Tribal Council Consolidated Report

PDF Version - Fill & Print (1,148 Kb, 6 Pages)

Form Instructions

DCI# 5677661 (2014-2015)

Privacy Act Statement

This statement explains the purposes of collecting your personal information and how it is used. Only information needed to respond to program requirements will be requested. Collection and use of personal information is in accordance with the Privacy Act. In some cases, information may be disclosed without your consent pursuant to subsection 8(2) of the Privacy Act.

Contact your regional office or program contact for information on the authority under which your personal information is collected and used.

We will use your personal information as assurance that the information contained in the form is accurate or to contact you about information contained in the form. The information collected is described in the Program Administration Class of Personal Information detailed at Info Source (c) . Contact your regional office or program contact for information on the retention and disposition of your personal information.

As stated in the Privacy Act, you have the right to access your personal information and request changes to incorrect information. Contact your regional office or program contact to notify us about incorrect information.

Identification Information

Recipient Name

Recipient Number

Region

Contact Information

Primary Contact Information
Given Name
Family Name
Title/Position
Telephone Number
Extension Number
Fax Number
Email Address (if available)
Mailing Address
Number/Street/Apartment/P.O. Box
City/Town
Province or Territory
Postal Code
Street Address
Same as Mailing Address
Number/Street/Apartment/P.O. Box
City/Town
Province or Territory
Postal Code

Secondary Contact Information

Given Name
Family Name
Title/Position
Telephone Number
Extension Number
Fax Number
Email Address (if available)
Mailing Address
Number/Street/Apartment/P.O. Box
City/Town Province or Territory
Postal Code
Street Address
Same as Mailing Address
Number/Street/Apartment/P.O. Box
City/Town Province or Territory
Postal Code

List of Reports

The Department is continuously working on simplifying how tribal councils access, plan and report on all the AANDC programs they are involved with. The intent is to move to a single application, a single plan and a single report (1-1-1). The first stage, 2014-2015, involves application and report data being collected using single forms for all AANDC programs that do not collect privacy data and/or use data collection software instead of standard forms.

Please see the Reporting Guide for Applications and Proposals not yet consolidated into this form.

Report Name

Number of Instances

41740 - FIRST NATIONS LAND MANAGEMENT REPORT

455955 - FAMILY VIOLENCE SHELTER AND PREVENTION PROJECT ANNUAL REPORT

460671 - CAPITAL PROJECTS REPORT

471935 - LANDS AND ECONOMIC DEVELOPMENT COMMUNITY PROFILE REPORT

471949 - DISABILITIES INITIATIVE REPORT

472877 - NATIONAL CHILD BENEFIT REINVESTMENT (NCBR) REPORT

472939 - LANDS AND ECONOMIC DEVELOPMENT PROGRAMS PROJECT STATUS REPORT

1208367 - FIRST NATIONS CHILD AND FAMILY SERVICES ANNUAL BUSINESS PLAN

3843372 - TREATY RELATED/INTERIM MEASURES REPORT

3866547 - CAPITAL FACILITIES AND MAINTENANCE PROGRAM SPECIAL INITIATIVES REPORT

455897 - INCOME ASSISTANCE REPORT

4548549 - REPORT ON ACTIVITIES AND EXPENDITURES

5814389 - REPORT ON TRIBAL COUNCIL FUNDING

41740 - FIRST NATIONS LAND MANAGEMENT REPORT (1)

Note: This reporting template must be used to properly identify and file attachments in meeting the reporting requirement in FNITP.

Phase:
Developmental Phase Quarterly Report
Operational Phase
Project Name
Project Number/ID
Report Period (Quarter)
Date (From) (YYYYMMDD)
Date (To) (YYYYMMDD)

Project Activities
Attach a copy of your Quarterly Milestone Report as outlined in Schedule C of your Community Approval Process Plan (CAPP).
The report should indicate which quarter you are reporting on by ticking off the appropriate box in the top right of the report you attach.

455955 - FAMILY VIOLENCE SHELTER AND PREVENTION PROJECT ANNUAL REPORT (1)

Section 1 (to be completed for Shelter and/or Prevention Project Reports)

1(a) Identification Information

Reporting for:
FVPP Shelter Funding
Prevention Project Funding
Both

Shelter Name

Prevention Project Name

Brief Project Description

1(b) Partnerships and Community

Type of Partnerships and Funding
Shelter
Funding and/or Collaboration
Prevention Project
Funding and/or Collaboration

Other Federal Department (Specify):
Band
Tribal Councils
Province
Municipality
Aboriginal Community Organizations
Child and Family Services Agencies
Addiction Treatment Centres
Health Services
Schools
Police/RCMP
Charitable/Not-For-Profit Organizations
Volunteers
Other (Specify):

Community Priority
Do your activities support a specific community priority?

Shelter Yes No
Prevention Yes No

If you responded Yes" to the above question, specify the priority or priorities being addressed.

Engagement With Communities
Describe how you inform communities about your programs and services and how you report on results to the community.

1(c) Services Offered in Shelter (Select All That Apply)
Shelter

Accompaniment
Advocacy/Referral to Other Services/Programs
Child Care
Children's Programs
Crisis Intervention
Crisis Line
Drop In
Follow-Up/Aftercare
Housing Information/Procedures
Legal Issues
Needs Assessments
Transportation

1(d) Prevention Activities With Shelter And/Or Prevention Project Funding (Up To 5 Priorities)

Treatment/Intervention
Shelter
Prevention Project

Addictions
Counseling/Abuser
Counseling/Children
Counseling/Group
Counseling/Individual
Mental Health/Illness
Suicide Intervention

Culturally Sensitive Services
Shelter
Prevention Project

Elder and/or Traditional Teachings
Family Healing
Healing Circles and/or Traditional Healing
Inner Healing
Residential School Survivor Support

Awareness
Shelter
Prevention Project


Alternatives to Violence
Anger Management
Bullying
Characteristics of Abuser
Cycle of Violence
Men's Programs
Outreach
Research Projects
Safety Planning

Self-Development
Shelter
Prevention Project

Financial Management Skills
Healthy Parenting
Healthy Relationship
Healthy Sexuality
Life Skills
Social Skills Development
Other (Specify):

1(e) Results and Challenges

Describe your shelter's and/or prevention project's results (as per your work plan), successes and/or challenges for this year.

What can be improved to achieve desired results for shelter operations and/or this prevention project?

Section 2 (to be completed for Shelter Reports)

2(a) Shelter Staff (Full Time Equivalent Positions)
Quantity

Director(s)
Assistant Director(s)
Administrative Assistant(s)
Crisis Care Worker(s)
Outreach Worker(s)
Family Counsellor(s)
Child and Youth Worker(s)
Housekeeper(s)
Child Care Worker(s)
Security Worker(s)
Total of Full Time Equivalents
Volunteers
Other (Specify)

2(b) Shelter Use Quantity
Quantity

Number of First Nation Communities Served
Number of Beds Nights
Number of Crisis Calls Received

Number of Referrals From:
Self Referral
Police/RCMP
Clinic/Hospital
Mental Health Programs Addictions Programs
Second Stage Housing
Other (Specify)

2(c) Shelter Clientele
Quantity

Total Number of Women Served
Total Number of First Nation Women (Ordinarily Resident On-Reserve) Served
Total Number of Women Served (Off-Reserve)
Total Number of Non-Aboriginal Women
Total Number of Single Women
Total Number of Women Served with Voluntary Self-Identified Disability(ies)
Total Number of Children (Age 18 And Under)

Age of Women Served
Quantity

16 - 29 Years Old
30 - 54 Years Old
55 Years Old and Above
Unknown Age

Length of Stay
Quantity

Under 1 Week
1 to 2 Weeks
3 to 4 Weeks
More Than 4 Weeks
Unknown

Frequency of Shelter Stays (Recurrence Rates)
Quantity

No Previous Stays in the Last 12 Months
1 Previous Stay in the Last 12 Months
2 to 4 Previous Stays in the Last 12 Months
5 or More Previous Stays in the Last 12 Months
Unknown

Post-Shelter Housing
Quantity

Return Home
Friends or Family
Second State/Transitional Housing
Other (Specify)
Unknown

Section 3 (to be completed for Prevention Project Reports)

3(a) Delivery Method of Prevention Activities
Number of Sessions
Number of Participants

Seminar/Workshop
Healing Circle and/or Traditional Healing
Cultural Camp
Elder and/or Traditional Teaching(s)
Other (Specify)

3(b) Prevention Project Target Demographic

Women
Men
Children
Families
Other (Specify):

3(c) Evaluation

Was an evaluation of the prevention project completed?
Yes
No
Not Applicable

Did the evaluation conclude the project was:
Successful, Needs Improvement, Faced Challenges

460671 - CAPITAL PROJECTS REPORT (1)

Site Name
Site Number

Type of Report:
Progress Provisional Final

Funding Arrangement Number

Schedule for Progress Report (YYYYMMDD):
Project Start Date Project Completion Date

If Progress Report, select phase of project:
Design Construction Commissioning Other

Statement of Expenditures:
Estimated Project Total Spent to Date Spent this Phase

Check all that apply for Progress and/or Provisional Reports:

All details of the project are resolved and there is no flaw, omission, uncompleted work, claim or outstanding payment.

The "As Constructed" plans are available.

Flaws, omissions, incomplete work, claims or outstanding payments exist, and an Action Plan and either a Substantial Completion
Certificate or a Certificate of Occupancy are attached.

The construction complies with all requirements of all applicable codes, standards and AANDC Funding Arrangement.

Official inspection report(s) or certificate(s) by qualified inspector(s) are attached.

Check all that apply for Completed Projects:

Building Inspection Final Report
Septic Installation Approval
Fire Commissioner Reports
Electrical Inspection Final Report
Concrete Testing Reports
Environmental License (Provincial/Territorial)
Survey and Soil Testing Reports
Certificate of Occupancy
Water/Sewage Testing Reports (Health Canada or Territorial Government)
Workers' Compensation (Safety and Labour Conditions)
Substantial Completion Certificate as per provincial legislation (e.g. Construction Lien Act)
Operator's Certification for Water/Sewage Treatment Plants
Environmental Mitigation Report, if required by Environmental Assessment
Other(s)

Narrative:

471935 - LANDS AND ECONOMIC DEVELOPMENT COMMUNITY PROFILE REPORT (1)

Fiscal Year

Section A: Economic Development Plan

For Communities Receiving Funding Under the Community Economic Development Program (CEDP)

Contact - Given Name
Family Name Telephone Number Email Address

Community Objective
Link to Program Objective

Description of Planned Activities

Section B: Land Management Plan

For Communities Receiving Funding Under Land Management Capacity Development Programs (RLEMP/RLAP/53-60)

Contact - Given Name
Family Name
Telephone Number
Email Address

Community Objective
Link to Program Objective

Description of Planned Activities

Section C: Lands and Economic Development - Community Profile

Does your community have a strategic economic development plan in place?
Yes No
Does your community have a land use plan in place?
Yes No
Does your community have an environmental sustainability plan?
Yes No

Describe your community's economic development governance system:
Separate from Chief & Council
Part of Council Operations
Other (Specify)

Do the qualifications for persons in economic development positions include post-secondary graduation in a program related to lands and economic development?
Yes No

Have any of the persons in economic development obtained certification from the Council for the Advancement of Native Development Officers?
TAED (Technician Aboriginal Economic Developer) Certification
PAED (Professional Aboriginal Economic Developer) Certification
N/A

Do the qualifications for persons responsible for land and environment management include post-secondary graduation in a program related to lands and environmental management?
Yes No

Have any of the persons in land obtained certification from the National Association of Land Managers (NALMA)?
PLMCP (Professional Lands Management Certification Program)
N/A

Number of community members employed full time
Number of community members employed part-time or seasonal
Total revenue generated from community owned businesses
Number of new partnerships negotiated with external partners to support community economic development
Value of investment made by external partners (non-government) to support community economic development

Section D: Impact of Past Initiatives

AANDC has supported a number of initiatives and/or projects in support of community economic development in your community. As it often takes a number of years before the results of these investments can be identified, a brief update on the status of past initiatives is requested.

Initiative/Opportunity (To be completed by AANDC staff prior to sending to the recipient.)
Status
Ongoing
On hold No longer being pursued
N/A

Economic Impacts Attributable to the Initiative/Opportunity

Number of full time jobs created/maintained
Number of part time jobs created/maintained
Total revenue generated
Partnership with private sector
Yes No
Value of investment from private sector partner
Number of community members employed full time
Number of community members employed part-time or seasonal
Total revenue generated from community owned businesses
Number of new partnerships negotiated with external partners to support community economic development
Value of investment made by external partners (non-government) to support community economic development

471949 - DISABILITIES INITIATIVE REPORT (1)

Section A: Contact Information

Region
Reporting Period (YYYYMMDD)
From To

Section B: Financial Summary

Total funding from AANDC's Disabilities Initiative
Have other sources contributed to funding?
Yes No
If Yes, list other contributions sources and amounts received.

Source
Amount ($)
Total Funding From Other Sources

Section C: Project Context

Project Summary (no more than 200 words) Project Results and Outcomes (no more than 200 words)

Objective(s) of the project:
Select the activity area(s) reached and indicate the actual amount of AANDC Disability Initiative funds spent for each.

Information Services
Public Education and Awareness
Information Sharing Events
Other (Specify)
Total AANDC Funds Spent

How many individuals were actually reached?
Population Group(s):
Select the group(s) reached and indicate the total (estimated) percentage of individuals who participated in the project by population group.

Women
Men
Children
Youth
Elders
Caregivers
Professionals (e.g. Counselors, Doctors, Academics, etc.)
Persons With Disabilities
Other (Specify)

472877 - NATIONAL CHILD BENEFIT REINVESTMENT (NCBR) REPORT (1)

First Nation Name
First Nation Number

NCBR Project Name New
Continuing

Main objective of the project:
Reduce the effects of child poverty (e.g. focus on children/youth)
Provide supports for parents/guardians, especially to become or remain attached to the workforce
Broad community-level impacts (e.g. reduce overlap and duplication)

Check the activity area(s) targeted and indicate the actual amount of AANDC funds spent for each:
$

Child Care
Child Nutrition
Support to Parents
Home to Work Transition
Cultural Enrichment

Total AANDC NCBR funds spent

Did any other source (e.g. government department and/or organization) contribute to the project, either by providing funding or in-kind supports (e.g. by donating time/materials)?
Yes No

If you answered 'yes' to the question above, indicate the source and type/amount of support provided.
(Note: answering this question is voluntary)

Description/Purpose of NCBR Project

NCBR Project Results/Accomplishments/Outcomes

How many families participated in and/or
benefitted from this NCBR project?

How many children (i.e. under the age of 18) participated in and/or directly benefitted from this NCBR project?

Select the ratio of females to males that
benefitted from this project:

All female
All male
Half female/Half male
Mostly female
Mostly male Don't know

472939 - LANDS AND ECONOMIC DEVELOPMENT PROGRAMS PROJECT STATUS REPORT (1)

Agreement Number
Project Name
Report Date (YYYYMMDD)
From To
Project Status:
On Target
Behind Plan
Completed (Final Report)
Transaction Activity Number (as identified in "Payment Plan" Annex)

Program (Indicate Program from which funding was received):
Aboriginal Entrepreneurship Program (AEP)
Community Opportunity Readiness Program (CORP)
Contaminated Sites
Lands and Economic Development Services Program (LEDSP)
Strategic Partnership Initiative (SPI)

AANDC Amount Approved
AANDC Amount Received
Funding Expended to Date
Surplus/Deficit

If the supported project included environmental mitigation measures, as outlined in the terms
of reference and/or funding agreement, did these measures have the desired effect/impact?
Yes No N/A

Provide a narrative report which describes the following:
- Project goals as per the terms of reference and funding agreement
- Results achieved
- Funds received from other sources
- Work completed to date
- Anything unexpected that positively or negatively impacted the project
- Planned future activities

Provide a statement of revenues and expenditures on key activities described in the project.

1208367 - FIRST NATIONS CHILD AND FAMILY SERVICES ANNUAL BUSINESS PLAN (1)

Part A - Final Report

Every recipient approved for funding under the Enhanced Prevention Focused Approach or Directive 20-1 for the provision of Child and Family Services to First Nations children and families ordinarily resident on reserve shall provide the following information in relation to the previous fiscal year approved business plan. Refer to the Instructions for details on each section.

Recipients funded under the Enhanced Prevention Focused Approach

  1. Executive Summary
  2. Update to the Recipient profile
  3. Summary report of the Child and Family Enhancement and Operational Plan, including the objectives and outcomes from the applicable Framework
  4. Achievements and Challenges (Enhanced Prevention Focused Approach)

Recipients funded under Directive 20-1

  1. Executive Summary
  2. Update to the Recipient profile
  3. Achievements and Challenges (Directive 20-1)

Part B - Business Plan

Every recipient approved for funding under the Enhanced Prevention Focused Approach or Directive 20-1 for the provision of Child and Family Services to First Nations children and families ordinarily resident on reserve shall provide a business plan with the following information for the planned performance of the upcoming fiscal year. Refer to the Instructions for details on each section. The business plan will represent a five year business planning cycle which will be updated annually. Refer to the Field Definitions on each section.

For Recipients Funded Under the Enhanced Prevention Focused Approach

  1. Executive Summary
  2. Community Profile/Environment Scan
  3. Agency Profile
  4. The Child and Family Services Enhancement and Operational Plan
  5. Attachments:
    1. Service Delivery Agreements
    2. A copy of the correspondence from the relevant band council(s) authorizing the agency to provide service in the respective community/communities
    3. Letters from the reference province and the relevant bands supporting the agency's business plan (only required if the funding recipient is in the initial year of the five year business plan)

For Recipients Funded Under Directive 20-1

  1. Executive Summary
  2. Community Profile/Environment Scan
  3. Agency Profile
  4. The Child and Family Services Operational Plan
  5. Attachments:
    1. Service Delivery Agreements
    2. A copy of the correspondence from the relevant band council(s) authorizing the agency to provide service in the respective community/communities
    3. Letters from the reference province and the relevant bands supporting the agency's business plan

Part C - Budget Forecast

The current year budget revenues are in accordance with the funding agreement for the current year.

Recipients funded under the Enhanced Prevention Focused Approach are required to provide a budget forecast that outlines revenues and expenditures for the delivery of child
and family services in relation to the business plan for the current year and projections for the following four years.

Recipients funded under Directive 20-1 are required to provide a budget forecast that outlines revenues and expenditures for the delivery of child and family services in relation to the business plan for the current year with the option to provide projections for the next four fiscal years.

2014-15 Budget Current Year
2015-16 Budget Forecast
2016-17 BudgetForecast
2017-18 Budget Forecast
2018-19 Budget Forecast

Revenues AANDC

Administration/Operations
Maintenance/Protection
Prevention/Least Disruptive Measures
Other Sources
Provincial Government
Children's Special Allowance
Child's Disability Benefit/Child Care
Other

Total Revenues
Expenses

Program Delivery Services
Intake, Assessment and Investigation
Child Protection Services
Prevention/Least Disruptive Measures
Supports for Permanency Services
Total Program Delivery Costs
Operations
Core Management
Financial Administration
Infrastructure Costs
Board Governance
Total Operations

Total Expenses
Net Operating Results

3843372 - TREATY RELATED/INTERIM MEASURES REPORT (1)

Note: This reporting template must be used to properly identify and file any attachments in meeting the reporting requirements in GCIMS.

Project Name
Project Number

Type of Report:
Interim
Final

Project Description: Describe the work carried out during the fiscal year for this project/initiative, in accordance with the approved proposal. Include the dates of the project activities for an interim report. If you wish to include attachments, use the "Attachment Table" below.

Project Results: Describe the results of this project/initiative, compared to the objectives in accordance with the approved proposal. If you wish to include attachments, use the "Attachment Table" below.

Attached: Project Expenditures as related to Project Budget (Revenues and Expenditures Statement)

AANDC Funding
AANDC Funding Expended
Surplus/Deficit

3866547 - CAPITAL FACILITIES AND MAINTENANCE PROGRAM SPECIAL INITIATIVES REPORT (1)

Note: This reporting template must be used to properly identify any attachments in meeting the reporting requirement in FNITP.

Under the Capital Facilities and Maintenance Program, Regions provide funding from time to time to recipients to undertake special projects or initiatives which are in accordance with program authorities and objectives, but do not involve the construction or maintenance of capital assets. This DCI is used to report on those activities.

Project Name
Type of Report Progress
Final

Type of Project
Training
Special Events
Services
Emergency Management
Capacity Development
Pilot Project Other (Specify)

Per the reporting requirements listed in the funding arrangements for this activity, you will find the following annexes or narratives attached to this report:

Study & Reports, Plans & Specifications, Certificate(s) and Invoice(s)
Work completed and results achieved as per the AANDC approved work plan
Funds received from AANDC and other identified sources and list of itemized expenditures
Other (if selected, MUST specify)

AANDC Project Funding
AANDC Funding Expended
Surplus/Deficit

455897 - INCOME ASSISTANCE REPORT (1)

Recipient Information

Reporting Period (YYYYMMDD)
Start Date
End Date

Part A

Frequency: Every quarter, four times a year, for all First Nations, whether under an annual or a multi-year funding agreement

5. Family Composition (Age and Gender)

Single
Clients
Male
Female
0-5
6-15
16-17
18-24
25-44
45-64
65+
Total Number
Total

Single Parent (With Child(ren)) Clients
Male
Female
Dependants
Male
Female
Total

Couples (Without Child(ren)) Clients
Male
Female
Dependants
Male
Female
Total

Couples With Child(ren) Clients
Male
Female
Dependants
Male
Female
Total

6. Service Delivery

Clients have access to Case Management process
Yes

No
If "Yes":
a) Case Management is accessed by clients directly through the Band/First Nation organization

b) Case Management is accessed by clients outside of the Band/First Nation organization through another organization (e.g., ASETS holder, employment centre) with a formal shared service agreement. Please specify the name of the organization below:

c) Case Management is accessed by clients outside of the Band/First Nation organization through another organization (e.g., ASETS holder, employment centre) without a formal shared service agreement. Please specify the name of the organization below:

7. Education Attainment and Gender of Clients Who Are Expected to Work and Not Expected to Work

Number of Clients
Expected to Work
Not Expected to Work
Male
Female
Male
Female
a) Did not complete high school (or grade 12)
b) High school diploma (or grade 12) equivalent
c) Post-secondary, apprenticeship or trades certificate, diploma or degree from a college or university (e.g. CEGEP)
Total

8. Age and Gender of Clients and Dependants (16+) Expected to Work and Not Expected to Work
Expected to Work
Not Expected to Work
Male
Female
Male
Female
Total Number a) Clients
b) Dependants (+16) Total

9. Number of Clients and Dependants (16+) Who Participated in Active Measures

A. Participated in Employment or Pre-employment Activities

Total Number

  1. Employment/Pre-employment (e.g. job shadowing, internship)
  2. Skills training
  3. Basic Literacy and Essential Skills training
  4. Adult Education (e.g. Adult Basic
  5. Education, General Educational Development)
  6. Voluntary work opportunity
  7. Career and job seeking skills counseling (e.g. career assessment)
  8. Pre-employment and employment supports (e.g. Child Care, WOP, Wage Subsidy)
  9. Other items identified in the reference province/territorial legislation

