National Disability Data Asset – Privacy Consultation Sessions – Nomination Form National Disability Data Asset - Privacy Consultation Sessions - Nomination Form Step 1 of 2 50% The following only applies if you are providing ‘sensitive information’ as part of your consultation response. Please note that you do not need to provide your sensitive information if you do not wish to do so. By providing your sensitive information as part of your consultation response, you consent to the Department of Social Services collecting your sensitive information and handling your sensitive information in accordance with this privacy notice.(Required) I consent for the information I have provided to be shared with the Australian Bureau of Statistics (ABS) for the purpose of facilitating participation in an ABS privacy consultation session. (Required) I consent for the information I provide (including during the consultation sessions) to be summarised by Maddocks in notes taken during the sessions, within the consultation report and to inform the Privacy Impact Assessment. (Required) I consent for the name of my organisation and/or the name of the organisation that referred me to be provided to Maddocks for the purpose of summarising the broad participant background through the consultation report. I understand that they will handle my personal information in accordance with the Maddocks Privacy Policy. Name(Required) Email address(Required) Postal address(for sending gift card if you attend a session) Street Address Address Line 2 City/Town/Suburb State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Available on 22 June 2023 1 to 3pm AEDT Yes No Available on 26 June 2023 1 to 3pm AEDT Yes No Available on 28 June 2023 1 to 3pm AEDT Yes No Would you like advice using Microsoft Teams? Yes No The presentation materials will be available in Plain Language (HTML, PDF), Easy Read (HTML, PDF). These will be sent to you a week before the session. Will this meet your accessibility needs? Yes No If no, what is your preferred format? Would you like a support person to attend with you? Yes No If yes, please check with them if you can provide their name and email addressName Email address We will have Auslan interpreters and live captioning. Do you have any other access requirements? Yes No If yes, please specify requirementsWhich organisation suggested this consultation session to you? Would you like us to contact you to discuss the privacy sessions? Yes No If yes, please provide your preferred contact method and contact details (e.g. text only and mobile phone number)Contact method Contact details I consent for the Department of Social Services/Australian Bureau of Statistics to contact me about being involved in future consultation sessions on the National Disability Data Asset. Yes No
engage.dss.gov.au
engage.dss.gov.au