Application Form A – Inborn Errors of Metabolism

Application Form A is the official Australian Government form used to apply for financial assistance for individuals diagnosed with certain Inborn Errors of Metabolism, specifically dihydropteridine reductase (DHPR) deficiency, hyperphenylalaninemia, and phenylketonuria (PKU). The form must be completed and resubmitted every 12 months to maintain eligibility.

What is Application Form A?

This PDF form collects personal details, medical diagnosis, treatment information, and financial data required by the Department of Health’s Inborn Errors of Metabolism program. It is a fillable PDF, meaning you can type directly into the fields without printing.

Who needs to complete this form?

• Individuals diagnosed with DHPR deficiency, hyperphenylalaninemia, or PKU.
• Parents or legal guardians applying on behalf of a minor.
• Anyone who has previously received assistance under the program and needs to renew their claim.

How to fill out Application Form A online

Instead of downloading the PDF and opening it in a separate editor, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load automatically, allowing you to complete the form directly in your browser.

Common mistakes to avoid

• Leaving required fields blank – the form will not submit.
• Providing outdated medical reports – attach the most recent diagnosis documents.
• Using an unsupported browser – Chrome is recommended for best performance.
• Submitting the form before the 12‑month renewal period – ensure you are within the eligibility window.

Where to submit the completed form

After you finish filling out the form, click the Submit button within the Formize interface. Your application will be securely transmitted to the Department of Health’s processing team. You will receive a confirmation email with a reference number for future inquiries.

Need more help? Review the FAQs below or contact your local health service for assistance.