Prelodgement Information Request
Healthy HeadWaters Water Use Efficiency project
Prelodgement information request form
Using this form
This form is intended for use by irrigators considering an application to the Healthy HeadWaters Water Use
Efficiency (HHWUE) project infrastructure funding program.
The Department of Natural Resources and Mines (DNRM) offers information to assist interested irrigators from
eligible zones of the Queensland Murray-Darling Basin to develop their expressions of interest. Irrigators should
note that each funding round will focus on specific water products and locations. Please refer to the current
infrastructure program catchments maps for a list of eligible zones. Water products that are not eligible include:
groundwater entitlements, surface water entitlements tied to land, and temporary or carryover water entitlements.
Submitting a prelodgement information request form
The form can be submitted by email, fax, mail or in person to the contacts below. DNRM will respond within 10
business days.
Potential applicants should note this form is separate from an application for the HHWUE infrastructure funding
program and is not a prerequisite to applying.
Contacting DNRM
For more information on this form or the HHWUE project, please contact the HHWUE project team at DNRM:
Mail:
PO Box 318
Toowoomba Qld 4350
Office: 203 Tor Street, Toowoomba Qld 4350
126 Alfred Street, St George Qld 4487
Phone: (07) 4529 1321 (Toowoomba)
(07) 4620 8123 (St George)
Email: [email protected]
Fax:
Web:
(07) 4529 1555
www.dnrm.qld.gov.au
DNRM office use only
Reference
Date received
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Technical advice application form
Prelodgement information request form
Part A: Applicant information
Name
Business trading name
Phone
Alternate phone
Fax
Email
Mailing address
State
Postcode
Country (if outside
Australia)
The department may seek to discuss information with a holder of the water entitlements listed at Part C. If the
applicant is not a holder of the water entitlements listed, please nominate a contact who is the entitlement holder
below.
Contact name
Phone
Email
Please tick to indicate which services you are requesting.
Confirmation of eligibility for current round (please complete all sections of this form)
You will receive a letter regarding the eligibility of the water, land and works
Copy of water titles (please complete Part C only)
You will receive one copy of the title for each water entitlement (to a limit of three) listed at Part C that is
eligible under the current HHWUE project application guidelines
Hydrological modelling data (Condamine and Balonne entitlements only, please complete
Part C only)
A Queensland Hydrology officer will contact you to assist
Characteristics of water entitlement under a multiyear account (Condamine and Balonne
entitlements only, please complete Part C only)
Your local DNRM Water Services officer will contact you to assist
Water management and trading advice (please complete Part C only)
Your local DNRM Water Services officer will contact you to assist
Project plan advice and development assistance (please complete all sections of this form)
Your local HHWUE project team member will contact you to assist
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Technical advice application form
Part B: Project information
Project location
Property name
Address
˚
Map coordinates of a point central to proposed works
Will any proposed work take place in New South Wales?
Yes
'
"S
˚
'
"E
No
Details of all land on which works will be undertaken
Lot
Plan
Registered owner/s
 Please attach
Please copy this page and attach an additional sheet of land details if more space is required.
Proposed works
Briefly describe your proposed on-farm water use efficiency infrastructure.
Part C: Related water entitlements
Water entitlements must be located in an area of the Queensland Murray–Darling Basin eligible for the current
funding round. If the water entitlements nominated below are not eligible, you may not receive all of the services
(including a copy of your water titles) requested at the start of this form.
Please note when requesting a copy of your water titles, that there is a limit of three titles per entitlement holder.
Further titles may be purchased from your local DNRM office. Please contact the HHWUE project team using the
details at the start of this form if you have any questions.
1. Registered water entitlement holder/s
Water entitlement number
Water entitlement type
Crown Plan
Choose an item...
Nominal volume (ML)
2. Registered water entitlement holder/s
Water entitlement number
Water entitlement type
Crown Plan
Choose an item...
Nominal volume (ML)
3. Registered water entitlement holder/s
Water entitlement number
Water entitlement type
Crown Plan
Choose an item...
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Nominal volume (ML)
Technical advice application form
Part D: Declaration
Privacy statement
The information collected in this form and any attachments is being used for the purpose of registering your interest
in and assessing your eligibility for the HHWUE infrastructure funding program. By signing this form, you are
permitting DNRM to collect and collate information relating to the HHWUE project for the purposes of public
distribution and specific provision to irrigators. The department will endeavour to maintain any confidentiality of
information relating to your form. However, consideration of your form may involve consultation and if so, details of
your form may be disclosed to third parties. The information will not otherwise be disclosed outside of the
department unless required or authorised by law (for example the Right to Information Act 2009). The information
provided will be held by the department. Any requests to access your information may be directed to the DNRM
contact on the cover of this form.
Signature
By signing this form you acknowledge:

all details are true and accurate

information provided by you in this form will be used for the purposes outlined in the privacy statement at
Part D of this form.
Completing this form does not guarantee the applicant funding under the HHWUE project.
Name
Signature
Date
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