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Appendix A - Wage Subsidy Utilization Statement Form

 

Children's Services                     Effective Date:  
Topic: Appendices Replaces: 
Subject: Wage Subsidy Utilization Statement  Appendix A 


WAGE SUBSIDY UTILIZATION STATMENT 

SECTION1: BASIC PROGRAM INFORMATION


This completed statement is due within 30 days after the end of the reporting period.  

Wage Subsidy Program Name: *
Licence Holder/Corporation:: *
Licence Holder/Corporation Address: *
Reporting Period: *

SECTION 2: SALARIES/PROVIDER PAYMENTS EXPENDITURES 

Staff Position #1:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #2:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #3:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #4:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #5:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #6:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #7:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #8:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #9:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #10:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #11:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Staff Position #12:
Number of Full Time Equivalent Staff:
Base Salary/Wage:
Wage Sudsidy:
Total:
Total Base Salary/Wage: *Add all Base Salary/Wage amounts listed above
Total Wage Sudsidy: Add all Wage Subsidy amounts listed above
Total: *Sum of Total Base Salary/Wage and Total Wage Subsidy
Number of Private-Home Day Care Providers: *

SECTION 3: VARIANCE REPORT

1. Total Regular Wage Subsidy received:
2. LESS Pay Equity Funding (if included in #1):
3. Net Regular Wage Subsidy (1-2):
4. Amount used for salaries:
5. Amount used for Employers' mandatory benefit costs:
6. Amount used for non mandatory benefit costs:
7. Subtotal: Salaries & Benefits (4+5+6)
8. Amount used for Private-Home Day Care Provider payments:
9. Amount used for non salary purposes (approved by DSB):
10. Total Regular Wage Subsidy used (7+8+9):
11. Variance* (3-10):
*If a variance exists, please explain: 

SERVICE PROVIDER INFORMATION

Verification Acceptance: *

I, Signing Office #1, verify that the wage subsidies have been used for the purposes intended, as stated above. 

Signing Officer #1 Name: *
Date: *Date verified (d/m/y)
Verification Acceptance: *

I, Signing Officer #2, verify that the wage subsidies have been used for the purposes intended, as stated above. 

Signing Officer #2 Name: *
Date: *Date verified (d/m/y)

MANITOULIN-SUDBURY DISTRICT SERVICES BOARD INFORMATION

Reviewed by: *
Date: *Date verified (d/m/y)
Recovery Required:
Comments:

Notes on Wage Subsidy Utilization Statement


Section 3 (Line # | Explanation):

  1. Total Wage Subsidy received by service provider for the previous fiscal year including Direct Operating Grant, Provider Enhancement Grant, Wage Enhancement Grant and Pay Equity Funding (excluding Best Start Wage Subsidy, Best Start Wage Improvement Funding and Pay Equity Funds resulting from the Memorandum of Settlement)    
  2. Pay equity funding if included in line 1    
  3. Line 1 minuse line 2 equals net wage subsidy    
  4. Wage subsidy used to increase salaries    
  5. Wage subsidy used to pay the employer's share of benefit costs (CPP, Worker's Compensation, Employment Insurance, Ontario Health Tax) resulting from the wage subsidy funding    
  6. Wage subsidy used towards non-mandatory benefits (i.e. Dental Plan, Group Insurance)    
  7. Subtotal of salaries & benefits (4+5+6)    
  8. Private-home day care agencies only: the total Wage Subsidy distributed to private -home day care providers    
  9. Wage subsidy used for non salary purposes, where approved by the child care service system manager    
  10. The total of lines 7+8+9    
  11. Variance: Line 3 minus Line 10

 

Note: If Wage Subsidy, Best Start Wage Subsidy and Best Start Wage Improvement Funding in total exceed $20,000, an audited financial statement, including third party verficiation in the special purpose report that funding was used for the purposes intended must be submitted with these utilization statements.

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