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DCI 472877.GCIMS (2015-2016)
Privacy Act Statement
This statement explains the purposes for 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 National Child Benefit Sub-Program within Social Development is derived from the Department of Indian Affairs and Northern Development Act, R.S.C., 1985, c. 1-6, as well as from annual Appropriation Acts granting authority to the Government to spend funds on programs. We will use personal information for assessing and determining eligibility for the administration of the program to which you are applying, and for reporting on aggregated results. We share the personal information you give us with those as outlined under AANDC PPU 240 detailed at Info Source.The information collected will be retained for a period offive 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. Contact your regional office to notify us about incorrect information, or contact the AANDC Public Enquiries by phone at 1 (800) 567-9604 for general enquires. For more information on privacy issues and the Privacy Act in general, you can consult the Privacy Commissioner at 1 (800) 282-1376.
Reporting Period From: (YYYMMDD)
Reporting Period To: (YYYMMDD)
Contact - Given Name
Mailing Address (Number/Street/Apartment/P.O. Box)
First Nation Name
First Nation Number
NCBR Project Name
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: $
Support to Parents
Home to Work Transition
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)?
List all the partners (funding and/or collaboration) who were involved in the delivery of this project such as federal, provincial, municipal, community, agencies/organizations, charities, etc.
Description/Purpose of NCBR Project
NCBR Project Results/Accomplishments/Outcomes
How many families participated in and/or directly 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 directly benefitted from this project:
- All female
- All male
- Half female/Half male
- Mostly female
- Mostly male
- Don't know
Attachment(s) and Supporting Documentation:
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.