ARCHIVED - First Nations Land Management Report


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Archived information

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PDF Version - Fill & Print (135 Kb, 1 Page)

Form Instructions

DCI# 41740.GCIMS (2015-2016)

Privacy Act Statement

This statement explains the purposes and use of your personal information. 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.

The collection and use of your personal information for this First Nations Land Management Report is collected under the authority section 45(1) of the First Nations Land Management Act. The "Organization Contact Information" is requested for communication purposes of the proposed project/activity. This information will not be disclosed without your prior consent, except as set out under subsection 8(2) of the Privacy Act.

All other information in the form, including any annexes and appendices may be shared with other internal Departmental systems, without any further consent and with other government departments, agencies and private sector organizations, as described in the following TBS and AANDC Personal Information Banks (PIBs):
· Automated Document, Records, and Information Management Systems TBS PSU 904
· Monitoring and Compliance of Reserve Land Instruments, AANDC PPU 096
· Lands and Economic Development Services AANDC LED 1402
These PIBs identify applicable retention and disposal information for participating applicants. The Privacy Act states that you have a right of access to your personal information and may request changes to incorrect information. Contact your appropriate Aboriginal Affairs and Northern Development office to request access to your personal information, notify us about incorrect information or withdraw participation after submitting your information.

For more information about your right of access. If you require clarification about this Statement, contact our Privacy Coordinator by email at the following address or by telephone at 819-997-8277. For more information on privacy issues and the Privacy Act in general, consult the Privacy Commissioner or by telephone at 1(800) 282-1376.

Note: This reporting template must be used to properly identify and file attachments in meeting the reporting requirement in the Grants and Contributions Information Management System (GCIMS).


Recipient Name

Recipient Number

Recipient Contact - Given Name

Family Name


Telephone Number

Email Address

Project Name

Project Number/ID

Report Period

Date (From) (YYYYMMDD)


Project Activities
Attach a copy of your Milestone Report as outlined in Schedule C of your Community Approval Process Plan (CAPP).

The report should indicate which period you are reporting on by ticking off the appropriate box in the top right of the report you attach.

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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