{{appLabel.appYear}} {{appLabel.appType}} Application

{{appLabel.charityName}}, CFC #{{appLabel.cfcCode}}

Your application qualifies as a verification application this year.

You are providing a FULL APPLICATION this year.

Download All Docs and Print Application

Step 1: Charity Contact Information

Who You Are

Contact Person

Contact Title

Email Address(es) (Use semicolons to separate multiple addresses)

This needs to be a valid email or a semicolon separated list of emails OR You have only provided one email address. To ensure the CFC can contact you about important information related to the campaign or your application, we highly recommend you supply multiple points of contact. Your multiple points of contact can include both personal and work email addresses

OPM will send the eligibility decision and other CFC communication to the email address(es) on file. At least one email address is required, however, applicants are highly encouraged to provide more than one email address. For member organizations, the Federation should enter its own email addresses if it wishes to manage CFC communication on behalf of its member organizations.

Contact Address

P.O. Box Accepted.

Address Line 1

Address Line 2

City

State

Zip

Phone Number

Optional Information

Organization's Website Address (Do not include "http://" in your website address.)

Fax Number

Step 2: Application Type

Step 2a: Base Commander Letter

UPLOAD REQUIRED DOCUMENT

Attach a copy of a letter from your Base Commander confirming FSYA/FSYP/WFR type and location..

Base Command Letter Uploaded

Step 3: Human Health & Welfare Services

Check box if applicable.

YES!
I certify that the organization named in this application is a human health and welfare organization providing services, benefits, or assistance to, or conducting activities affecting human health and welfare. The services, benefits, assistance, or program activities affecting human health and welfare provided in calendar year {{appLabel.appYear - 1}} are reflected in the Area of Service submitted in the next step of this application, if applicable.

Step 4: Areas of Service

Areas of Service is not required.

Areas of Service is Required.

YES!

I certify that the organization named in this application provided or conducted real services, benefits, assistance, or program activities in 15 or more different states or one foreign country over the three-year period immediately preceding the start of the campaign application year.

YES!

I certify that the organization named in this application provided or conducted real services, benefits, assistance, or program activities in a foreign country over the three-year period immediately preceding the start of the campaign application year.

YES!

I certify that the organization named in the application has a substantial local presence in the geographical area covered by the local campaign.

This year Area of Service is not required for your organization.

You must complete Step 2 prior to adding Area of Service.

You are filing application as a National/International charity and must provide proof of services in a minimum of 15 states or at least 1 international location.

You are filing an application for a local charity which requires submission of Areas of Service.

You are filing application as a International charity and must provide proof of services provided in One International Location.

#	State/Country	Zone Name	Status	Admin Review Status
{{ $index+1 }}	{{ service.zone }}	{{ service.officeState }}, {{ service.officeCountry }}	Review Pending Incomplete Not Set

Hours of Operation (limited to 256 characters)

Hours of Operation Per Each Day of the Week (Example: Monday-Friday, 9AM - 5PM; Saturday, 10AM - 3PM; Sunday, Closed)

Web-Based / Virtual Services

Were any of the above reported services web-based? No Yes

Note: Per 5 CFR §950.202(a)(1)(iii), for each web-based/virtual service that your organization reported, it must submit:

Service log or other record indicating geographic distribution (i.e City/state and/or country)
Scope of services received by users, in addition to
Two of the following:
- Evidence of website registration;
- Summary reports documenting customer feedback; and/or
- Evidence that recipients of web-based services paid a fee.

Reports that reflect only the number of hits or visits to a website are not sufficient to establish the provision of real services.

To submit the required documentation, upload a .pdf that lists information by relevant geographic area based on CFC zone (i.e. local, National/International or International), and year.

