Privacy and Security
Completed Access to Information Requests
Proactive Disclosure
Sample form only: do not complete
This form is for reference purposes only. It is not to be completed in this format.
To complete this form online and submit it to the CRTC, download the form.
File electronically via My CRTC Account by attaching the application to the cover page. My CRTC Account allows you to securely submit documents to the Commission with a user ID and password. Therefore, a signature is not required when using My CRTC Account. Applicants who file their application in this manner are not required to submit a hard copy of the application and its related documents.
Applicants who need further information relative to CRTC processes can contact a Commission specialist at 1-866-781-1911.
The following questionnaire is in HTML format and may be downloaded to the word processing software of your choice. This enables you to complete the downloaded questionnaire by inserting your response in bold letters immediately following the question. You may add lines to the tables if necessary but do not alter or delete any text from the questionnaire.
The application must be divided into sections as set out in the questionnaire and include the numbered questions followed by the corresponding response. Responses must be provided, at a minimum, in a size 10 font.
The following documents should be submitted as separate electronic documents using the naming convention specified below. The document number (Doc#) indicates the ascending order in which the documents should appear on the public file.
| Document | Electronic file name |
|---|---|
| The Covering Letter (if any) | Doc1 - Cover Letter dated ____ |
| The Application Form | Doc2 - Form 106 "Application to Renew a Broadcasting Licence for a Commercial or ethnic Radio Programming Undertaking" |
| Appendix 1 | Doc3 - Appendix 1 - Supplementary brief |
| Appendix 2A | Doc4 - Appendix 2A - Ownership Information |
| Appendix 2B | Doc5 - Appendix 2B - Corporate Documents |
| Appendix 3 | Doc6 - Appendix 3 – Industry Consolidation & Cross-Media Ownership |
| Appendix 4 | Doc7 - Appendix 4 - Over and above contributions |
| Each confidential document | NOT WEB - Doc# - Confidential - "brief description of the document" |
| Each abridged version of each confidential document | Doc# - Abridged version - "same description of document for which confidentiality is requested" |
Type of station:
AM undertaking ( ) FM undertaking ( )
Location of undertaking: _______________________Call sign:______________
| Call sign | Location |
|---|---|
Name of legal entity who is authorized by the Commission to operate this undertaking:
Address:
City:
Province/Territory:
Postal code:
Telephone:
Fax:
Email:
(if there is no appointed designated representative under question 1.2)
Name:
Title:
Telephone:
Email:
I, _________________________, the applicant, hereby designate____________________ as my designated representative for and on my behalf and in my name to sign, file and complete (if necessary) an application with the Canadian Radio-television and Telecommunications Commission and to sign and file a reply with respect there to and I do hereby ratify, confirm and adopt as my own act, such application and all replies made thereto.
Date:
At:
Example: city, province
Signature (a signature is not required when submitting electronically):
Address of designated representative:
Title:
Telephone:
Fax:
Email:
I, ___________________________________ , solemnly declare that:
I am the designated representative of the applicant named in this application brief and as such have knowledge of all matters declared therein.
The statements made in this application or any document filed pursuant to any request for further information by the Commission are (will be) to the best of my knowledge and belief true in all respects.
The opinions and estimates given in this application or any document filed pursuant to any request for further information by the Commission are (will be) based on facts as known to me.
I have examined the provisions of the Broadcasting Act and the broadcasting regulations and policies relevant to this application.
And I have signed
Signature (a signature is not required when submitting electronically):
Date:
Witnessed by
Signature (a signature is not required when submitting electronically):
Name:
Date:
At:
Example: city, province
The Canadian Radio-television and Telecommunications Commission Rules of Practice and Procedure (the Rules of Procedure) allow an interested person to request that the Commission exercise a power under the Rules of Procedure or change the Rules of Procedure for a specific proceeding (sections 5 and 7). This is generally called a procedural request. You may consult Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, 23 December 2010, and Guidelines on the CRTC Rules of Practice and Procedure, Broadcasting and Telecom Information Bulletin CRTC 2010-959, 23 December 2010, for more information.
Is the applicant requesting that the Commission make an exception to its Rules of Procedure in the treatment of this application?
Yes ( ) No ( )
If yes, please indicate which section of the Rules of Procedure you wish to vary and provide a detailed rationale as to why this request should be granted :
The Commission will return the application if it has not been duly completed. The onus will be on the applicant to submit a complete application that provides all of the relevant information, to identify all regulatory issues raised in the application and to provide supporting documentation.
Submit a website address or email address where an electronic copy of the application may be requested:
Website:
Example: www.mycompany.com
Email:
Example: no-reply@no-reply.com
The undertaking is being operated in compliance with the provisions of the licence, the Broadcasting Act and all regulations and policies applicable to the CRTC.
Yes ( ) No ( )
If no, provide the full details of any non-compliance that occured during the licence term, including the reasons, any remedial action and, where applicable, the period of time expected before the undertaking is operating in compliance.
The applicant proposes to operate this undertaking, including all authorized ethnic SCMO services, if applicable, under the same terms, conditions and definitions, as specified in the current licence, as well as the conditions of licence specified in the appendix to Conditions of licence for commercial AM and FM radio stations, Broadcasting Regulatory Policy CRTC 2009-62, 11 February 2009.
Yes ( ) No ( )
If no, indicate any proposed amendments, along with the reasons why they are being sought.
For each amendment proposed at 1.7 a), provide the following information in a supplementary brief identified as Appendix 1:
a description of your current commitments as well as the status of those commitments;
a description of your proposed changes;
the reasons in support of the proposed changes in relation to your service overall, the broadcasting system and the Broadcasting Act; and
the implications/repercussions of maintaining the current terms, conditions and definitions.
If the supplementary brief exceeds 10 pages, include an executive summary.
In the case of changes to the technical installations, you must complete Form 303 Application for a technical amendment.
If you are proposing to continue the operation of an ethnic SCMO service, provide the language of the service and the ethnic group served.
All applicants must complete section a) of the appendix but may be exempt from completing section b).
The entity applying to renew a broadcasting licence to operate a commercial radio undertaking.
The parent corporation, the corporations which form part of the control chain and all corporations or legal entities listed in Table 2.2 of Appendix 2A, holding directly or indirectly 10% or more of the voting interest of the corporation to which Table 2.2 pertains.
You may be exempt from completing this section if all ownership information for each of the entities that form part of the control chain has been supplied within the last 12 months from the date of this application and accepted as satisfactory by the Commission. You must also ensure that:
no changes have occurred since the last filing that would be subject to a notification requirement or prior approval by the Commission pursuant to the Radio Regulations, 1986 (the Regulations);
no amalgamation has occurred; and
the exemption statement in section a) of Appendix 2A has been completed.
Attach as Appendix 2B, a copy of all changes or amendments to the constituting documents (for example, Certificate and Articles of Incorporation, Amendment or Amalgamation, By-Laws, Partnership Agreement, etc.), that are not already on file with the Commission:
for the applicant; and
for the parent corporation and for each corporation or other legal entity listed in Table 2.2 of Appendix 2A, holding directly or indirectly 20% or more of the voting interest of the corporation to which Table 2.2 pertains.
If industry consolidation and cross-media ownership are not applicable, please proceed to section 4.
Has the information in 3.2 been submitted to the Commission within the last 12 months?
Yes ( ) No ( )
If yes, provide reference to the application containing this information:
Application No.: __________________ Date filed:_____________________
If yes, proceed to section 4.
If no, complete section 3.2.
Complete the following table, providing a list of all entities involved in any of the areas listed below for which any investment (equity and/or debt securities) is held by the applicant, its directors, a corporation which directly or indirectly controls the applicant and any shareholder holding 20% or more of the voting interest of the applicant. The table may be attended as Appendix 3.
Other CRTC licence and exempted undertakings
Daily newspaper
Non-daily newspaper or other media publisher
Production or distribution of programming material
Lessor of property, plant or equipment of applicant
Telecommunications company regulated under the Telecommunications Act
Company owning securities in any of categories a to f
| Name of security holder | Name of corporation in which securities are held | Business classification code | Type of securities held |
Vote
(y/n) |
% held compared to number issued |
|---|---|---|---|---|---|
Section 15(2) of the Regulations sets out the basic annual Canadian Content development (CCD) contribution requirement. Section 15(4), state that stations with total revenues of $1.25 million or less must forward no less than 60% of the basic annual CCD contribution to FACTOR or MUSICACTION with the exception of ethnic stations or spoken word stations as defined in Section 15 of the Regulations. A licensee operating an ethnic station or a spoken word station may direct the basic CCD payments to eligible initiatives that support its content.
Section 15(5) states that stations with total revenues greater than 1.25 million must foward at least 15% of their total contribution to the Community Radio Fund of Canada and at least 45% to FACTOR or MUSICACTION, with the same exception for ethnic or spoken word stations.
Licensees may also chose to make contributions over and above the Basic requirement, apart from these governed by conditions of licence imposed in the context of a new licence.
If the applicant proposes to exceed basic contributions to CCD as required by section 15(2) of the Regulations, the licensee shall, by condition of licence, devote a minimum of $ ___________ per year in direct contributions over and above the required basic amount to CCD.
Provide a detailed description of the initiatives and funding level to which the applicant proposes to direct the over and above amount identified in a) excluding those funds allocated to FACTOR or MUSICACTION (Appendix 4).
Licensees are reminded that all contributions other than those allocated to FACTOR or MUSICACTION must qualify according to the definition set out in Commercial Radio Policy 2006, Broadcasting Public Notice CRTC 2006-158, 15 December 2006 (Broadcasting Public Notice 2006-158) paragraphs 108 to 110. The Commission will be requiring licensees to demonstrate how the recipients of those CCD funds meet the Commission's definition when filing their annual returns.
The definition of local programming shall be as set out in paragraphs 207 and 208 of Broadcasting Public Notice 2006-158, as amended from time to time.
Provide a commitment to a minimum level of local programming to be broadcast in each broadcast week: ___ hours ___ mins.
Referring to paragraphs 202 to 208 of Broadcasting Public Notice a 2006-158, describe how the service you provide meets the particular needs and interests of the communities you are licensed to serve.
In the supplementary brief, include details concerning:
spoken word content: this includes news, weather, sports, promotions of local events, public affairs, documentaries, programs of public debate including talk shows and open lines; and
musical selections and music-oriented programs: these include pre-recorded and live material.
Paragraph 92 of Broadcasting Public Notice 2006-158 states that the Commission will ask licensees through the renewal process for specific commitments to provide airplay for and to promote emerging Canadian artists and their music. In Definition of emerging Canadian artists on commercial radio, Broadcasting Regulatory Policy CRTC 2011-316, 12 May 2011, the Commission adopted definitions for emerging English-and French-language Canadian artists.
Currently, what total percentage of musical selections aired by the station in a broadcast week features Canadian emerging artists?
What percentage of musical selections featuring Canadian emerging artists do you intend to broadcast in the next licence term?
How, beyond the provision of airplay, do you intend to promote Canadian emerging artists?
Is the licensee a member in good standing of the Canadian Broadcast Standards Council?
Yes ( ) No ( )
Confirm that the licensee will adhere to the following codes, as a condition of licence, during all hours of broadcast:
The Canadian Association of Broadcasters' Broadcast Code for Advertising to Children (Revised Broadcast Code for Advertising to Children, Public Notice CRTC 1993-99, 30 June 1993), as amended from time to time and approved by the Commission.
Yes ( ) No ( )
If no, provide reasons why the licensee would not be able to meet this obligation.
The Canadian Association of Broadcasters Equitable Portrayal Code (Equitable Portrayal Code, Public Notice CRTC 2008-23, 17 March 2008), as amended from time to time and approved by the Commission (to be suspended as long as the licensee is a member in good standing of the Canadian Broadcast Standards Council).
Yes ( ) No ( )
If no, provide reasons why the licensee would not be able to meet this obligation.
Information relating to employment equity is available in Implementation of an employment equity policy, Public Notice CRTC 1992-59, 1 September 1992, and Amendments to the Commission's Employment Equity Policy, Public Notice CRTC 1997-34, 2 April 1997.
The Commission requires that the applicant respond to questions regarding employment equity on behalf of the undertaking as a whole, with reference to all of its employees in aggregate; that is, employees of all undertakings for which it holds licences.
Is the licensee subject to the Employment Equity Act (applicable to federally-regulated employers with 100 or more employees)?
Yes ( ) No ( )
If yes, proceed to section 5.2.
If no, proceed to section 5.1b.
Provide examples of any measures (including hiring, training, apprenticeship programs, work arrangements, etc.) that you have or will put in place for the designated groups (women, Aboriginal peoples, persons with disabilities and visible minorities).
How do you or will you communicate details of your employment equity policies to managers and staff?
Have you assigned, or will you assign, a senior level person to be responsible for tracking progress and monitoring results?
Yes ( ) No ( )
If yes, what authority does or will that person have to ensure that goals are achieved?
What financial resources do you have or will you put in place to promote employment equity in the workplace (for example, funds for daycare, access for persons with disabilities, etc.)?
Information relating to on-air presence and voice-overs is set out in Consultations Regarding On-air Job Categories to be Included in the Employment Equity Plans of Broadcasters, Public Notice CRTC 1994-69, 10 June 1994, and Amendment to Reporting Requirements for Employment Equity in On-air Positions, Public Notice CRTC 1995-98, 19 June 1995.
| On-air employees | Number | % |
|---|---|---|
| Women | ||
| Aboriginal Peoples | ||
| Persons with Disabilities | ||
| Visible Minorities | ||
| Total number of on-air employees |
When the Commission refers to cultural diversity, it is referring to the inclusion of groups that have been traditionally under-represented in broadcasting: ethnocultural minorities, Aboriginal peoples, as well as persons with disabilities. Such under-representation includes these groups presence and portrayal on the air and their participation in the industry.
As set out in Canadian Association of Broadcasters Best Practices for Diversity in Private Radio; Reporting requirements on cultural diversity for commercial radio operators, Broadcasting Public Notice CRTC 2007-122, 2 November 2007 (Broadcasting Public Notice 2007-122), the Commission expects all radio broadcasters to follow the Canadian Association of Broadcasters' best practices for diversity in radio in order to incorporate and reflect the reality of Canada's ethnocultural minorities, Aboriginal peoples and persons with disabilities in their programming.
Describe the steps that you have taken to implement these best practices, as well as those initiatives you are planning to implement in the next licence term.
For the purpose of meeting the reporting requirements established in Broadcasting Public Notice 2007-122, please confirm whether you are a large, medium or small radio operator, in accordance with the definitions set out in paragraph 22 of the same notice, and that you will comply with the corresponding reporting requirement.
Sections 30 to 34 of the Rules of Procedure set out a process by which parties to Commission proceedings may file information on the record of a public proceeding in confidence.
A party filing information can “designate” it as confidential at the time it is filed with the Commission (section 31) if it falls into one of the following categories:
At the time that the party files the information it designates as confidential, it must provide an abridged version of the document along with an explanation of how the information falls into a category of information listed in section 31. The party must provide a detailed rationale to explain why the disclosure of the information is not in the public interest (section 32(1)).
The confidential version of the document must be filed separately and must be marked “confidential” on each page. If the document is filed electronically, each file containing confidential information must include “confidential” in the file name.
The abridged version of the document and the reasons for the designation of information as confidential will be placed on the public record of the proceeding.
Please consult Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, 23 December 2010, and Procedures for filing confidential information and requesting its disclosure in Commission proceedings, Broadcasting and Telecom Information Bulletin CRTC 2010-961, 23 December 2010, for the complete process for filing confidential information.
Are you requesting for some information to be designated as confidential?
Yes ( ) No ( )
If yes, you must provide a detailed rationale to explain why the disclosure of the information is not in the public interest:
| Appendix Number and Name |
Appended
(Yes or No) |
E-filed
(Yes or No) |
|---|---|---|
| Section 1: General Information | ||
| 1A - Supplementary Brief | ||
| Section 2: Ownership | ||
| 2A - Ownership Information | ||
| 2B - Corporate Documents | ||
| Section 3: Industry Consolidation and Cross-media Ownership | ||
| 3 - Industry Consolidation & Cross-Media Ownership | ||
| Section 4 : Programming | ||
| 4 - Over and above Contributions | ||
CRTC 106 (2012-09-28) - Renewal – Commercial Radio
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