Federal Interlocutor Contribution Program Report

PDF Version - Fill & Print (136 Kb, 1 Page)

Form Instructions

DCI# 41772 (2014-2015)

Privacy Act Statement:

The information you provide in this document is collected under the authority of the Office of the Federal Interlocutor for Métis and Non-Status Indians, Federal Interlocutors Contribution Program. Information on individuals is used by Aboriginal Affairs and Northern Development Canada employees. 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 Personal Information Bank INA PPU 330, which is detailed at InfoSource.

Recipient Name

Recipient Number

Email Address

Telephone Number

Project Title and Funding Type

Arrangement Number

Type of Report:

  • Interim Activity/Progress and Financial Reporting
  • Attached as document
  • Final Activity/Progress and Financial Reporting
  • Included in this report

Report Due Date (YYYYMMDD)

Project Description:

Describe the work carried out during the fiscal year. Include dates of the project activities for an interim report.
Refer to your funding agreement work plan and attach the detailed report and any required supporting documentation.

Project Results:

Describe the results of this project/initiative. Refer to your funding agreement work plan and attach the detailed report and any required supporting documentation.

Required Supporting Documentation Attached:

  • Project Expenditures as per Project Budget (Statement of Revenues and Expenditures)
  • Detailed Project Report as per Project Deliverables and annexes as required

AANDC Funding

AANDC Funding Expended

Surplus/Deficit

Authorized/Submitted by:

Given Name

Family Name

Email Address

Telephone Number

Title

Date (YYYYMMDD)