Duty Lawyer Record - Family Law

Next action Create file (specify type) ______Lodge Application Other

Send copy to______No further action / file away

Duty Lawyer assessment (mandatory before NON-FILEservice delivery)

Conflict enquiry result: No conflict Conflict Info barrier secured (specify): ______

Name & DOB______Name & DOB______

Name & DOB______Name & DOB______

Client first name

Work TypeInformation onlyProcedural advice onlyLegal advice

MentionDirectionsHearing (*interim / subsequent / final)Conference (type)

Comments (if required to be entered in ATLAS)______

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1. Personal details

Title Mr Mrs Ms Miss Mstr None

First name______

Middle name______

Family name______

Have you used any other names? Yes No

If YES, please state other names:______

______

Gender Male Female Not applicable

X (indeterminate/intersex/unspecified)

Date of birth_____/_____/_____If estimate, tick

2. Contact details

Are you homeless? Yes No

Where do you live?

______

______Postcode______

Is this where you usually live? Yes No

Can we send mail to this address? Yes No

If no, where can we write to you?

______

______Postcode______

Do you prefer to be contacted by email? Yes No

Email address______

Phone numbers: Is SMS contact ok? Yes No

Mobile______Home______

Work______Other______

3. Origin

Country of birth ______Year of arrival ____

Are you of Aboriginal or Torres Strait Islander origin?

No Aboriginal Torres Strait Islander

Aboriginal and Torres Strait Islander

4. Language

Do you speak a language other than English at home?

No

YesWhich language?______

Do you need an interpreter? No

YesWhich language?______

How well do you speak English?

Very well Well Not well Not at all

How well do you read English?

Very well Well Not well Not at all

Has anyone helped you to fill in this form? Yes No

5. Disability

Do you have a disability?

No Not stated(Go to Question 6)

YesWhat kind of disability?

Acquired brain injuryIntellectual Hearing

Mental health Psychiatric Physical

Speech Visual

Not disclosed Other

6. Employment status

What is your employment status?

Not employed (Go to Question 7)

Full time Part time Casual Self employed

What work do you do?______

How much do you earn each week after tax? $______

Do you support someone financially? Yes No

Does anyone support you financially? Yes No

7. Benefit details

Do you have a health care card? Yes No

Are you on a benefit? No (Go to Question 8)

YesCRN (optional)

What type of benefit do you receive?

ABSTUDY Age pension Austudy

Carer’s benefit Disability support pension

Newstart allowance Parenting payment

Partner allowance Sickness allowance

Special benefit Veterans/war service

Widow allowance Widow B pension

Wife pension Youth allowance Other

Do you receive the maximum rate of benefit?

Yes No

8. Living arrangements

What are your usual living arrangements?

Single Married Living with partner

Separated from partner Married but separated

Divorced Widowed Not applicable

Custody details: VLA use only

Custody/detention location______

______

Date remanded into custody or detention___/___/___

Expected release date_____/_____/_____

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