ARCHIVED - First Nations Child and Family Services Annual Final Report

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Form Instructions

DCI# 1208367.GCIMS (2015-2016)

Privacy Act Statement:

This statement explains the purposes of the collection and use of 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 personal information for this First Nations Child and Family Services Sub- Program within Social Development is derived from the Department of Indian Affairs and Northern Development Act, R.S.C., 1985, c. I-6, and from annual Appropriation Acts granting authority to the Government to spend funds on programs. We will use personal information to assess and determine service provider's eligibility to administer the program, and for reporting on aggregated results. We share the personal information you give us with those as outlined in the AANDC PPU 210 detailed at Info Source. The information collected will be retained for five years, then sent to Library and Archives Canada. As stated in the Privacy Act, you have the right to access the personal information you give us and request changes to incorrect information, or contact the AANDC Public Enquiries by phone at 1 (800) 567-9604 for general enquires. Contact your regional office to notify us about incorrect information. For more information on privacy issues and the Privacy Act in general, you can consult the Privacy Commissioner at 1 (800) 282-1376.

Identification

Recipient Name

Recipient Number

Mailing Address (Number/Street/Apartment/P.O. Box)

City/Town

Province or Territory

Postal Code

Telephone Number

Facsimile Number

Email Address

Reporting Period
Reporting Period From (YYYYMMDD)
Reporting Period To (YYYYMMDD)

Contact
Given Name
Family Name
Title
Telephone Number
Email Address

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 (please 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 Strategic 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. Summary report of the Child and Family Operational Plan
  4. Achievements and Challenges (Directive 20-1)

Part B - Financial Summary

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 strategic plan for the current year and projections for the following year.
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 operational plan for the current year and provide projection for the next fiscal year.

 

2015-16 Budget Current Year 2016-17 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

 

 

 

Attachment(s):

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

Name of Supporting Document

Method of Submission

Authorization:

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

Given Name

Family Name

Title

Date (YYYYMMDD)

Date modified: