Application Form A – Inborn Errors of Metabolism (Fillable PDF)

Application Form A is the official Australian Government form used to apply for financial assistance for individuals diagnosed with specific Inborn Errors of Metabolism (IEM) – namely Dihydropteridine Reductase (DHPR) deficiency, hyperphenylalaninemia, and Phenylketonuria (PKU). The form is required for the annual reassessment and re‑application process.

What Is Application Form A?

This form collects detailed medical, personal, and financial information to determine eligibility for the government‑funded program that helps cover treatment costs, dietary supplements, and related health services for eligible IEM conditions.

Who Should Use This Form?

• Individuals diagnosed with DHPR deficiency, hyperphenylalaninemia, or PKU.
• Parents or legal guardians applying on behalf of a child with one of these conditions.
• Anyone who received assistance in a previous year and needs to renew their eligibility.

How to Complete the Form Online with Formize

Instead of downloading the PDF and opening it in a separate editor, you can fill it out directly on this page using the Formize PDF Filler app. Follow the simple steps below.

Common Mistakes to Avoid

• Leaving required fields blank – the filler will highlight missing information.
• Submitting outdated medical reports – ensure all documents are from the last 12 months.
• Using an unsupported browser – Chrome or Edge provides the best experience.

Download the Fillable PDF

If you prefer the traditional method, you can download the official PDF and print it.