Australian Government Reference Number:
(For administration use only)
NDRRA Notification Form - Version #
State/ Territory ACT / NSW / VIC / TAS / QLD / NT / SA / WA Contact Details:
(Please Circle) Name:
Disaster Event Details:
Name of Event:
Type of Event:
Date(s) Event Occurred:
NDRRA Assistance Available:
Please list all LGA’s affected by the event and indicate the assistance measures being provided. When complete please send to firstname.lastname@example.org.
Should a State/Territory activate additional assistance measures or LGA’s for this event, an updated Notification Form must be sent to Emergency Management Australia immediately.
Please attach a detailed description of all assistance measures available for this event. Include information such as the name of the assistance measure, a brief description of its purpose, amounts available, application
closing dates and details of the administering agency including contact information.
Category A Category B Category C Category D
Concess Concess Concess
Personal Personal Counter Rest. Interest Interest Clean Up Clean Up
Loans for Loans for Concess Loans for Freight Community
Hardship and Disaster Essential Rate Rate Grants to Grants to and and
CDO Small Primary Loans for Needy Subsidies Recovery (Please list)
Assistance Financial Operations Public Subsidies Subsidies VNPB NI Recovery Recovery
Business Producers VNPB Individuals PP Fund
LGA (PHD) Counselling (CDO) Assets SB PP Grant SB Grant PP
(SB) (PP) (NI)
3.2.2 a, b, c 3.2.2 g 3.2.2 f 3.3.1 a 3.3.1 c 3.3.2 a 3.3.2 a 3.3.2 b 3.3.2 b 3.3.2 c 3.3.2 d 3.3.2 d 3.3.2 e 3.3.2 e 3.4.1 a 3.4.1 b 3.4.1 c 3.5
E.g. Dorset 11/6/12 9/6/12 9/6/12 1/6/12
Insert rows as
Estimated cost $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
Total estimated cost $
I certify that the disaster event notified in this form meets the definition of an eligible disaster as specified in the Natural Disaster Relief and Recovery Arrangements Determination 2011.
NOTE: This Notification Form must be certified by an appropriate officer of the State/Territory agency responsible for natural disaster relief and recovery.