WebService File Uploaded

{{pledgeYear}} Areas of Service - Local Charity Service Office Address Use existing charity address: {{charity.officeAddress1}} {{charity.officeAddress2}} {{charity.officeCity}}, {{charity.officeState}}, {{charity.officeZip \|zipcode}} Use new address {{service.officeAddress1}} {{service.officeAddress2}} {{service.officeCity}}, {{service.officeState}}, {{service.officeZipCode \| zipcode}} Hours of Operation (limited to 256 characters) Hours of Operation Per Each Day of the Week (Example: Monday-Friday, 9AM - 5PM; Saturday, 10AM - 3PM; Sunday, Closed) Organization's Dedicated Phone Number Schedule of Services {{ pledgeYear-1 }} Service Description How: (Explain how the services were provided) Who: (Benefited from the Service(s)) What: (Provide a description of the actual services, benefits, assistance, or program activities provided) Where: (Provide City, State and/or counties where the services were delivered) When: (Provide beginning and end dates of when the services were provided. If one-time activities, end dates do not need to be selected) One-time Check only if the reported service was a one-time activity. The “Start date” will need to be entered but the “End date” will be disabled. Start date: End date: {{ pledgeYear-1 }} Service Description (including who provided the service; limited to 256 characters) Monetary Value of Benefit OR Number of Beneficiaries
{{pledgeYear}} Areas of Service - National/International Charity {{pledgeYear}} Areas of Service - International Charity State/Country of Service Area Selected Country Selected State Organization's Dedicated Phone Number Schedule of Services {{ pledgeYear-1 }} Service Description How: (Explain how the services were provided) Who: (Benefited from the Service(s)) What: (Provide a description of the actual services, benefits, assistance, or program activities provided) Where: (Provide City, State and/or counties where the services were delivered) When: (Provide beginning and end dates of when the services were provided. If one-time activities, end dates do not need to be selected) One-time Check only if the reported service was a one-time activity. The “Start date” will need to be entered but the “End date” will be disabled. Start date: End date: {{ appNavbar.pledgeYear-1 }} Service Description (including who provided the service; limited to 256 characters) Monetary Value of Benefit OR Number of Beneficiaries {{ pledgeYear-2 }} Service Description How: (Explain how the services were provided) Who: (Benefited from the Service(s)) What: (Provide a description of the actual services, benefits, assistance, or program activities provided) Where: (Provide City, State and/or counties where the services were delivered) When: (Provide beginning and end dates of when the services were provided. If one-time activities, end dates do not need to be selected) One-time Check only if the reported service was a one-time activity. The “Start date” will need to be entered but the “End date” will be disabled. Start date: End date: {{ pledgeYear-2 }} Service Description (including who provided the service; limited to 256 characters) - National/ International and International Only Monetary Value of Benefit OR Number of Beneficiaries {{ pledgeYear-3 }} Service Description How: (Explain how the services were provided) Who: (Benefited from the Service(s)) What: (Provide a description of the actual services, benefits, assistance, or program activities provided) Where: (Provide City, State and/or counties where the services were delivered) When: (Provide beginning and end dates of when the services were provided. If one-time activities, end dates do not need to be selected) One-time Check only if the reported service was a one-time activity. The “Start date” will need to be entered but the “End date” will be disabled. Start date: End date: {{ pledgeYear-3 }} Service Description (including who provided the service; limited to 256 characters) - National/ International and International Only Monetary Value of Benefit OR Number of Beneficiaries

Step 5: Exemption Status

A group Exemption Letter is not required if option 2 or 3 is selected.

We see you are operating as a group exemption. We believe you should select OPTION 2.

We believe you are an Affiliate of {{parentEin}}/{{parentName}}/{{parentCfcCode}}. You should be selecting OPTION 3

Option 1

I certify that the Internal Revenue Service (IRS) recognizes the organization named in this application as tax-exempt under 26 U.S.C. 501(c)(3) to which contributions are tax deductible pursuant to 26 U.S.C. 170(c)(2) and it is not part of a group exemption.

Option 2

You must include a current list of subordinates that are covered by the group exemption. The EIN on the applicant’s Form 990 must match the EIN on the current list of subordinates.

Current List of Subordinates Uploaded

Option 3

You must include a letter from your organization’s national headquarters, signed by the CEO or equivalent officer, certifying that your local organization (explicitly named in the letter) operates as a bona-fide chapter or affiliate in good standing of the national organization and it is covered by the national organization’s 501(c)(3) tax-exemption, IRS Form 990 and audited financial statements. A copy of the national organization’s 501(c)(3) letter will be required in the next step.

Organization's Letter Uploaded

Step 6: IRS Determination Letter

We successfully found your EIN in the IRS Master File. You may proceed to the next step.

We could not find your EIN in the IRS Master File. You are required to upload IRS determination letter.

YES!
I certify that the Internal Revenue Service (IRS) recognizes the organization named in this application as tax-exempt under 26 U.S.C. 501(c)(3) and to which contributions are tax deductible pursuant to 26 U.S.C. 170(c)(2).

IRS Determination Letter Uploaded

Listing Name

Organizations operating under a group exemption are required to submit a current list of subordinates, with EINs, that are covered by the group exemption. Organizations that are chapters or affiliates operating under a national organization must submit a letter from the national headquarters. See instructions on Step 5 for additional information on requirements that must be included in the documentation.

DBA Name: {{charityListingViewObject.charityDBAName}}
IRS Name: {{charity.charityIrsName}}

DBA Authorization Letter Uploaded

Step 7: Financial Statements

Audited Financials are not required if option 1 or 2 is selected.

Based on the organization’s total revenue (Part VIII, Line 12, Column A) reported in the IRS Form 990, verify that the correct certification was selected on Step 7 and if the appropriate financial statements were submitted. If not, the application should be a "Fail".

Option 1

I certify that the organization named in the application has annual revenue of $250,000 or more as reported on the IRS Form 990 (Attachment C/Step 8) and accounts for its funds on an accrual basis in accordance with generally accepted accounting principles (GAAP) and has an audit of its fiscal operations completed annually by an independent certified public accountant in accordance with generally accepted auditing standards (GAAS).

Audited Financial Statement Uploaded

Fiscal period end date:

Option 2

I certify that the organization named in the application has annual revenue of at least $100,000 but less than $250,000 as reported on the IRS Form 990 (Attachment C/Step 8), accounts for its funds on an accrual basis in accordance with generally accepted accounting principles (GAAP) and has either an audit or a review of its fiscal operations completed annually by an independent certified public accountant.

Audited Financial Statement Uploaded

Fiscal period end date:

Option 3

I certify that the organization named in the application has annual revenue of less than $100,000 as reported on the IRS Form 990 (Attachment C/Step 8). The organization has controls in place to ensure that funds are properly accounted for and is able to provide accurate and timely financial information to interested parties. (Financial statements are not required.)

Step 8: IRS Form 990 or Pro Forma IRS Form 990

Option 1

I certify that the organization named in this application prepares and submits to the IRS a complete copy of the organization’s IRS Form 990.

IRS Form 990 Uploaded

PLEASE ENTER DETAILS FOR THE CURRENT FORM 990

Please enter details for the current Form 990
Fiscal period start date:
Fiscal period end date:

Accounting Method:

Is the uploaded tax return signed and dated by an Officer at the Organization?

Yes
No

Option 2

I certify that the organization named in this application is not required to prepare and submit an IRS Form 990 to the IRS. IRS Form 990 Uploaded

IRS Form 990 Uploaded

PLEASE ENTER DETAILS FOR THE CURRENT FORM 990

Yes
No

Step 9: Administrative and Fundraising Rate (AFR)

Fill in the required fields with information from the IRS Form 990 and confirm the AFR.

NOTE: When entering the organization’s total revenue (Part VIII, Line 12), General and Management Expenses (Part IX, Line 25, Column C), and Fundraising expenses (Part IX, Line 25, Column D), round up to the nearest dollar. The system does not accept decimals.

Management & General Expenses
Fundraising Expenses
Total Revenue

Your AFR is: {{applicationStep9.fundraisingRate}}%
AFR = total expenses divided by total revenue X 100

Confirm Your AFR

YES!
I certify that the administrative and fundraising rate (AFR) for the organization named in this application is the AFR Calculated from entry above. This percentage has been computed from information on the IRS Form 990 submitted with this application.

Step 10: Governing Body

Fill in required fields with information from Form 990.

YES!
I certify that an active and responsible governing body, whose members have no material conflict of interest and a majority of whom serves without compensation, directs the organization named in this application. For the majority of the board to be considered uncompensated, less than 50% of the people marked as either Institutional trustee or Individual trustee or director in column C of Part VII may have any compensation showing in columns D, E or F. If 50% or more have any compensation in those columns, the majority of the board is not considered uncompensated.

Number of Trustees / Institutional Trustees

Number of Voting Members of the Board

If the number of trustees or institutional trustees is fewer than the number of voting members, you must provide an explanation to justify the discrepancy. To remedy the discrepancy, you may need to amend your IRS Form 990 with the IRS and submit the corrected version with your CFC application.

Explanation of discrepancy (1000 characters max)

{{1000 - applicationStep10.explanationDiscrepancy.length}} characters remaining

Step 11: Verifying Statements

Check box to confirm that all the following statements are true.

YES!
I certify that the organization named in this application prohibits the sale or lease of CFC contributor lists.

YES!
I certify that the organization named in this application conducts publicity and promotional activities based upon its actual program and operations, and that these activities are truthful and non-deceptive, include all material facts, and make no exaggerated or misleading claims.

YES!
I certify that the organization named in this application effectively uses the funds contributed for its announced purposes.

YES!
I certify that the organization named in this application is in compliance with all statutes, Executive orders, and regulations restricting or prohibiting U.S. persons from engaging in transactions and dealings with countries, entities, or individuals subject to economic sanctions administered by the U.S. Department of the Treasury’s Office of Foreign Assets Control. The organization named in this application is aware that a list of countries subject to such sanctions, a list of Specially Designated Nationals and Blocked Persons subject to such sanctions, and overviews and guidelines for each such sanctions program can be found at http://www.treas.gov/ofac. Should any change in circumstances pertaining to this certification occur at any time, the organization will notify OPM's Office of CFC immediately.

{{appLabel.appYear}} {{appLabel.appType}} Application

{{appLabel.charityName}}, CFC #{{appLabel.cfcCode}}

Check box if applicable.

You are filing application as a National/International charity and must provide proof of services in a minimum of 15 states or at least 1 international location.

You are filing an application for a local charity which requires submission of Areas of Service.

You are filing application as a International charity and must provide proof of services provided in One International Location.

Web-Based / Virtual Services

{{pledgeYear}} Areas of Service - Local Charity

{{pledgeYear}} Areas of Service - National/International Charity

{{pledgeYear}} Areas of Service - International Charity

Listing Name

{{charityListingViewObject.listingName}}

{{charityInformation.charityName}}

PLEASE ENTER DETAILS FOR THE CURRENT FORM 990

PLEASE ENTER DETAILS FOR THE CURRENT FORM 990

{{appLabel.appYear}} {{appLabel.appType}} Application

{{appLabel.charityName}}, CFC #{{appLabel.cfcCode}}

Check box if applicable.

You are filing application as a National/International charity and must provide proof of services in a minimum of 15 states or at least 1 international location.

You are filing an application for a local charity which requires submission of Areas of Service.

You are filing application as a International charity and must provide proof of services provided in One International Location.

Web-Based / Virtual Services

{{pledgeYear}} Areas of Service - Local Charity

{{pledgeYear}} Areas of Service - National/International Charity

{{pledgeYear}} Areas of Service - International Charity

Listing Name

{{charityListingViewObject.listingName}}

{{charityInformation.charityName}}

PLEASE ENTER DETAILS FOR THE CURRENT FORM 990

Added Electronic Signature of Officer

PLEASE ENTER DETAILS FOR THE CURRENT FORM 990

Added Electronic Signature of Officer