ARCHIVED - Tribal Council Consolidated Report

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PDF Version PDF Version of the Tribal Council Consolidated Report Version - Fill & Print (894 Kb, 34 Pages)

Form Instructions

DCI# 5677661.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). 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 Information

Recipient Name
Recipient Number
Region
Telephone Number
Fax Number
Website
Email Address (if available)
Mailing Address
Number/Street/Apartment/P.O. Box
City/Town
Province or Territory
Postal Code
Street Address
Same as Mailing Address
Number/Street/Apartment/P.O. Box
City/Town
Province or Territory
Postal Code

Contact Information

Primary Contact Information

Given Name
Family Name
Title/Position
Telephone Number
Extension Number
Fax Number
Email Address (if available)
Mailing Address
Same as Recipient Information
Number/Street/Apartment/P.O. Box
City/Town
Province or Territory
Postal Code
Street Address
Same as Mailing Address
Number/Street/Apartment/P.O. Box
City/Town
Province or Territory
Postal Code
Do you want to specify a secondary contact? Yes No

Secondary Contact Information

Given Name
Family Name
Title/Position
Telephone Number
Extension Number
Fax Number
Email Address (if available)
Mailing Address
Same as Recipient Information
Number/Street/Apartment/P.O. Box
City/Town
Province or Territory
Postal Code
Street Address
Same as Mailing Address
Number/Street/Apartment/P.O. Box
City/Town
Province or Territory
Postal Code

List of Reports

The Department is continuously working on simplifying how tribal councils access, plan and report on all the AANDC programs they are involved with. The intent is to move to a single
application, a single plan and a single report (1-1-1). The first stage involves application and report data being collected using single forms for all AANDC programs that do not collect
privacy data and/or use data collection software instead of standard forms.

Please see the Reporting Guide for Applications and Proposals not yet consolidated into this form.

Report Name

Number of Instances

5814389 - TRIBAL COUNCIL FUNDING REPORT

460671 - CAPITAL PROJECTS REPORT

3866547 - CAPITAL FACILITIES AND MAINTENANCE PROGRAM SPECIAL INITIATIVES REPORT

41740 - FIRST NATIONS LAND MANAGEMENT REPORT

471935 - LANDS AND ECONOMIC DEVELOPMENT SERVICES PROGRAM (LEDSP) PLANNED ACTIVITIES AND REPORT

472939 - LANDS AND ECONOMIC DEVELOPMENT PROGRAMS PROJECT STATUS REPORT

455897 - INCOME ASSISTANCE REPORT

455917 - CHILD AND FAMILY SERVICES MAINTENANCE REPORT

455955 - FAMILY VIOLENCE SHELTER AND PREVENTION PROJECT ANNUAL REPORT

471949 - DISABILITIES INITIATIVE REPORT

472877 - NATIONAL CHILD BENEFIT REINVESTMENT (NCBR) REPORT

1208367 - FIRST NATIONS CHILD AND FAMILY SERVICES ANNUAL FINAL REPORT

3843372 - TREATY RELATED/INTERIM MEASURES REPORT

4548549 - ACTIVITIES AND EXPENDITURES REPORT

5814389 - TRIBAL COUNCIL FUNDING REPORT

Report Information

Expenditures* ($)

A) Core Administrative Costs
B) Delivery of AANDC Funded Services
C) Capacity Development of Member First Nations

Activity
Description of Work Completed
Expenditures* ($)
Capacity Development Activities Total (C)
Total Expenditures (A+B+C)

* This information is required only when Tribal Council Funding was provided as a Set contribution.

Member First Nation Endorsement

Member First Nation Name
Endorsement
Signature (if applicable)

460671 - CAPITAL PROJECTS REPORT (1)

Project Name
Project Number
Site Name
Site Number

Type of Report:
Progress
Provisional
Final

Funding Arrangement Number

Schedule for Progress Report (YYYYMMDD):
Project Start Date
Project Completion Date

If Progress Report, select phase of project:
Design
Construction
Commissioning
Other

Statement of Expenditures:
Estimated Project Total
Spent to Date
Spent this Phase

Check all that apply for Progress and/or Provisional Reports:

All details of the project are resolved and there is no flaw, omission, uncompleted work, claim or outstanding payment.

The "As Constructed" plans are available.

Flaws, omissions, incomplete work, claims or outstanding payments exist, and an Action Plan and either a Substantial Completion
Certificate or a Certificate of Occupancy are attached.

The construction complies with all requirements of all applicable codes, standards and AANDC Funding Arrangement.

Official inspection report(s) or certificate(s) by qualified inspector(s) are attached.

Check all that apply for Completed Projects:

Building Inspection Final Report
Septic Installation Approval
Fire Commissioner Reports
Electrical Inspection Final Report
Concrete Testing Reports
Environmental License (Provincial/Territorial)
Survey and Soil Testing Reports
Certificate of Occupancy
Water/Sewage Testing Reports (Health Canada or Territorial Government)
Workers' Compensation (Safety and Labour Conditions)
Substantial Completion Certificate as per provincial legislation (e.g. Construction Lien Act)
Operator's Certification for Water/Sewage Treatment Plants
Environmental Mitigation Report, if required by Environmental Assessment
Other(s)

Narrative:

I hereby certify that all work has been completed in accordance with the Terms and Conditions set out in the Funding Agreement and the Effective Project Approval, and that all specified codes and standards have been met.

Given Name
Family Name
Title Date
(YYYYMMDD)

Received at AANDC by:
Given Name
Family Name
Date (YYYYMMDD)

3866547 - CAPITAL FACILITIES AND MAINTENANCE PROGRAM SPECIAL INITIATIVES REPORT (1)

Note: This reporting template must be used to properly identify any attachments in meeting the reporting requirement in FNITP.

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.

Project Name
Type of Report
Progress
Final

Type of Project
Training
Special Events
Services
Emergency Management
Capacity Development
Pilot Project
Other (Specify)

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
Surplus/Deficit

41740 - FIRST NATIONS LAND MANAGEMENT REPORT (1)

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).

Phase:
Developmental Phase
Operational Phase
Project Name
Project Number/ID
Report Period
Date (From) (YYYYMMDD)
Date (To) (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.

471935 - LANDS AND ECONOMIC DEVELOPMENT COMMUNITY PROFILE REPORT (1)

Fiscal Year

Section A: Economic Development Planned Activities

(to be submitted by January 15th or agreed upon date with AANDC regional office)

Contact - Given Name
Family Name
Title
Mailing Address (Number/Street/Apartment/P.O. Box)
City/Town
Province/Territory
Postal Code
Telephone Number
Facsimile Number
Email Address

Does your community have a strategic economic development plan in place?
Yes No If Yes, date of plan (YYYYMMDD):

Describe your community's economic development governance system:
Separate from Chief and Council
Part of Council Operations
Other (Specify)

How many community businesses are owned and/or operated by the First Nation?
On Reserve:
Off Reserve:

Do the qualifications for persons in economic development positions include post-secondary
graduation in a program related to economic development?
Yes No N/A

Have any of the persons in economic development obtained certification from the Council for the Advancement of Native Development
Officers or other certification program/entity?

TAED (Technician Aboriginal Economic Developer) Certification

PAED (Professional Aboriginal Economic Developer) Certification

Other (Specify)

N/A

Communities Receiving Funding Under the Community Economic Development Program (CEDP) ONLY

Community Economic Development Objective:

Rank 1
Program Objective
Planned Activities Description
Planned Budget ($)

Rank 2
Program Objective
Planned Activities Description
Planned Budget ($)

Rank 3
Program Objective
Planned Activities Description
Planned Budget ($)

Rank 4
Program Objective
Planned Activities Description
Planned Budget ($)

Total Planned Expenditures

Approval Section A (Person Authorized by the First Nation)

Given Name
Family Name
Title

By checking this box, I am verifying that the information provided in Section A is accurate to the best of my knowledge

Date (YYYYMMDD)

Section B: Land Management Planned Activities

(to be submitted by January 15th or agreed upon date with AANDC regional office)

Contact - Given Name
Family Name
Title
Mailing Address (Number/Street/Apartment/P.O. Box)
City/Town
Province/Territory
Postal Code
Telephone Number
Facsimile Number
Email Address

Does your community have an environmental sustainability plan?
Yes No If Yes, date of plan (YYYYMMDD):

Does your community have a land use plan in place?
Yes No If Yes, date of plan (YYYYMMDD):

Does your community have a waste management plan?
Yes No If Yes, date of plan (YYYYMMDD):

Do the qualifications for persons responsible for land and environmental management include post-secondary graduation in a program related to lands and environmental management?

Yes No N/A

Have any of the persons in land and environmental management obtained certification from the National Association of Land Managers (NALMA)?

Professional Lands Management Certification Program (PLMCP)
N/A

Communities Receiving Funding Under the Reserve Land and Environment Management Program (RLEMP) ONLY

Community Land Management Objective:

Rank 1
Program Objective
Planned Activities Description
Planned Budget ($)

Rank 2
Program Objective
Planned Activities Description
Planned Budget ($)

Rank 3
Program Objective
Planned Activities Description
Planned Budget ($)

Rank 4
Program Objective
Planned Activities Description
Planned Budget ($)

Rank 5
Program Objective
Planned Activities Description
Planned Budget ($)

Total Planned Expenditures

Approval Section B (Person Authorized by the First Nation)

Given Name
Family Name
Title

By checking this box, I am verifying that the information provided in Section B
is accurate to the best of my knowledge

Date (YYYYMMDD)

Section C: Lands and Economic Development - Planned Activities Report

(to be submitted by May 31st or agreed upon date with AANDC regional office)

Program Objective
Planned Activities Status
Actual Expenditures ($)

Economic Development Activities Report

Program Objective
Planned Activities Status
Actual Expenditures ($)
Total Actual Expenditures (Economic Development)

Approval Section C (Economic Development) (Person Authorized by the First Nation)

Given Name
Family Name
Title

By checking this box, I am verifying that the information provided in Section C (Economic Development) is accurate to the best of my knowledge

Date (YYYYMMDD)

Land Management Activities Report

Program Objective
Planned Activities Status
Actual Expenditures ($)
Total Actual Expenditures (Land Management)

Approval Section C (Land Management) (Person Authorized by the First Nation)

Given Name
Family Name
Title

By checking this box, I am verifying that the information provided in Section C (Land Management) is accurate to the best of my knowledge

Date (YYYYMMDD)

Section D: Impact of Past Initiatives

(to be submitted by May 31st or agreed upon date with AANDC regional office)

AANDC has supported a number of targeted initiatives and/or projects in support of community economic development in your community through proposal driven economic development programs (i.e. CEOP, CORP). As it often takes a number of years before the results of these investments can be identified or measured, the following information will only be requested for a sample of projects over a 5 to 8 year period, depending on the type of project. AANDC will inform communities whose projects have been selected; the project's name will also appear below if prompted to provide actual performance indicators generated from this project.

Project Name
Fiscal Year

Community Economic Benefits

Aboriginal Jobs Created
Full Time
Part Time

Aboriginal Jobs Maintained
Full Time
Part Time

Non-Aboriginal Jobs Created
Full Time
Part Time

Non-Aboriginal Jobs Maintained
Full Time
Part Time

Number of community members trained:

Comments

Value of investment from private sector partners:

Comments

Number of businesses created:

Comments

New Government revenues generated (lease, tax, etc.):

Comments

Other Community Benefits:

Comments

472939 - LANDS AND ECONOMIC DEVELOPMENT PROGRAMS PROJECT STATUS REPORT (1)

Agreement Number
Project Name
Report Date (YYYYMMDD)
From To
Project Status:
On Target
Behind Plan
Completed (Final Report)
Transaction Activity Number (as identified in "Payment Plan" Annex)

Indicate Program from which funding was received:

Aboriginal Entrepreneurship Program (AEP)
Contaminated Sites
Lands and Economic Development Services Program (LEDSP)
Community Opportunity Readiness Program (CORP)
Lands Advisory Board and Resource Centre (LABRC)
Strategic Partnership Initiative (SPI)

AANDC Amount Approved
AANDC Amount Received
Funding Expended to Date
Surplus/Deficit

If the supported project included environmental mitigation measures, as outlined in the terms
of reference and/or funding agreement, did these measures have the desired effect/impact?
Yes No N/A

Provide a narrative report which describes the following:
- Project goals as per the terms of reference and funding agreement
- Funds received from other sources
- Anything unexpected that positively or negatively impacted the project
- Results achieved
- Work completed to date
- Planned future activities

Provide a statement of revenues and expenditures on key activities described in the project.

455897 - INCOME ASSISTANCE REPORT (1)

Reporting frequency for all parts of the report: Every quarter, four (4) times a year, for ALL recipients, whether under an annual or a multi-year funding arrangement

Recipient Information

Reporting Period (YYYYMMDD)
From
To

Part A: Clients and Dependants

5. Clients and Dependants by Educational Attainment, Family Composition, Age and Sex

(including Enhanced Service Delivery Recipients)

  Single(s) Single(s)
with child(ren)
Couple(s) Couple(s)
with child(ren)
Total
Age Education Sex Client Client Dependant Client Dependant Client Dependant  
0-5   male                
female                
6-15   male                
female                
16-17 Did not complete secondary
(high) school diploma
male                
female                
Secondary (high) school
diploma or equivalent
male                
female                
Post-secondary, apprenticeship
or trades certificate, diploma or degree from a
college/CEGEP or university
male                
female                
18-24 Did not complete secondary
(high) school diploma
male                
female                
Secondary (high) school
diploma or equivalent
male                
female                
Post-secondary, apprenticeship
or trades certificate,
diploma or degree from a
college/CEGEP or university
male                
female                
25-34 Did not complete secondary
(high) school diploma
male                
female                
Secondary (high) school
diploma or equivalent
male                
female                
Post-secondary, apprenticeship
or trades certificate,
diploma or degree from a
college/CEGEP or university
male                
female                
35-44 Did not complete secondary
(high) school diploma
male                
female                
Secondary (high) school
diploma or equivalent
male                
female                
Post-secondary, apprenticeship
or trades certificate,
diploma or degree from a
college/CEGEP or university
male                
female                
45-64 Did not complete secondary
(high) school diploma
male                
female                
Secondary (high) school
diploma or equivalent
male                
female                
Post-secondary, apprenticeship
or trades certificate,
diploma or degree from a
college/CEGEP or university
male                
female                
65 + Did not complete secondary
(high) school diploma
male                
female                
Secondary (high) school
diploma or equivalent
male                
female                
Post-secondary, apprenticeship
or trades certificate,
diploma or degree from a
college/CEGEP or university
male                
female                
Total                

6. Clients and Dependants (16+) Who Participated In Active Measures, by Family Composition, Age and Sex

(including Enhanced Service Delivery Recipients)

  Single(s) Single(s)
with child(ren)
Couple(s) Couple(s)
with child(ren)
Total
Age Sex Client Client Dependant Client Dependant Client Dependant  
16-17 male                
female                
18-24 male                
female                
25-34 male                
female                
35-44 male                
female                
45-64 male                
female                
65 + male                
female                
Total                

7. Clients and Dependants (16+) Who Participated In Active Measures With Employment Earnings, by Family Composition, Age and Sex

(including Enhanced Service Delivery Recipients)

  Single(s) Single(s)
with child(ren)
Couple(s) Couple(s)
with child(ren)
Total
Age Sex Client Client Dependant Client Dependant Client Dependant  
16-17 male                
female                
18-24 male                
female                
25-34 male                
female                
35-44 male                
female                
45-64 male                
female                
65 + male                
female                
Total                
Total Amount of Employment Earnings:  

8. Clients and Dependants (16+) Who Exited to Employment or Education, by Family Composition, Age and Sex

(including Enhanced Service Delivery Recipients)

  Single(s) Single(s)
with child(ren)
Couple(s) Couple(s)
with child(ren)
Total
Age Exits Sex Client Client Dependant Client Dependant Client Dependant  
16-17 Exited to employment male                
female                
Exited to education male                
female                
Other reasons male                
female                
18-24 Exited to employment male                
female                
Exited to education male                
female                
Other reasons male                
female                
25-34 Exited to employment male                
female                
Exited to education male                
female                
Other reasons male                
female                
35-44 Exited to employment male                
female                
Exited to education male                
female                
Other reasons male                
female                
45-64 Exited to employment male                
female                
Exited to education male                
female                
Other reasons male                
female                
65 + Exited to employment male                
female                
Exited to education male                
female                
Other reasons male                
female                
Total                

9. Service Delivery (Including Enhanced Service Delivery Recipients)

Clients have access to Case Management (refer to definition of Case Management in the Instructions) Yes No

If "Yes":

a) Case Management is accessed by clients directly through the Band
b) Case Management is accessed by clients outside of the Band through a formal shared service agreement with another organization. Specify the name of the organization below:
c) Case Management is accessed by clients outside of the Band through another organization (e.g., ASETS holder, employment centre) without a formal agreement. Specify the name of the organization below:

Part B: Financial Management Report

10. Income Assistance Expenditures

a) Basic Needs (including food, clothing, shelter, fuel, etc.)
Total Amount ($)

b) Special Needs

Total Amount ($)

c) Service Delivery
Total Amount ($)

d) Employment and Training (excluding Enhanced Service Delivery)


Total Amount ($) Total

11. Shelter Information

i) Clients and Expenditures

a) Number of clients who receive Shelter Allowance (rent, fuel/utilities)
and total related expenditures
Total Number of Clients
Total Amount ($)

b) Number of clients who receive only fuel/utilities and total related expenditures
Total Number of Clients
Total Amount ($)

ii) Housing Units

c) Number of housing units occupied by Income Assistance clients
Total Number of Units

d) Number of housing units occupied by Income Assistance clients for which only fuel/utilities costs were paid
Total Number of Units

e) Number of housing units occupied by Income Assistance clients for which fuel/utilities costs and rent were paid
Total Number of Units

12. Children Out of Parental Home (COPH)

Total Number of Children

Total Amounts ($)

13. National Child Benefit Supplement (NCBS) Tracking - NCBS-eligible Provinces/Territories

NCBS Tracking

Total Number of Children

Total NCBS Amounts ($)

Part C: Recipients Under Enhanced Service Delivery (ESD) Only

14. Number of New Caseworkers

(Recipients under Enhanced Service Delivery Only)

Total Number of New Caseworker Positions:

15. Clients and Dependants That Are Being Case Managed, by Age and Sex

(Recipients under Enhanced Service Delivery Only)

Age 18-24

New clients and dependants only that are being case managed
Male
Female
Total

Total clients and dependants that are being case managed
Male
Female
Total

16. Clients and Dependants That Were Referred to First Nations Job Fund (FNJF) or Other Programs For Job Skills Training, by Age and Sex

(Recipients under Enhanced Service Delivery Only)

Age 18-24

a) Referred to FNJF only
Male
Female
Total

b) Referred to other programs for job skills training (not FNJF)
Male
Female
Total

c) Referred to other services (see Instructions)
Male
Female
Total

Total

17. Clients and Dependants Under Enhanced Service Delivery Who Did Not Meet Employability Criteria, by Age and Sex

(Recipients under Enhanced Service Delivery Only)

Age 18-24

Male
Total

Female
Total

Total

18. Clients and Dependants Who Exited Enhanced Service Delivery to Employment or Education, by Age and Sex

(Recipients under Enhanced Service Delivery Only)

Age 18-24

a) Exited to employment
Male
Female
Total

b) Exited to education
Male
Female
Total

c) Other reasons (see Instructions)
Male
Female
Total

Total
Male
Female

19. Enhanced Service Delivery Expenditures

(Recipients under Enhanced Service Delivery Only)

a) Case Management Capacity
Total Amount ($)

b) Client Support
Total Amount ($)

c) Service Delivery Infrastructure Support
Total Amount ($)

455917 - CHILD AND FAMILY SERVICES MAINTENANCE REPORT (1)

Province or Territory

Agency Name
Funding Recipient Number
Fiscal Year 2015-2016
Funding Recipient Name (Agreement)
Type of Submission
Reporting Period

Child #
IRS Number
Non-Registered Temp. No.
Child's Family Name
Child's Given Name
Date of Birth
Gender

Financial Summary for DCI

Placement Type / Service

Total Number of Child Placements
Foster Homes
Group Homes
Institutional Care
Kinship Care
Post Adoption Subsidy

Total Number of Days
Foster Homes
Group Homes
Institutional Care
Kinship Care
Post Adoption Subsidy

Total Care Cost
Foster Homes
Group Homes
Institutional Care
Kinship Care
Post Adoption Subsidy

Total Additional Child Expenses
Foster Homes
Group Homes
Institutional Care
Kinship Care

Total Maintenance Cost
Foster Homes
Group Homes
Institutional Care
Kinship Care

Children and Family Services Prevention Activities

Individuals and Families
Number of Children
Number of Families

Groups and Communities
Number of Sessions
Number of Participants

455955 - FAMILY VIOLENCE SHELTER AND PREVENTION PROJECT ANNUAL REPORT (1)

Section 1 (to be completed for Shelter and/or Prevention Project Reports)

1(a) Identification Information

Reporting for:
FVPP Shelter Funding
Prevention Project Funding
Both

The Prevention Project Was Delivered:
On-Reserve
Off-Reserve

Recipient Name
Recipient Number
Shelter Name
Prevention Project Name
Prevention Project Actual Cost:

1(b) Partnerships

Type of Partnerships and Funding Shelter and Prevention Project

Shelter Funding and/or Collaboration

Band
Tribal Councils
Aboriginal Community Organizations
Child and Family Services Agencies
Schools
Other Federal Department (Specify):
Provincial Department (Specify):
Municipality
Addiction Treatment Centres
Health Services
Police/RCMP
Charitable/Not-For-Profit Organizations
Volunteers
Other (Specify):

Prevention Project Funding and/or Collaboration

Band
Tribal Councils
Aboriginal Community Organizations
Child and Family Services Agencies
Schools
Other Federal Department (Specify):
Provincial Department (Specify):
Municipality
Addiction Treatment Centres
Health Services
Police/RCMP
Charitable/Not-For-Profit Organizations
Volunteers
Other (Specify):

Community Plan/Needs Assessment
Did you complete a community plan or a needs assessment?

Shelter Yes No
Prevention Yes No

If you responded "Yes" to the above question, describe how the activities reported are linked to the community plan or the needs
assessment.

Engagement With Communities

Describe how you inform communities about your programs and services, and how you report on the results of your activities to the community.

1(c) Shelter Services

Accompaniment
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Advocacy/Referral to Other Services/Programs
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Child Care
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Children's Programs
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Collaboration at the Community Level
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Community Education and Awareness Raising
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Crisis Intervention
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Crisis Line
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Counselling
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Drop In
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Follow-Up/Aftercare
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Housing Information/Procedures
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Individual Case Planning
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Legal Issues
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Transportation
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Referrals for Men's Programming (Outside the Shelter)
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Women's Programs
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

Other (Specify)
Main Services Offered
(Prioritize from 1 to 5)
Unavailable Services
(Select those that apply)

1(d) Prevention Activities

For shelters: Describe the prevention activities that were delivered with shelter funding for this year.

For prevention projects: Describe the prevention activities that were delivered with prevention project funding for this year. Explain how
different or similar these activities were compared to the prevention project proposal.

1(e) Results and Challenges

Describe the results of your shelter and/or prevention project (as per your work plan), successes and/or challenges for this year.

What can be improved to achieve desired results for shelter operations and/or this prevention project?

Section 2 (to be completed for Shelter Report)

2(a) Shelter Staff (Full Time Equivalent Positions)
Quantity

Director(s)
Assistant Director(s)
Administrative Assistant(s)
Crisis Care Worker(s)
Outreach Worker(s)
Family Counsellor(s)
Child and Youth Worker(s)
Housekeeper(s)
Child Care Worker(s)
Security Worker(s)
Total of Full Time Equivalents
Volunteers
Other (Specify)

2(b) Shelter Use
Quantity

Number of First Nation Communities Served
Number of Bedroom /Unit Nights
Number of Crisis Calls Received
Number of Turn-aways
Number of Referrals From:
Self Referral
Police/RCMP
Clinic/Hospital
Mental Health Programs
Addictions Programs
Second Stage Housing
Schools
Other (Specify)

2(c) Shelter Clientele
Quantity

Total number of First Nation women (ordinarily resident on-Reserve) served
Total number of Métis and Inuit women (living on-Reserve) served
Total number of Aboriginal women (living off-Reserve) served
Total number of non-Aboriginal women (living on-Reserve or off-Reserve) served
Total number of women served
Total number of women served with voluntary self-identified disability(ies)
Total number of girls (age 17 and under)
Total number of boys (age 17 and under)

Age of Women Served
Quantity

Less than 18 accessing service without parent
18 - 24 years old
25 - 34 years old
35 - 44 years old
45 - 54 years old
55 - 64 years old
65 years old and over
Unknown age

Age of Girls Served
Quantity

0 - 4 years old
5 - 9 years old
10 - 14 years old
15 - 17 years old
Unknown age

Age of Boys Served
Quantity

0 - 4 years old
5 - 9 years old
10 - 14 years old
15 - 17 years old
Unknown age

Length of Stay
Quantity

Under 1 week
1 to 2 weeks
2 to 3 weeks
3 to 4 weeks
More than 4 weeks

Frequency of Shelter Stays (Recurrence Rates)
Quantity

No previous stays in the last 12 the last 12 months
1 previous stay in the last 12 months
2 to 4 previous stays in the last 12 months
5 or more previous stays in the last 12 months
Unknown

Other Achievements Due to Shelter Services (During Shelter Stay)
Quantity

Total number of women who started to search for a job
Total number of women who found employment
Total number of women who applied for Income Assistance
Total number of women who enrolled in training or school
Total number of women who began legal procedures to obtain child(ren) custody
Total number of women who found short-term housing
Total number of women who found second stage/transitional housing
Total number of women who found long-term housing
Total number of women who reported the violence to the police or RCMP
Total number of women who started an addictions program (by shelter referral)
Total number of children who returned to school (due to shelter programming for children)

Section 3 (to be completed for Prevention Project Reports)

3(a) Delivery Method of Prevention Activities
Number of Sessions
Number of Participants - All Sessions

Seminar/Workshop
Healing Circle
Cultural Camp
Traditional Healing
Elder Teaching
Other (Specify)

3(b) Prevention Project Target Demographic

Age of Women
18 - 24 years old
25 - 34 years old
35 - 44 years old
45 - 54 years old
55 - 64 years old
65 years old and over

Age of Men
18 - 24 years old
25 - 34 years old
35 - 44 years old
45 - 54 years old
55 - 64 years old
65 years old and over

Age of Girls
0 - 4 years old
5 - 9 years old
10 - 14 years old
15 - 17 years old

Age of Boys
0 - 4 years old
5 - 9 years old
10 - 14 years old
15 - 17 years old

Families

Other (Specify):

3(c) Measuring Project Success

Was a survey, participant feedback or self-evaluation of the prevention project completed?
Yes
No
Not Applicable

If "Yes", describe what the results of this survey, participant feedback or self-evaluation were.

If "Yes", specify how the survey, participant feedback or self-evaluation contributed to your prevention plan.

471949 - DISABILITIES INITIATIVE REPORT (1)

Section A: Contact Information

Reporting Period (YYYYMMDD)
From To

Section B: Financial Summary

Total funding from AANDC's Disabilities Initiative:

Project expenditures:
Provide the project expenditures, broken down
by activity and/or objective.

Navigator Services
Information Services
Public Education and Awareness
Community Outreach
Information Sharing Events
Other (Specify):
Total AANDC Funds Spent

Section C: Project Context

Project Summary (no more than 200 words):

Project Results and Outcomes (no more than 200 words):

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.

Partner
Involvement
How many individuals were actually reached?

Population Group(s):
Select the group(s) reached and indicate the
total (estimated) percentage of individuals who
participated in the project by population group.

Women
Men
Children
Youth
Elders
Caregivers
Professionals (e.g. Counselors, Doctors, Academics, etc.)
Persons With Disabilities
Other (Specify)

472877 - NATIONAL CHILD BENEFIT REINVESTMENT (NCBR) REPORT (1)

First Nation Name
First Nation Number

NCBR Project Name
New
Continuing

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:
$

Child Care
Child Nutrition
Support to Parents
Home to Work Transition
Cultural Enrichment

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)?
Yes No

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.

Partner

Involvement

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

1208367 - FIRST NATIONS CHILD AND FAMILY SERVICES ANNUAL FINAL REPORT (1)

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

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

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

3843372 - TREATY RELATED/INTERIM MEASURES REPORT (1)

Note: This reporting template must be used to properly identify and file any attachments in meeting the reporting requirements in GCIMS.

Contact - Given Name
Family Name
Email Address
Telephone Number
Project Name
Project Number

Type of Report:
Interim
Final

Project Description: Describe the work carried out during the fiscal year for this project/initiative, in accordance with the approved proposal. Include the dates of the project activities for an interim report. If you wish to include attachments, use the "Attachment Table" below.

Project Results: Describe the results of this project/initiative, compared to the objectives in accordance with the approved proposal. If you wish to include attachments, use the "Attachment Table" below.

Attached: Project Expenditures as related to Project Budget (Revenues and Expenditures Statement)

AANDC Funding
AANDC Funding Expended
Surplus/Deficit

I hereby certify that the information provided is accurate to the best of my knowledge.

Person Authorized by the Band Council - Given Name
Family Name
Title Date
(YYYYMMDD)

4548549 - REPORT ON ACTIVITIES AND EXPENDITURES (1)

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.

Aboriginal Financial Officers Association of Canada
Assessment and Historical Research: Special Claims
Assisted Living
British Columbia Capacity Initiative
Comprehensive Claims Submission
Consultation and Policy Development
ecoENERGY for Aboriginal and Northern Communities Program
Emergency Management Assistance Program
Enrolment and Ratification
Family Violence Prevention Program: Prevention Projects
Federal Initiative on Consultation
First Nations Child and Family Services
Group Independent Assessment Process
Income Assistance
Inherent Right
Inherent Right: Consultation
Intergovernmental Forums: Interim Métis Organizational
Intergovernmental Forums: Regional Intergovernmental
Intergovernmental Forums: Territorial Development
Mackenzie Valley Land and Water Board
Negotiation Preparedness Initiative
Office of the Treaty Commissioner
Pre-implementation Funding for Self-Government Agreements
Professional and Institutional Development
Specific and Special Claims Negotiations
Specific and Special Claims Submission
Treaty Commission and Discussions
Yukon Environmental and Socio-Economic Assessment Act

PROJECT INFORMATION

Project Name
Project Number

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

Period
Date From (YYYY-MM-DD)
Date To (YYYY-MM-DD)

ACTIVITY

Provide a brief description of the activity.

If the activity was completed within the period identified above, enter the date the activity was completed.

If the activity was not completed within the period identified above, explain why it was not completed and describe any work completed within this period.

List any deliverables associated with this activity that are specified in the recipient's funding agreement and attach if completed.

Provide any additional comments you would like to share regarding this activity.

If this is a final report, describe the final outcomes and any highlights.

PROGRAM PERFORMANCE INDICATORS

ecoENERGY for Aboriginal and Northern Communities Program

If this is a final report, describe the current stage of the project based on the work activities completed, the project next steps, and the anticipated construction/operation date of the project.

Identify any aspects of the project that have changed that may affect the estimated greenhouse gas emissions reductions of the project.

EXPENDITURE REPORT

Period
Date From (YYYY-MM-DD)
Date To (YYYY-MM-DD) Budget Item

Budget Amount
$0.00
Expenditure Amount
$0.00
Variance
$0.00
Total
$0.00
$0.00
$0.00

In-Kind Sources (if applicable)

Source Name
Value (Optional)
$0.00
Total In-Kind Sources
$0.00

Contact 1

Given Name
Family Name
Title/Position

CONTACT INFORMATION

Enter the contact information for the individual(s) responsible for completing this form.
Telephone Number
Extension Number
Fax Number
Email
Mailing Address (Number/Street/Apartment/P.O. Box)
City/Town
Province or Territory
Postal Code

Supporting Documents

List the supporting documents submitted with this application in the following table.

Associated Report Method of Submission Name of Supporting Document Date of Submission
       

Declaration

The information provided is accurate to the best of my knowledge.
Given Name
Family Name
Title
Date (YYYYMMDD)

Date modified: