details

Mr
Miss
Ms
Legal Name of Applicant:
Mrs

Full Name: Muhammad Arslan Munir

Mr
Miss
Ms
Legal Name of Director:
Mrs

Full Name: Muhammad Arslan Munir

Date of Birth:
14/11/1983
Email: arcalan.munir@gmail.com

Mobile: 0406438466

ABN: 43234323109

Legal Registered ABN CARE R US

Name:

Trading Name: CARE R US

YES
GST Registered?
NO

Registered Business 111 GRACE CRES KELLYVILLE NSW 2155

Address:

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Victoria
New South Wales
Queensland
States You Wish To Tasmania
Operate in: Northern Territory
Western Australia
South Australia
Australian Capital Territory

Is Postal Address a P.O. YES

Box? NO

Parent Organisation
Type of Business: Individual with ABN
Entity with an ABN

Australian Private Company

Individual/SoleProprietor
Partnership
Australian Public Company
Incorporated Association
Legal Entity Type: IncorporateCooperative
Organisation
Trustee on behalf of a trust
LocalGovernment
State/TerritoryGovernment
AboriginalCorporation

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Section 2: Services and Qualifications

Please note: Equivalency to a Disability Support Worker includes: Cert III in

Disability, Cert III in Independent Support and Cert III in Community Services.

102. Assistance to Access and Maintain Employment:

Qualifications:
Aboriginal Health Worker
Developmental Educator
Disability Support Worker
Welfare Worker
Social Worker
Teacher

103. Assistive Products for Personal Care and Safety:

No Qualification Required

104. Assistance with Daily Personal Activities (High

Intensity):
* Supplementary module (extra cost at time of audit)
Qualifications:
Aboriginal Health Worker
Disability Support Worker
WelfareWorker
Registered Nurse (RN)

Specialisations (please select):

Restrictive Practices
Complex Bowel Care
Tracheostomy Management
Urinary Catheter Care
Complex Wound Management
Sub-cutaneous Management

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PEG Feeding and Management

Ventilator Management
Severe Dysphagia

105. Personal Mobility Equipment:

No Qualification Required.

106. Assistance with Life Stage Transition:

* Please note that level 1&2 support coordination, psychosocial recovery
coaching and accommodation & tenancy assistance all fall within this service
group.
Qualifications:
Aboriginal Health Worker
Developmental Educator
Disability Support Worker
Welfare Worker
Social Worker

107. Assistance with Daily Personal Activities:

Qualifications:
Aboriginal Health Worker
Disability Support Worker
WelfareWorker

108. Assistance with Travel and Transport:

No qualification required.
Australian Drivers Licence

109. Vehicle Modification:

Qualifications:
Engineer
Mechanic

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110. Specialised Positive Behaviour Support:

* Supplementary module (extra cost at time of audit)
Will you be implementing restrictive practices? ☐ YES ☐ NO
Qualifications:
Occupational Therapist
Psychologist
Social Worker
Other Health Professional

111. Home Modifications:

Qualifications:
Architect
Building Designer
Building Inspector/Works Assessor
Building Surveyor, Builder
Building Work Project Manager
Building Work Supervisor
Carpenter / Joiner
Electrician
Occupational Therapist
Plumber, Gas Fitter, or Drainer
Rehabilitation Engineer
Tiler

112. Assistive Equipment for Recreation:

No qualification required.

113. Vision Equipment:

No Qualification Required.

114. Community Nursing Care:

Qualifications:
Registered Nurse

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115. Assistance with Daily Tasks / Shared Living:

* SIL (supported independent living), ILO and STA are all components of this
service group
Qualifications:
Disability Support Worker
Welfare Worker
Taxi or bus driver

116. Innovative Community Participation:

No Qualifications Needed.

117. Development of Life Skills:

Qualifications:
Aboriginal Health Worker
Disability Support Worker
WelfareWorker

118. Early Childhood Supports:

* Supplementary module (extra cost at time of audit)
Qualifications:
Audiologist
Art Therapist
Counsellor
Developmental Educator,
Music Therapist Registration,
Orthoptist
Occupational Therapist
Physiotherapist
Podiatrist
Psychologist
Speech Pathologist
Social Worker
Teacher

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119. Specialised Hearing Services:

Qualifications:
Audiologist

120. Assistance with Household Tasks:

Qualifications:
Cleaner
Gardener
Other

121. Interpreting and Translating:

Qualifications:
Interpreter
Translator

122. Hearing Equipment:

No qualification required.

123. Assistive Products for Household Tasks:

No qualification required.

124. Communication and Information Equipment:

No qualification required.

125. Participation in the Community:

Qualifications:
Aboriginal Health Worker
Developmental Educator
Disability Support Worker
Welfare Worker

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126. Exercise Physiology & Personal Wellbeing:

Qualifications:
Exercise Physiologist
Personal Trainer

127. Plan Management:

Qualifications:
Accountant
Bookkeeper

128. Therapeutic Supports:

Qualifications:
Audiologist
Art Therapist
Counsellor
Development Educators
Dietician
Exercise Physiologist
Music Therapist
Orthoptist
Occupational Therapist
Physio Therapist
Podiatrist, Psychologist
Rehabilitation Counsellor
Speech Pathologist
Social Worker
Teacher

129. Specialised Driver Training:

Qualifications:
Driving Instructor Registration/Qualification

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130. Assistance Animals:

No qualifications are required.

131. Specialist Disability Accommodation (SDA):

* Supplementary module (extra cost at time of audit)
No qualification required.
Housing provider

132. Support Coordination:

* Supplementary module (extra cost at time of audit)
Qualifications:
Occupational Therapist
Psychologist
Social Worker
Other Allied Health Professional

133. Specialised Supported Employment:

Qualifications:
Aboriginal Health Worker
Disability Support Worker
WelfareWorker
Teacher

134. Hearing Services:

Qualifications:
Audiologist
Audiometrist

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135. Custom Prosthetics:

Qualifications:
Orthotist
Prosthetist
Pedorthist
Physiotherapist
Podiatrist

136. Group and Centre-Based Activities:

Qualifications:
Developmental Educator
Disability Support Worker
WelfareWorker
Social Worker

YES
Administering Medication?
NO

Disposing of Waste, Infectious and Hazardous YES

Substances? NO

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Section 3: Suitability

The NDIS Commission will assess the suitability of the Applicant, including the
Applicant’s Key Personnel, in conjunction with the qualifications, competencies and
experience of the Applicant. The below questions will be used as part of the
suitability assessment. The answers to these questions will be assessed on a
case-by-case basis.

This information must be included for all Key Personnel in your organisation,
including directors, Board Members, Chief Officers, and any other senior
management.

Please check YES or NO for the following questions:

Question 1
Has the Applicant ever been in receivership, subject to a winding-up order
and/or under administration?

This includes where the Applicant:

● Is under external administration (or equivalent in home jurisdiction)

● Is subject to a winding-up order or an application for winding up (or
equivalent in home jurisdiction)
● Has a receiver or receiver and manager been appointed to the
company (or equivalent in home jurisdiction)
● Has a company administrator been appointed to the company (or
equivalent in home jurisdiction)
● Is the company currently subject to a deed of company
administration (or equivalent in home jurisdiction)
● Has received notice that action for the involuntary cancellation of its
incorporation had commenced or is proposed?

☐ YES ☐ NO

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Question 2
Have any of the Applicant’s Key Personnel ever been convicted of an indictable
offence?

This includes convictions of indictable offences against a law of the

Commonwealth, State or Territory or other jurisdiction (including foreign
country).
Where the answer is yes, please indicate which Key Personnel was convicted,
and the nature of the conviction.

☐ YES ☐ NO

Question 3
Is the Applicant, or any of the Applicant’s Key Personnel an insolvent under
administration, or been an insolvent under administration ( or equivalent in
home jurisdiction)?

☐ YES ☐ NO

Question 4
Has the Applicant, or any of the Applicant’s Key Personnel commenced
bankruptcy proceedings?

☐ YES ☐ NO

Question 5
Have any of the Key Personnel been disqualified as a Director of a company,
and/ or disqualified from managing corporations?

☐ YES ☐ NO

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Question 6
Have any of the Applicant’s Key Personnel, or the Applicant overall, been subject
to any findings or judgement in relation to fraud, misrepresentation or
dishonesty?

This includes where the Applicant’s Key Personnel or the Applicant overall
has:
Been the subject of any findings or judgment in relation to fraud,
misrepresentation or dishonesty in any administrative, civil or criminal
proceedings, or is currently party to any proceedings that may result in the
applicant being the subject of such findings or judgment been disqualified
from managing corporations under Part 2D.6 of the Corporations Act 2001.

☐ YES ☐ NO

Question 7
Has the Applicant or any of the Applicant’s Key Personnel been subject of any
investigation, adverse finding or enforcement by any regulator, including
authorities responsible for the quality or regulation of services for people with
disability?

This includes any adverse findings or enforcement action by:

● A department of or authority or the other body established for a
public purpose by the Commonwealth, a State or Territory, including
those with responsibilities relating to the quality or regulation of
services provided to the people with a disability, older people or
children.
● The National Disability Insurance Agency.
● The Australian Securities and Investment Commission.
● The Australian Charities and Not-for-profits Commission.
● The Australian Competition and Consumer Commission.
● The Australian Prudential Regulation and Authority.
● The Australian Crime Commission.
● AUSTRAC:
○ A work health and safety authority of a State or Territory.

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○ A body of a State or Territory that has similar responsibilities to

those mentioned above enforcement action may include:
- Banning Orders.
- Cancellation of NDIS Registration.
- Involuntary cancellation of an entity’s incorporation
status.
- Any other compliance or enforcement activity.

☐ YES ☐ NO

Question 8
If you have circled YES to any of the above questions, please provide a detailed
comment below with an explanation.

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Section 4: Declaration

Have you previously

established a PRODA ● IF NO – Skip this step.
(Provider Digital
Access) Account? ● IF YES – Please provide us with your PRODA
details below. We will call you upon login
attempts to retrieve verification codes from
☐ YES ☐ NO you. (You will not have to send us an ID)

Username:
ONLY DO THIS STEP IF YOU
REQUIRE REGISTRATION Password:
FOR THE NDIS.

Recommended Forms of ID (We require all 3):

Medicare Card *
Australian Drivers Licence *
Australian Passport *

ID Verification
Please attached 3 of the Plus, two Alternative ID:
required ID for your
registration. Medicare Card
Australian Drivers Licence
Each form of ID must Australian Passport
be clear and legible. ImmiCard

Plus, one of the following:

ONLY DO THIS STEP IF YOU
REQUIRE REGISTRATION
Australian Passport
FOR THE NDIS.
Australian Birth Certificate
Australian Citizenship (Front and Back)
Foreign Passport Certificate of Citizenship
by Descent
ImmiCard

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Health Care Providers Association Pty Ltd accepts no responsibility for the accuracy
or completeness of any information provided.

I confirm that the information provided on and in connection with this form is true,
complete, and accurate. I allow Health Care Providers Association Pty Ltd to create
or make changes to my PRODA concerning our contract and this form if necessary.
I allow Health Care Providers Association Pty Ltd to use this information in
completing the required services as agreed upon in the service agreement and put
this information forward to potential clients and the online HCPA Portal.

Muhammad Arslan Munir & Ali Salman

_________________________________________________________________
Full Legal Name

_________________________________________________________________
Signature

15/09/2023
_______________________________
Date

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Document ID: 61fe96a1-1ebb-4d67-a705-31b98afdc6af

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NDIS Checklist.pdf Sep 14, 2023 23:43:54 UTC

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Charlie O'Mullane
created the document Sep 14, 2023
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Charlie O'Mullane
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Arslan & Ali

first viewed document Sep 15, 2023
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Arslan & Ali

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Document ID: 61fe96a1-1ebb-4d67-a705-31b98afdc6af