Treasury Board of Canada Secretariat forms
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Access to Information and Privacy
Access to Information Request Form
(TBC/CTC 350-57)
| Title | Access to Information Request Form |
|---|---|
| Number | (TBC/CTC 350-57) |
| Category | Access to Information and Privacy |
Which government institution holds my information?
It is important to first determine which government institution is most likely to have the information you are seeking.
- Refer to Information About Programs and Information Holdings for a description of personal information held by the institution or
- Contact the Access to Information and Privacy (ATIP) Coordinator of the institution.
Make an online request
Use the ATIP Online Request Portal, for a faster, easier and more convenient way to submit access to information or privacy requests. Apply online today to certain government institutions to save time and postage.
Mail a request
If you are unable to use the ATIP Online Request Portal, you may request information using the Access to Information Request Form (TBC/CTC 350-57) (available in PDF or HTML formats), or send a letter clearly explaining what records you are seeking, to the ATIP Coordinator of the government institution holding the information.
Available formats
Personal Information Request Form
(TBC/CTC 350-58)
| Title | Personal Information Request Form |
|---|---|
| Number | (TBC/CTC 350-58) |
| Category | Access to Information and Privacy |
Which government institution holds my information?
It is important to first determine which government institution is most likely to have the information you are seeking.
- Refer to Information About Programs and Information Holdings for a description of personal information held by the institution or
- Contact the Access to Information and Privacy (ATIP) Coordinator of the institution.
Make an online request
Use the ATIP Online Request Portal, for a faster, easier and more convenient way to submit access to information or privacy requests. Apply online today to certain government institutions to save time and postage.
Mail a request
If you are unable to use the ATIP Online Request Portal, you may request information using the Access to Information Request Form (TBC/CTC 350-57) (available in PDF or HTML formats), or send a letter clearly explaining what records you are seeking, to the ATIP Coordinator of the government institution holding the information.
Available formats
Consent for a Personal Information Request Form
(TBC/CTC 350-60E)
| Title | Consent for a Personal Information Request Form |
|---|---|
| Number | (TBC/CTC 350-60E) |
| Category | Access to Information and Privacy |
Available formats
Authorizing a Personal Information Request to be Made on Your Behalf Form
(TBC/CTC 350-55E)
| Title | Authorizing a Personal Information Request to be Made on Your Behalf Form |
|---|---|
| Number | (TBC/CTC 350-55E) |
| Category | Access to Information and Privacy |
Available formats
Access to Information Tracking Document
(TBC/CTC 350-59)
| Title | Access to Information Tracking Document |
|---|---|
| Number | (TBC/CTC 350-59) |
| Category | Access to Information and Privacy |
Available formats
Record Correction Request Form
(TBS/SCT 350-11)
| Title | Record Correction Request Form |
|---|---|
| Number | (TBS/SCT 350-11) |
| Category | Access to Information and Privacy |
Available formats
Report on the Access to Information Act
(TBS/SCT 350-62)
| Title | Form for the Statistical Report on the Access to Information Act |
|---|---|
| Number | (TBS/SCT 350-62) |
| Category | Access to Information and Privacy |
Instructions
Institutions must submit statistical reports annually to the Information and Privacy Policy Division on activities relating to the administration of the Access to Information Act that take place in their institutions.
Reports submitted must be created in XML or XLS formats; however an HTML version is available here to illustrate the data elements that are required in the report.
Statistical data for previous years are available in an open format.
Available formats
Report on the Privacy Act
(TBS/SCT 350-63)
| Title | Form for the Statistical Report on the Privacy Act |
|---|---|
| Number | (TBS/SCT 350-63) |
| Category | Access to Information and Privacy |
Instructions
Institutions must submit statistical reports annually to the Information and Privacy Policy Division on activities relating to the administration of the Privacy Act that take place in their institutions.
Reports submitted must be created in XML or XLS formats; however an HTML version is available here to illustrate the data elements that are required in the report.
Statistical data for previous years are available in an open format.
Available formats
Privacy Act Material Breach Report Form
(TBS/SCT 350-64E)
| Title | Privacy Act Material Breach Report Form |
|---|---|
| Number | (TBS/SCT 350-64E) |
| Category | Access to Information and Privacy |
Reporting Material Privacy Breaches to the OPC and TBS
This form is for use by Government of Canada Institutions to report material privacy breaches to the Office of the Privacy Commissioner (OPC) and the Treasury Board of Canada Secretariat (TBS). The OPC Material Breach Reporting Portal (under development) may also be used to report material privacy breaches to the OPC and TBS.
As of March 1st, 2024, Government of Canada institutions must use either the OPC Material Breach Reporting Portal or the TBS Privacy Act Material Breach Report Form to report material privacy breaches to the OPC and TBS.
Available formats
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Do not edit the form within Microsoft Edge, Google Chrome, Apple Safari, Mozilla Firefox or other browsers.
Privacy Checklist Template
(TBS/SCT 350-65E)
| Title | Privacy Checklist Template |
|---|---|
| Number | (TBS/SCT 350-65E) |
| Category | Access to Information and Privacy |
Instructions
Institutions must complete privacy checklists using the prescribed template.
Available formats
Privacy Impact Assessment Template
(TBS/SCT 350-66E)
| Title | Privacy Impact Assessment Template |
|---|---|
| Number | (TBS/SCT 350-66E) |
| Category | Access to Information and Privacy |
Instructions
Institutions must prepare a privacy impact assessment (PIA) using the prescribed template. Completed and approved PIAs must be submitted to the Treasury Board of Canada Secretariat and the Office of the Privacy Commissioner.
Available formats
Personal Information Bank Submission Form
(TBS/SCT 350-67E)
| Title | Personal Information Bank Submission Form |
|---|---|
| Number | (TBS/SCT 350-67E) |
| Category | Access to Information and Privacy |
Instructions
Institutions must submit requests to register, modify, transfer or terminate personal information banks to the Treasury Board of Canada Secretariat using the prescribed Personal Information Bank Submission form.
Available formats
Privacy Impact Assessment Web Summary Template
(TBS/SCT 350-68E)
| Title | Privacy Impact Assessment Web Summary Template |
|---|---|
| Number | (TBS/SCT 350-68E) |
| Category | Access to Information and Privacy |
Instructions
Institutions must prepare summaries of their privacy impact assessment (PIA) for the web using the prescribed template. Completed summaries must be published to the institution’s website following the approval of the PIA.
Available formats
Phoenix pay system
Claim expenses, financial losses and damages caused by Phoenix
- Claim out-of-pocket expenses
If you incurred expenses such as interest charges or late fees because of Phoenix, you can submit a claim. - Claims for impacts on income taxes and government benefits
If you were owed salary from one year that was only paid the following year, you might pay too much income tax or receive reduced government benefits and credits, such as the Canada child benefit. - Request an advance for government benefits
If your government benefits, such as the Canada child benefit, or other credits were reduced because you were overpaid by Phoenix, you can request an advance to help you during this time. - Reimbursement for tax advice
Find out if you are eligible for reimbursement of expenses related to tax advice. - Claim compensation for severe impacts
If you experienced severe personal or financial hardships, such as financial costs, lost investment income, or impacts to your career or well-being, you can submit a claim. - Claim general compensation for damages related to Phoenix
Former employees can claim financial compensation equivalent to leave through the 2019 Phoenix pay system damages agreement.
Disability Insurance
Disability insurance claim forms
The Disability Insurance Plan claim forms can be found on the Sun Life DI webpage: www.sunlife.ca/DI.
- Employee’s Statement (490L-M-12500-E)
- Attending Physician’s Questionnaire (490L-P-12500-GEN-E, 490L-P-12500-MHC-E, or 490L-P-12500-MSK-E)
- Employer’s Statement (Immediate Supervisor or Manager)(4841-E)
- Employer’s Statement (Compensation Advisor)(4811-E)
Leave
Application for Leave with Income Averaging
(TBS/SCT 325-10)
| Title | Application for Leave with Income Averaging |
|---|---|
| Number | (TBS/SCT 325-10) |
| Category | Leave |
Available formats
Application for Pre-retirement Transition Leave
(TBS/SCT 325-9)
| Title | Application for Pre-retirement Transition Leave |
|---|---|
| Number | (TBS/SCT 325-9) |
| Category | Leave |
Available formats
Dental Care
Employee claim forms for dental care
- Public Service Dental Care Plan - Claim form
(The Canada Life Assurance Company) - Public Service Dental Care Plan - Authorization for Claims Submission and Redirection of Payment
(The Canada Life Assurance Company)
Pensioners’ claim forms for dental care
- Pensioners’ Dental Services Plan (PDSP) Claim Form (PDF Document – 54 KB)
(Sun Life Financial) - Some PDSP forms were made obsolete as of . For more information on PDSP enrolment and eligibility, see the PDSP menu.
Pensioners’ Dental Services Plan Authorization for Claims Submission and Re-direction of Payment Form
(00093-E-3-05)
| Title | Pensioners’ Dental Services Plan - Authorization for Claims Submission and Re-direction of Payment |
|---|---|
| Number | (Inventory Number 00093-E-3-05) |
| Category | Pensioners’ Dental Services Plan |
Available formats
Public Service Health Care Plan
Employee claim forms for the Public Service Health Care Plan
- PSHCP Claim Form (PDF Document – 614 KB)
(Public Service Health Care Administration Authority Web Site) - PSHCP Claim Form-Out-of-Country claims (Comprehensive Coverage) (PDF Document – 655 KB)
(Public Service Health Care Administration Authority Web Site)
Public Service Management Insurance Plan
Claim Forms for Long-Term Disability
Forms to be completed and sent to iA Financial Group
- Employee’s Statement (F54-1011A-57)
- Attending Physician’s Questionnaire (F54-1014A-57 for a mental health condition), or (F54-1015A-57 for a musculoskeletal condition), or (F54-1016A-57 for all other medical conditions)
- Employer’s Statement (F54-1012A-57 immediate supervisor or manager)
- Employer’s Statement (F54-1013A-57 departmental compensation/Human Resources advisor)
Claim Form for Accidental Dismemberment Benefit
(TBS/SCT 5954, 5955)
| Title | Claim for Accidental Dismemberment Benefit |
|---|---|
| Number | (TBS/SCT 5954, 5955) |
| Category | Public Service Management Insurance Plan |
Available formats
Claim Form for Death Benefit
(TBS/SCT 5948, 5949)
| Title | Claim for Death Benefit |
|---|---|
| Number | (TBS/SCT 5948, 5949) |
| Category | Public Service Management Insurance Plan |
Available formats
Security
Security in Contracting
Security Requirements Check List (SRCL)
(TBS/SCT 350-103)
| Title | Security Requirements Check List (SRCL) |
|---|---|
| Number | (TBS/SCT 350-103) |
| Category | Security in Contracting |
Requirement for completion
In accordance with Section 10.4 of the Security Policy for the Government of Canada, contracting authorities must:
- Ensure security screening of private sector organizations and individuals who have access to protected and classified information and assets, as specified in the standards.
- Ensure safeguarding of government assets, including IT systems.
- Specify the necessary security requirements in terms and conditions in any contractual documentation.
Available formats
Security Screening
- Security Screening Application and Consent Form
- Notification of Change in Security Clearance
(CSIS/SCRS 4160e) (Canadian Security Intelligence Service Web Site)
Security Screening Certificate and Briefing Form
(TBS/SCT 330-47)
| Title | Security Screening Certificate and Briefing Form |
|---|---|
| Number | (TBS/SCT 330-47) |
| Category | Security Screening |
Requirement for completion
In accordance with the Security Policy for the Government of Canada, both the requirement for and the processing of a personnel security screening action must be based on a specified need. As such, please do not initiate the completion of this or any other security screening form unless this need has been identified by the federal government department/agency that requested you to complete them.
For security reasons and to ensure that your own privacy rights are being safeguarded, security forms available on our Treasury Board Secretariat web-site cannot be electronically sent. As such, please print and mail or hand carry completed forms to the federal government department/agency that requested you complete them.
Available formats
Personnel Screening, Consent and Authorization Form
(TBS/SCT 330-23e) Archived
Archived information
Archived information is provided for reference, research or recordkeeping purposes. It is not subject à 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.
| Title | Personnel Security Screening Form |
|---|---|
| Number | (TBS/SCT 330-23) |
| Category | Security Screening |
Instructions prior to completing the form
In accordance with the Policy on Government Security, both the requirement for and the processing of a personnel security screening action must be based on a specified need. As such, please do not initiate the completion of this or any other security screening form unless this need has been identified by the federal government department/agency that requested you to complete them.
For security reasons and to ensure that your own privacy rights are being safeguarded, this security form cannot be sent electronically. It must be printed and mailed or submitted by hand directly to the federal government department/agency that requested you complete it.
Please pay special attention to obtain both the information required and carefully read the instructions provided. If necessary, please contact your Human Resources contact or security office for specifics.
Available formats
Security Clearance Form
(TBS/SCT 330-60e) Archived
Archived information
Archived information is provided for reference, research or recordkeeping purposes. It is not subject à 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.
| Title | Security Clearance Form |
|---|---|
| Number | (TBS/SCT 330-60) |
| Category | Security Screening |
Instructions prior to completing the form
In accordance with the Security Policy for the Government of Canada, both the requirement for and the processing of a personnel security screening action must be based on a specified need. As such, please do not initiate the completion of this or any other security screening form unless this need has been identified by the federal government department/agency that requested you to complete them.
For security reasons and to ensure that your own privacy rights are being safeguarded, security forms available on our Treasury Board Secretariat web-site can not be electronically sent. As such, please print and mail or hand carry completed forms to the federal government department/agency that requested you complete them.
Available formats
TB Submission
Treasury Board Submission
(TBC 300-1)
| Title | Treasury Board Submission Form |
|---|---|
| Number | (TBC 300-1) |
| Category | TB Submission |
Instructions
These forms are being offered to you as an on-line service and are available to you in Rich Text (RTF) formats.
If you choose the RTF format, you will have two options for completing the form:
- Fill in the form on-screen and then print it for submission by mail;
- or print the form and fill in the fields by hand for submission by mail.
Available formats
Specimen Signature
(GC 136)
| Title | Specimen Signature |
|---|---|
| Number | (GC 136) |
| Category | TB Submission |
Available formats
Labour Relations
Bargaining Agent Identification - Notice of Change
(TBS/SCT 340-51)
| Title | Bargaining Agent Identification Notice of Change |
|---|---|
| Number | (TBS/SCT 340-51) |
| Category | Labour Relations |
Instructions
Fill-in by computer and send to the appropriate bargaining agent(s):
E-mail addresses for Bargaining Agents
| Bargaining Agent | E-Mail Address |
|---|---|
| Association of Canadian Financial Officers (ACFO) | information@acfo-acaf.com |
| Association of Justice Counsel (AJC) | admin@ajc-ajj.ca |
| Canadian Association of Professional Employees (CAPE) | finance@acep-cape.ca |
| Unifor CATCA Local 5454 | catca@catca.ca |
| Unifor Local 2182 | president@2182.ca |
| Canadian Federal Pilots Association (CFPA) | office.manager@cfpa-apfc.ca |
| Canadian Military Colleges Faculty Association (CMCFA) | execasst@cmcfa-apcmc.ca |
| Canadian Merchant Service Guild (CMSG) | CMSG@Ottawa-email.com |
| Canadian Union of Public Employees 104 (CUPE) | secretary@cupe104.ca |
| Federal Government Dockyard Chargehands Association (FGDCA) | FGDCA@Hushmail.com |
| Federal Government Dockyard Trades and Labour Council East (FGDTLC(E)) | councileast@gmail.com |
| Federal Government Dockyard Trades and Labour Council West (FGDTLC(W)) | councilwest@shaw.ca |
| International Brotherhood of Electrical Workers (IBEW) | Paul.cameron@ibew2228.ca |
| Professional Association of Foreign Service Officers (PAFSO) | finance@pafso-apase.com |
| Professional Institute of the Public Service of Canada (PIPSC) | TB340_51@pipsc.ca |
| Public Service Alliance of Canada (PSAC) | TBS-SCT340-51@psac-afpc.com |
| National Police Federation (NPF) | darmstrong@npf-fpn.com or bsauve@npf-fpn.com |
| Union of Canadian Correctional Officers – CSN (UCCO-SACC-CSN) | erika.yelle@csn.qc.ca |
Available formats
Employee Consent to Provide Personal Information to Bargaining Agents
(TBS/SCT 340-51a) Archived
Archived information
Archived information is provided for reference, research or recordkeeping purposes. It is not subject à 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.
| Title | Employee Consent to Provide Personal Information to Bargaining Agents |
|---|---|
| Number | (TBS/SCT 340-51a) |
| Category | Labour Relations |
Available formats
Grievance Transmittal Form
(TBS/SCT 340-54)
| Title | Grievance Transmittal Form |
|---|---|
| Number | (TBS/SCT 340-54) |
| Category | Labour Relations |
Available formats
Managerial or Confidential Position
(TBS/SCT 340-10)
| Title | Managerial or Confidential Position |
|---|---|
| Number | (TBS/SCT 340-10) |
| Category | Labour Relations |
Available formats
Group Grievance Presentation (PSLRA s. 215)
(TBS/SCT 340-56)
| Title | Group Grievance Presentation (PSLRA s. 215) |
|---|---|
| Number | (TBS/SCT 340-56) |
| Category | Labour Relations |
Available formats
Individual Grievance Presentation (PSLRA s. 208)
(TBS/SCT 340-55)
| Title | Individual Grievance Presentation (FPSLRA s. 208 or s. 238.24) |
|---|---|
| Number | (TBS/SCT 340-55) |
| Category | Labour Relations |
Available formats
Policy Grievance Presentation (PSLRA s. 220)
(TBS/SCT 340-53)
| Title | Policy Grievance Presentation (PSLRA s. 220) |
|---|---|
| Number | (TBS/SCT 340-53) |
| Category | Labour Relations |
Available formats
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