ARCHIVED - Capital Facilities and Maintenance Program - Special Initiatives Report


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PDF Version - Fill & Print (139 Kb, 1 Page)

Form Instructions

DCI# 3866547.GCIMS (2015-2016)

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 reporting template must be used to properly identify any attachments in meeting the reporting requirement in GCIMS.

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.

Recipient Name

Recipient Number

Contact - Given Name

Family Name

Email Address

Telephone Number

Project Name

Type of Report

Type of Report

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



Indicate the name(s) of supporting document(s) being submitted and the method of submission.

Name of Supporting Document

Method of Submission

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

Given Name

Family Name



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