First Nations Infrastructure Investment Plan - Annual Report

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Form Instructions

DCI# 460674 (2014-2015)

Privacy Act Statement

The information you provide in this document is collected under the authority of Capital and Facilities Maintenance Program - Payments to support Indians, Inuit and Innu for the purpose of supplying public services in capital facilities and maintenance. Information on individuals is used by Aboriginal Affairs and Northern Development Canada Capital and Facilities Maintenance Program employees who need to know the information in order to respond to your request and/or the program requirements. We do not share the personal information with other government departments. The personal information will be kept for a period of 30 years. Individuals have the right to the protection of and access to their personal information under the Privacy Act. The information collected is described under the Treasury Board Personal Information Bank INA PPU 608 which is detailed at InfoSource.

Note: This report shall only include eligible projects under the Capital Facilities and Maintenance program and fit within the parameters of the National Priority Ranking Framework. This report shall not include projects which are being funded through a First Nations Operation & Maintenance allocation.

Recipient Name

Recipient Number

Fiscal Year

Funding Contribution

Actual AANDC Funding

AANDC Funding and/or AANDC Formula-Based Funding

Regional Project Name

Regional Project Number

ICMS Project Number

Type of Capital Project

Funding for which Project Stage (excluding O&M)

Current Estimated Project Cost (All Sources)

Other Funding, including First Nation and/or Provincial

AANDC Formula- Based Funding

AANDC Proposal Driven Funding

Previous Year(s)

Current Year to Date

Current Year

Current Year + 1

Current Year + 2

Current Year + 3

Current Year + 4

Beyond Five Years

Total Funding

Multi-Year Project Narrative:

Comments: Any additional information including the identification of non-AANDC funding (include source) and funding from CFNFA First Nation's Block.

I hereby certify that the information provided in this Capital Plan has been reviewed and is acceptable to the Band Council.

Person Authorized by the Band Council

Given Name

Family Name

Business Email Address

Business Telephone Number

First Nation Contact

Given Name

Family Name

Date (YYYYMMDD)