ARCHIVED - Social Assistance Transfer Funding Final/Annual Report


This website will change as a result of the dissolution of Indigenous and Northern Affairs Canada, and the creation of Indigenous Services Canada and the eventual creation of Crown-Indigenous Relations and Northern Affairs Canada. During this transformation, you may also wish to consult the updated Indigenous and Northern Affairs home page.

Archived information

This Web page has been archived on the Web. Archived information is provided for reference, research or record keeping purposes. It is not subject to the Government of Canada Web Standards and has not been altered or updated since it was archived. Please contact us to request a format other than those available.

PDF Version - Fill & Print (203 Kb, 2 Pages)

Form Instructions

DCI# 471717.ON.GCIMS (2015-2016)

Privacy Act Statement

The information you provide in this document is collected under the departmental authority for contributions to provide income support for the purpose of managing the Social Assistance Transfer Funding Program. Information on individuals may be used by Aboriginal Affairs and Northern Development Canada Funding Services employees to verify eligibility. AANDC may share the information provided with the Ontario Ministry of Community and Social Services (MCSS) to ensure there is no duplication of benefits under Ontario Works. The personal information will be kept for a period of 7 years. Individuals have the right to the protection of and access to their personal information under the Privacy Act. The information collected is described under the Treasury Board Personal Information Bank INA PPU 046 which is detailed at InfoSource.

First Nation Name

Project Name

Project Number

Start Date (YYYYMMDD)

Completion Date (YYYYMMDD)

Employee Given Name Employee Family Name Head of Family or Single Number of Dependents Total Work Weeks Monthly Gross Wages Monthly Welfare Entitlements Welfare Amount Eligible for Transfer to Project Actual Entitlements Transferred to Project STEP Paid Out Reasons for Adjustment
Any Adjustment      
Amount of Social Assistance Transferred      

Certification by Social Services Administrator

1. I certify that the persons listed above are entitled to receive Social Assistance under Ontario Works.

2. I certify that the monthly welfare entitlements are calculated in accordance with the Ontario Works regulations.

3. I certify that all documents in support of eligibility, the signed consent form to disclosure of information, are placed on recipients' case files.

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

Given Name

Family Name




First Nation Name


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



Postal Code

Telephone Number

Facsimile Number

1. Were objectives met on balance?

2. a) Were any full time positions created directly as a result of this project?

If yes, how many?

b) Did the project indirectly result in ongoing employment?

If yes, specify

3. a) What problems or barriers were experienced during the administration of the project that affected the success of the program?

b) What corrective action was undertaken to address these problems and did it rectify/improve the situation?

4. Outline the significant benefits accrued to the employee, the community and the employer.

5. a) Was there a surplus or deficit in the Social Assistance transfer budget at the completion of the project?

If so, advise as to the exact amount.

b) Outline the factors that resulted in any savings or over-expenditures in the budget.

6. What recommendations would you make to improve the effectiveness of future projects of this type?

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

Given Name

Family Name



Date modified: