Welfare to Work Case Study
Right to Privacy and Consent Form

About the Project
In July 2006, the Federal Government introduced new rules for people receiving Centrelink payments as part of changes called “Welfare to Work”.

Welfare and community organisations want to know how these new rules are affecting people.  The best way to find this out is to ask people to tell their story.  This is called a case study.

Over the next year or two, organisations across Australia will be collecting stories from people who have been affected by Welfare to Work.  Organisations will use the stories to help the Government and the media to understand the impact of Welfare to Work.

The database is coordinated by the Australian Council of Social Service.  Information is provided directly by other community organisations.

Taking Part
There are many reasons to share your story.  Stories that are told by the people who are affected themselves are powerful and have a great impact on the people who hear them.  You can tell your own story better than someone else can tell it for you.  

By sharing your story you will also be helping to argue for changes that will make Australia fairer.

If you agree, your story will be kept in an electronic database and other community organisations will be able to read it.  However, no-one will know your name or any other information that could identify you.

Your Rights
Before you decide to share your story, it is important that you understand your rights.  You have the right:
to choose not to share your story
to decide not to answer some questions
to get help to tell us your story (including using an interpreter)
to stay anonymous
to tell us how you would like your story to be used
to ask for more help if you need it for any problems you are having
to see your story when it is finished
to know how your story is used
to find out more information about this project
to give us feedback about this project

You also have the right to have your privacy protected.  This is talked about more below.

If you decide not to take part in this project that’s okay and this won’t affect the way you are treated by us in the future.  

You can also decide at any time that you don’t want to take part in the project anymore and ask for your story to be removed.  However, it is possible that your story may have been used in the meantime.

Your Privacy
We respect your right to privacy.  This project complies with national and state laws that protect your privacy.

We will make sure that we do not share your name or any other information that could identify you with anyone else.  We will also make sure that the information you give us is stored securely.

If you agree, other community organisations will be able to read your story, but they will not be able to change it.

We will not give your contact details to anyone else unless we get your permission first.

What will Happen to Your Story
Stories that are put on the database will be read by other community organisations.  Organisations will use some stories, where people have said this is okay.  Sometimes, people may want to speak to you about your story.  For example, the media may think that your story is a good one.  In these cases, if you have agreed to be contacted again in the future, we will call you.  We will not give your name or contact details to anyone else including the media, without receiving your explicit approval first. 

If you are happy to take part in this project, please sign the following form to show that you have agreed to take part.

This form will not be kept with your case study, to make sure that your story stays confidential.
Consent
Please tick the relevant box/boxes, or write ‘yes’ or ‘no’ after each statement, and sign below to show that you have read and understood this information.

?	I agree to contribute my story to the (ACOSS) national database and for it to be used to monitor the impact that the Welfare to Work legislation is having on affected individuals. 

?	 I am happy for my story to be used, but I would like to be contacted first.

?	I agree to being contacted if another organisation or the media would like to find out more information about my story.



Signed:

Date:	  /  /


If you would like to be contacted before your story is used, and/or you agree to be contacted by another organisation or the media, please provide your contact details below.

Name:
Preferred contact phone number: