The specialised smoke alarm alerts users to fire hazard through visual (flashing light) and tactile (vibrating pad) stimuli to ensure safety within your home, particularly when asleep.

To be eligible you must be:

Deaf or hard of hearing with a severe to profound loss in both ears, or a severe high frequency loss ≥70dB (averaged across 2, 3 & 4kHz) in both ears
A resident of Victoria or Tasmania
Not eligible for other funding schemes such as NDIS

The smoke alarm pack retails at $685. Those who are eligible will receive the pack for a $50 out of pocket fee. The fee can be waived for those who hold a Pension Concession Card.

To apply for the subsidy, please complete the online application form below. For more information or alternate ways to apply for the subsidy please contact Expression Audiology via email: audiology@expression.com.au

The Victorian Smoke Alarm Subsidy Scheme is part of the State Government’s Victorian Aids and Equipment Program. The Tasmanian Specialised Smoke Alarm Program is made possible through the support of the Tasmanian Government.

Smoke Alarm Subsidy Application Form

This form will take approximately 5 minutes to complete. You will need to upload proof of Deafness or degree of hearing loss.

To receive a smoke alarm kit you need to make a $50 co-payment. If it is difficult for you to meet this cost, please contact audiology@expression.com.au for solutions.

One smoke alarm kit is supplied per person, you can apply for more than one smoke alarm per household if there are multiple people who meet the eligibility criteria in the same house. Separate applications should be completed for each individual applying for the subsidy.

Your Personal Information

Full name

Parent/Guardian's name (if applicant is under the age of 18)

Date of birth (dd/mm/yyyy)

Address

Postcode

State

Phone

Email

Preferred Contact Method

Do you have cochlear implant(s)? YesNo

Has someone else living in your house applied for a smoke alarm subsidy before? YesNo

If yes, please provide the name of this person

Are you a Pension Concession Card holder? YesNo

If yes, please provide your CRN:

Living Arrangements

Do you live in Your own propertyA rental propertyOffice of housing accommodation (e.g. public housing)Disability funded accommodation (e.g. a community residential unit)Other (please state)

Which of the following best describes your living situation Live in a deaf household (no hearing occupants)Live in a hearing household (at least 1 hearing occupant)Live aloneOther (please state)

Please provide further details on your home:

Number of bedrooms

Number of living areas

Number of hallways

Number of levels / storeys

Number of stairways

Which of the following do you use in every day communication? AuslanOther sign languageSpoken language other than EnglishSpoken EnglishOther (please state)

Are you receiving services through the National Disability Insurance Scheme (NDIS)? YesNo

Are you receiving Home and Community Care services through your local Council? YesNo

Are you receiving a Commonwealth Government Home Care Package? YesNo

Client Responsibilities

As a recipient of the Victorian Smoke Alarm Scheme or the Tasmanian Specialised Smoke Alarm Program you are responsible for the following. Please agree to all the conditions below in order to receive your smoke alarm.

Maintaining the alarm

Test the alarm weekly to ensure it is working. Please see the attached instructions on how to test the alarm. Agree

Refrain from making inappropriate use of or modification to the smoke alarm. Agree

Contact Expression Australia immediately if:

The alarm is broken or faulty for a replacement within the two-year warranty period. Agree

The alarm is broken or faulty for a replacement outside of the two-year warranty period. A replacement alarm can be provided for an additional $50 co-payment. Agree

I change address or my contact details. Agree

General Conditions

I understand that my $50 co-payment is a non-refundable contribution to the cost of the smoke alarm, and the Victorian or Tasmanian State Government will cover the rest of the cost.* Agree

Minimise putting any member of the public at risk through the inappropriate or negligent use of the smoke alarm. Agree

Proof of Profound Deafness

Please choose ONE of TWO options and attach the statement to this application.

I have attached a most recent audiogram (within the last twelve months) proving that I am Deaf or hard of hearing with a severe to profound loss in both ears, or a severe high frequency loss in both ears.

OR

I have attached a referee letter from a Teacher of the Deaf, Audiologist, Case Manager, Expression Australia staff, Deaf Victoria staff, Able Australia staff OR Doctor (GP) stating that I am profoundly deaf or have a severe high frequency hearing loss.

Attach Files

Permitted file types, Word doc, JPEG, PNG, PDF. Max size 2MB

Declaration

I have read and agree to the conditions and responsibilities as a client of the Expression Australia Smoke Alarm Subsidy Scheme Agree

I understand that my application will be reviewed against eligibility criteria and I will be informed of the outcome of my application via my preferred contact method as indicated above Agree

I agree to be contacted by Expression Audiology if further information is required to assess my eligibility Agree

I declare that the information provided in this application is true and correct Agree