Aged care application for the dementia and cognition supplement in home care provided before 1 November 2025 form (AC014)

Use this form to advise us that a care recipient within your aged care service is eligible to receive the Dementia and Cognition Supplement.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology or need an interpreter.

Download and complete the Aged care application for the dementia and cognition supplement in home care provided before 1 November 2025 form.

This form must be completed and signed by an authorised person of the approved provider.

To submit this form, register a Dementia and Cognition Supplement event on the Aged Care Provider Portal (ACPP). You can then upload the form and any additional documents.

If the ACPP is not available, return the completed form and supporting documents by following the instructions on the form.

Page last updated: 1 November 2025.
QC 20551