Total

B. Received Employment or Pre-employment Financial Supports

  1. Training allowance
  2. Wage subsidy
  3. Transportation
  4. Equipment
  5. Child care
  6. Employment-related relocation costs
  7. Accommodation
  8. Transfers to employers, other institutions and governments for training and employment services
  9. Other items identified in the reference province/territorial legislation
  10. Other (Specify)

Total

10. Age and Gender of Clients and Dependents (16+) Who Participated in Active Measures

16-17
Male Female

18-24
Male Female

25-44
Male Female

45-64
Male Female

Total Number
Total

11. Employment Earnings of Clients and Dependents (16+) Who Participated in Active Measures

a) Total Number of Clients Who Participated in Active Measures with Employment Earnings

16-17
Male
Female

18-24
Male
Female

25-44
Male
Female
45-64
Male
Female

Total
Total Number

b). Amount ($) of Employment Earnings Total Amount ($)

12. Clients and Dependents (16+) Who Exited to Employment or Education

16-17
Male
Female

18-24
Male
Female

25-44
Male
Female

45-64
Male
Female
Total Number
a) Exited to Employment
b) Exited to Education
c) Unable to Track
Total

13. Partnership for Active Measures Activities

(Select all that apply)

  1. Employment and Social Development Canada (ESDC) (formerly known as HRSDC)
  2. Health Canada
  3. Other Federal Government Department(s)
  4. Provincial or Territorial Government
  5. Private Sector
  6. First Nation Organization(s)
  7. Other (Specify)

Part B

Frequency: Risk based in accordance with the schedule of reporting requirements contained in the agreement

14. Income Assistance Expenditures

Total Amount ($)

a) Basic Needs
b) Special Needs
c) Employment and Training (excluding Enhanced Service Delivery)
Total

15. Shelter Information

i) Clients and Expenditures
Total Number of Clients
Total Amount ($)

a) Number of clients who receive Shelter Allowance (rent, fuel/utilities) and total related expenditures
b) Number of clients who receive only fuel/utilities and total related expenditures

ii) Housing Units
Total Number of Units

c) Number of housing units occupied by Income Assistance clients
d) Number of housing units occupied by Income Assistance clients for which only fuel/utilities costs were paid
e) Number of housing units occupied by Income Assistance clients for which fuel/utilities costs and rent were paid

16. Children Out of Parental Home (COPH)

Total Number of Children
Total Amount ($)
Total

Part C: Recipients Under Enhanced Service Delivery Only

Frequency: Every quarter, four times a year, for all First Nations, whether under an annual or a multi-year funding agreement

17. Number of Case Workers

The number of new caseworkers positions:
Total Number

18. Age and Gender of Clients That Are Being Case Managed

16-17
Male
Female

18-24
Male
Female

25-44
Male
Female
45-64
Male
Female

Total Number
Total

19. Age and Gender of Clients That Were Referred to First Nations Job Fund

18-24
Male
Female
Total

20. Age and Gender of Clients Under Enhanced Service Delivery Who Did Not Meet Employability Criteria

18-24
Male
Female
Total

21. Clients Who Exited Enhanced Service Delivery to Employment or Education

18-24
Male
Female
Total Number

a) Exited to Employment
b) Exited to Education
c) Unable to Track
Total

22. Enhanced Service Delivery Expenditures

Total Amount ($)

a) Case Management Capacity
b) Client Support
c) Service Delivery Infrastructure Support
d) Ontario Works - Employment Assistance

Frequency: Every quarter, four times a year, for all First Nations, whether under an annual or a multi-year funding agreement

23. National Child Benefit Supplement (NCBS) Tracking - NCBS-Eligible Provinces/Territories

Total Number of Children
Total NCBC Amounts ($)
NCBS Quarterly Tracking

4548549 - REPORT ON ACTIVITIES AND EXPENDITURES (1)

PROGRAM IDENTIFICATION

Choose the program on which you are reporting from the list below. Selecting a program hides the fields that are not required for that program.

Aboriginal Financial Officers Association of Canada
Assessment and Historical Research: Special Claims
Assisted Living
British Columbia Capacity Initiative
Comprehensive Claims Submission
Consultation and Policy Development
ecoENERGY for Aboriginal and Northern Communities Program
Emergency Management Assistance Program
Enrolment and Ratification
Family Violence Prevention Program: Prevention Projects
Federal Initiative on Consultation
First Nations Child and Family Services
Gathering Strength: Reorientation to Self-Government
Gathering Strength: Reorientation to Self-Government - Capacity Development
Group Independent Assessment Process
Income Assistance
Income Assistance: Enhanced Service Delivery Projects
Income Assistance: Reform Pilot Projects
Income Assistance: Shelter Allowance Pilot Projects
Inherent Right
Inherent Right: Consultation
Intergovernmental Forums: Interim Métis Organizational
Intergovernmental Forums: Regional Intergovernmental
Intergovernmental Forums: Territorial Development
Mackenzie Valley Land and Water Board
Negotiation Preparedness Initiative
Negotiation Preparedness Initiative: Capacity Development
Office of the Treaty Commissioner
Pre-implementation Funding for Self-Government Agreements
Professional and Institutional Development
Specific and Special Claims Negotiations
Specific and Special Claims Submission
Treaty Commission and Discussions
Yukon Environmental and Socio-Economic Assessment Act

PROJECT INFORMATION

Project Name
Project Number

ACTIVITY REPORT

Period
Date From (YYYY-MM-DD)
Date To (YYYY-MM-DD)

ACTIVITY

Provide a brief description of the activity.

If the activity was completed within the period identified above, enter the date the activity was completed.

If the activity was not completed within the period identified above, explain why it was not completed and describe any work completed within this period.

List any deliverables associated with this activity that are specified in the recipient's funding agreement and attach if completed.

Provide any additional comments you would like to share regarding this activity.

If this is a final report, describe the final outcomes and any highlights.

PROGRAM PERFORMANCE INDICATORS

ecoENERGY for Aboriginal and Northern Communities Program

If this is a final report, describe the current stage of the project based on the work activities completed, the project next steps, and the anticipated construction/operation date of the project.

Identify any aspects of the project that have changed that may affect the estimated greenhouse gas emissions reductions of the project.

EXPENDITURE REPORT

Period
Date From (YYYY-MM-DD)
Date To (YYYY-MM-DD) Budget Item
Budget Amount
$0.00
Expenditure Amount
$0.00
Variance
$0.00
Total
$0.00
$0.00
$0.00

In-Kind Sources (if applicable)

Source Name
Value (Optional)
$0.00
Total In-Kind Sources
$0.00

CONTACT INFORMATION

Enter the contact information for the individual(s) responsible for completing this form.

Contact 1

Given Name
Family Name
Title/Position
Telephone Number
Extension Number
Fax Number
Email
Mailing Address (Number/Street/Apartment/P.O. Box)
City/Town
Province or Territory
Postal Code

5814389 - REPORT ON TRIBAL COUNCIL FUNDING (1)

Note: Tribal councils can provide attached documents that contain expenditure, activity, and/or endorsement information, as an alternative to providing that information directly on this form.

Report Information

Expenditures* ($)

A) Core Administrative Costs
B) Delivery of AANDC Funded Services
C) Capacity Development of Member First Nations

Activity
Description of Work Completed
Expenditures* ($)
Total

* This information is required only when Tribal Council Funding was provided as a Set contribution.

Member First Nation Endorsement

Member First Nation Name
Endorsement
Signature (if applicable)

Supporting Documents

List the supporting documents submitted with this application in the following table.

Associated Proposal/Report
Method of Submission
Name of Supporting Document
Date of Submission

Declaration

The information provided is accurate to the best of my knowledge.

Given Name
Family Name
Title
Date (YYYYMMDD)