Activities and Expenditures Report

PDF Version - Fill & Print (186 Kb, 3 Pages)

Form Instructions

DCI# 4548549.GCIMS (2015-2016)

Privacy Act Statement

This statement explains the purposes and use of your personal information. Only information needed to respond to program/reporting 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. We will use your personal information in order to respond to your request (s) and/or program requirements. The collection and use of your personal information provided to AANDC for selected program/funding reporting and administration purposes, is authorized by program specific legislation and is required for your participation. The information collected is described by program specific Personal Information Banks (PIB) detailed at Info Source. For further details about applicable legislative authority, PIB description and/or to notify us about incorrect information or to withdraw participation after submitting your information contact the Department at 1 (800) 567-9604. If you require clarification about this Statement, contact our Privacy Coordinator at (819) 997-8277. For more information on privacy issues and the Privacy Act in general, you can consult the Privacy Commissioner at 1 (800) 282-1376.

RECIPIENT IDENTIFICATION

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.

PROJECT INFORMATION

ATTACHMENTS

There are two options available to complete this form: you may enter the information directly on the form, or you may complete the Recipient Identification and Program Identification sections and attach a document containing the information required for the program you have selected.

Additionally, any deliverables specified in the recipient's funding agreement should be attached if completed.

ACTIVITY REPORT

ACTIVITY

PROGRAM PERFORMANCE INDICATORS

EXPENDITURE REPORT

DECLARATION

The information provided is accurate to the best of my knowledge

CONTACT INFORMATION

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

If you require an alternate format, please email us at: Formulaires.Forms@aadnc-aandc.gc.ca

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