Official Languages Appendix

Name of federal institution: 
Title of submission: 
Name of person completing the questionnaire:
Telephone number: 
Sector:

Instructions
Answer “yes” or “no” to each of the following questions:
1.	Is your submission seeking the Treasury Board’s approval for a new policy instrument or the revision of an existing policy instrument?
2.	Is your submission seeking the Treasury Board’s approval for a new service or program, the revision or renewal of an existing service or program, or the extension of a service or program?
3.	Is your submission seeking the Treasury Board’s approval for a service delivery contract under which those delivering services are not employees of federal institutions?
4.	Is your submission seeking the Treasury Board’s approval for a change in organizational form or a privatization?
5.	Is your submission seeking the Treasury Board’s approval for a change to the way in which services are delivered to the public or federal employees?
6.	Is your submission seeking the Treasury Board’s approval to award a grant or contribution to a non-governmental organization?
7.	Is your submission seeking the Treasury Board’s approval for a new federal-provincial agreement or a revision of an existing agreement?
8.	Is your submission seeking the Treasury Board’s approval related to the relocation of a head office?

If you answered “no” to every question in the checklist, an impact analysis is not required:
•	In an official languages appendix to the TB submission under Government-Wide Policy Considerations, state the following, “After examination, no impacts on official languages are foreseen.”
•	Attach the completed Official Languages Checklist to your TB submission as part of this official languages appendix.
If you answered “yes” to any one of the questions above, please complete an Official Languages Impact Analysis: 
•	The completed Official Languages Checklist and the Official Languages Impact Analysis of the proposal’s impact on the institution’s official languages obligations must be attached to the TB submission as an official languages appendix.
•	The analysis should include a summary of the official languages impacts and should cover the steps taken or planned to ensure Treasury Board ministers that the program or initiative complies with the institution’s official languages obligations.