eServiceCanada Referral Request Form

Terms of Use for Reaching All Canadians - Service Referral Initiative

PLEASE READ CAREFULLY these Terms and Conditions of Use for this service (the “Referral Request portal”) because they contain important information about your legal rights and obligations. These Terms and Conditions of Use should be read in conjunction with the Canada.ca Terms and Conditions. In the event of any discrepancies, the present Terms and Conditions of Use take precedence over Canada.ca Terms and Conditions.

The Terms and Conditions of Use continue to apply every time you use the Referral Request portal. By using the portal, you agree to abide by the Terms. It is your responsibility to understand and retain these Terms.

For the purposes of these Terms and Conditions of Use, "ESDC" means His Majesty the King in right of Canada as represented by the Minister of Employment and Social Development.

Purpose

The purpose of the Service Referral Initiative is to help hard-to-reach and at-risk clients who are unable to access Service Canada services and benefits through any other service channel. In support of the Service Referral Initiative, the only purpose of the Referral Request portal is to allow authorized representatives of select organizations to submit a callback request on behalf of an individual. The submission of a callback request will allow Service Canada to directly contact the individual whose contact information was provided for the callback request. The use of the Referral Request portal is only available for organizations working with Service Canada as part of the Service Referral Initiative. The Referral Request portal must not be used for other service requests.

Your Use of the Referral Request portal

1. Your access and use of the Referral Request portal is subject to 1) your acceptance of these Terms and Conditions of Use and 2) your compliance with these terms. If you decide not to accept these Terms and Conditions of Use, you will not be permitted to access and use the Referral Request portal. Your agreement with these Terms and Conditions of Use means that you select "I Agree to the Terms and Conditions of Use and have read and understand the Privacy Notice Statement".
2. You confirm that you have obtained the consent of the individual on behalf of whom you are submitting this request and only for the purpose of submitting a request for that individual to be contacted by a Service Canada representative.
3. You are using this service at your own risk. You are responsible for and agree to maintaining and protecting the confidentiality of any personal information, and if you are using a public computer to submit a request and should terminate the connection to the Referral Request portal when leaving the computer.
4. You (or if applicable, your organization) are responsible, accountable and liable for all use and misuse of the Referral Request portal associated with personal information provided.
5. You agree that you will not provide any financial, employment, or medical information or other information not specifically requested as part of the Referral Request portal.
6. You must use the services provided via the Referral Request portal solely for the purposes for which they are offered and for no other purpose including improper or illegal purpose or activity.
7. There are times where the system may unexpectedly be down or brought off-line for routine maintenance.
8. This Referral Request portal will only allow 15 minutes of inactivity before your secure session is terminated. Should the session be terminated after 15 minutes, information entered during this time will not be retained and you are required to re-enter the information in a new session.
9. If, at any time, you withdraw your agreement to any of the Terms and Conditions of Use, you must stop use of the Referral Request portal.
10. Please be advised that ESDC carries out the Referral Request portal using services from third party provider Microsoft Corporation. The Microsoft data centres used by ESDC are located in Canada. If you choose to access and use the Referral Request portal, please note that you are bound by the Terms of Agreement of Microsoft Corporation. For additional information, see Microsoft Data Privacy Policy & Privacy Principles.

Disclaimers

You understand and agree that ESDC provides the Referral Request portal "as is" with no representation, warranty or guarantee, implied or express, of any kind whatsoever and that ESDC disclaims any and all liability in relation to the use of the Referral Request portal, including any loss, damage or injury arising from or related to:

1. any matters or factors outside of its control, including the availability or unavailability of the internet, or telecommunications or other infrastructure systems, or
2. the non-acceptance of information provided through the Referral Request portal; or
3. any non-compliance with these Terms and Conditions.

I hereby agree to indemnify and hold ESDC harmless from any such liability.

Changes to these Terms and Conditions of Use

ESDC may change these Terms and Conditions of Use at any time. Such changes shall be effective immediately on the date they are published.

Governing Laws

These Terms and Conditions of Use shall be governed, interpreted and construed in accordance with the laws of the Province of Ontario.

Privacy Notice Statement – eServiceCanada Referral Request Form

The collection and use of the personal information is authorized under the Department of Employment and Social Development Act (DESDA), Employment Insurance Act, Canada Pension Plan and other applicable laws. The information you provide on behalf of the client you are assisting will be used by Service Canada to contact them by phone call. The provided information will never result in administrative decisions being made about the client. Participation is voluntary. Refusal to provide personal information will result in Service Canada being unable to contact the client by phone.

ESDC carries out this application using services from third-party provider Microsoft Corporation, which may be subject to foreign laws. For more information, see Microsoft Data Privacy Policy & Privacy Principles.

The personal information is administered in accordance with the Department of Employment and Social Development Act, Privacy Act and other applicable laws. The client has the right to the protection of, access to, and correction of their personal information, which is described in Personal Information Bank PSU 938 “Outreach Activities. Instructions for obtaining this information are outlined in the government publication: Info Source.

Info Source may also be accessed on-line at any Service Canada Centre. If the client is not satisfied with our response to their privacy, they have the right to file a complaint with the Privacy Commissioner of Canada regarding Service Canada’s handling of their personal information at: Report a concern.

I Agree to the Terms and Conditions of Use and have read and understand the Privacy Notice Statement (required)*