2011 CFC FSYA Application

OMB APPROVED

No. 3206-0131

C ombined Federal Campaign

2010 2011 Application Instructions for

Family Support and Youth Activities

Background

Enclosed is the model application for use Family Support and Youth Activities (FSYA), also known as Morale, Welfare and Recreation (MWR) organizations, applying to participate in the Combined Federal Campaign (CFC). An FSYA is an organization that operates on a military base for the benefit of the members of the military who work or live on that installation or day-care centers that are located in a Federal facility. The following instructions and form are intended to assist an FSYA in applying for participation in the CFC. All aspects of the CFC, including eligibility for par­ticipation, are strictly governed by Federal regula­tion. The current CFC regulations can be viewed on our website at www.opm.gov/cfc. Additional copies of the application can also be downloaded from the website.

All required documents and attachments must be complete and submitted before the application deadline each year. The CFC will not accept late applications. It is the applicant’s responsibility to submit its application and information by the scheduled deadline. Requests for consideration after the deadline will not be considered.

Applicants whose applications do not contain required documents or who submit incomplete or out-of-date documents will not be permitted to correct their applications during the appeals process. Organizations that apply for local eligibility and are found ineligible will have an opportunity to appeal to the Local Federal Coordinating Committee (LFCC) for reconsideration. If found ineligible on appeal by the LFCC, the organization may appeal the LFCC’s decision to the Direc­tor of the Office of Personnel Management (OPM). The Director's decision is final for administrative purposes. Appellants should ensure that their appeals are complete and respon­sive to the actual reasons for the LFCC denial decision.

Each LFCC determines the application deadline for organizations seeking local eligibility. Since local dates will vary, please check with the local CFC for local application deadlines and filing informa­tion. Local campaign contact information can be found on the CFC website at www.opm.gov/cfc/Search/Locator.asp.

If a local application form is available, OPM suggests that organizations use the local application pro­vided when applying to the CFC.

The CFC will not accept application forms with modifications to any of the certification statements.

In order to determine whether an organization may participate in the campaign, the LFCC may request evidence of corrective action regarding any prior violation of regulation or directive, sanction, or penalty, as appropriate. The LFCC will decide whether the organization has demonstrated, to the LFCC’s satisfaction, that the organization has taken appropriate corrective action. Failure to demonstrate satisfactory corrective action or to respond to the LFCC’s request for information within 10 business days of the date of the request may result in a recommendation to OPM that the organization will not be included in the Charity List. The Director’s decision will be communicated in writing to the organization.

FAXES OR ELECTRONIC SUBMISSIONS OF APPLICATIONS ARE NOT ACCEPTED

DEFINITIONS

Organization Legal name of the applicant organization.

Employer Identification Number (EIN) The nine-digit EIN that appears on the IRS determination letter, if applicable. An FSYA that has not been assigned an EIN may leave this field blank.

5 Digit CFC Number The 5 digit number assigned to the organization by the CFC. Organizations that did not previously participate in the CFC should leave this field blank.

Mailing Address A physical mailing address must be provided - Post Office Box addresses will not be accepted.

Telephone Organization’s telephone number.

Contact Person The contact person is the indi­vidual to whom the CFC will direct communica­tions. This may be any individual in the organi­zation.

Contact Title Self-explanatory

Contact Address Contact person’s physical mailing address if different than the organization's

address. Post Office Boxes may be used. Participation decision letters and other CFC communications will be sent to the contact person at this address.

Contact Telephone Contact person’s telephone number, if different than the organization’s tele-phone number.

Fax Contact person’s fax number.

Contact E-Mail Contact person’s electronic mail address. Applicants are encouraged to provide more than one email address.

Website Address List the complete Internet address of the applicant organization (no e-mail addresses). This information is required, if the organization has an Internet address.

Disbursement Address List the address where paper checks will be sent, if different from mailing address. Post office boxes may be used for the disbursement address.

Electronic Funds Transfer (EFT) Information List the Routing and Account numbers, along with the name of the financial institution, where funds should be disbursed. This is an optional method for receipt of CFC contributions. NOTE: Some campaigns may elect not to disburse funds electronically.

Certifying Official The certifying official is the individual who has the authority to affirm that all statements in the application are accurate. For FSYAs, the certifying official must be commander of the military installation or the head of the Federal facility where the organization is located.

INSTRUCTIONS

For details regarding CFC eligibility requirements for FSYAs, refer to CFC regulations at 5 CFR § 950.204(c) on the CFC website at www.opm.gov/cfc.

Applicants must check the box next to certification statement #1 to demonstrate agreement to comply with the statement and to certify that it meets the requirement. Failure to provide a check mark for the statements will be considered a refusal to certify and will result in the denial of the application.

Item 1

Each FSYA applying to participate in the CFC must, as a condition of participation, certify that it 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, and individuals subject to economic sanctions administered by the U.S. Department of the Treasury’s Office of Foreign Assets Control (OFAC).  The programs administered by OFAC restrict or prohibit U.S. persons from engaging in transactions and dealings with targeted countries, entities, and individuals.  OFAC publishes a list of Specially Designated Nationals and Blocked Persons (SDN List).  The persons on the SDN List are subject to economic sanctions.  The SDN List and additional information relating to the economic sanctions programs that OFAC administers are available at http://www.treas.gov/ofac.  A link to the SDN List is available on the CFC website (www.opm.gov/cfc).  For further information, please see CFC Memo 2005-13.

Item 2

Include as Attachment A a copy of the letter from the commanding officer of the military installation or the head of the Federal agency where the day-care facility is located certifying that the organization meets the criteria in 5 C.F.R. §950.204(d).

This certification letter must be completed annually and dated on or after January 1 of the campaign year to which the organization is applying. The letter must certify that the organization meets the following criteria:

• The organization is a nonprofit, tax-exempt organization that provides family service programs or youth activity programs to personnel in the Command or in the Federal facility where the organization is located. The activity does not receive a majority of its financial support from appropriated funds.

• The organization has a high degree of integrity and responsibility in the conduct of its affairs. Contributions received are used effectively for the announced purposes of the organization.

• The organization is directed by the base Non-Appropriated Fund Council or an active voluntary board of directors which serves without compensation and holds regular meetings.

• The organization conducts its fiscal operations in accordance with a detailed annual budget, prepared and approved at the beginning of the fiscal year. Any significant variations from the approved budget must have prior authorization from the Non-Appropriated Fund Council or the directors. The family support and youth activities must have accounting procedures available to an installation auditor and the inspector general.

• The organization has a policy and practice of nondiscrimination on the basis of race, color, religion, sex or national origin applicable to persons served by the organization.

• The organization prepares an annual report which includes a full description of the organization’s activities and accomplishments. These reports are made available to the public upon request.

Item 3

Include as Attachment B, a statement in 25 words or less that describes the organization’s program activities. The statement should not repeat the organization's name. The organization must also provide the legal name as registered with the IRS if the organization does business under a different name. All organizations must include their IRS Employee Identification Number (EIN) regardless of whether or not they are operating under a "dba" (“doing business as”). The organization must also include a telephone number that can be reached from any location in the U.S. and the organization’s administrative and fundraising rate. The legal name, telephone number, EIN, taxonomy codes (see below), and administrative and fundraising rate will NOT count as part of the 25-word statement. An Internet address where information on the organization can be obtained may be included and will not count toward the 25 words. OPM will not be responsi­ble for incorrect Internet addresses. E‑mail addresses are not accepted.

Taxonomy Codes Each organization can identify up to three categories, in priority order, which most closely identify the type of mission, services, and activities provided. The corresponding letters will be printed in your organization’s listing in the CFC charity list (see example below) to assist donors in identifying charities by type of service provided. Categories are derived from the National Taxonomy of Exempt Entities (NTEE) classification system developed by the National Center for Charitable Statistics. The 26 categories are:

A Arts, Culture, and Humanities

B Educational Institutions & Related Activities

C Envir. Quality, Protection & Beautification

D Animal Related

E Health – General and Rehabilitative

F Mental Health, Crisis Intervention

G Disease, Disorders, Medicinal Disciplines

H Medical Research

I Crime, Legal Related

J Employment, Job Related

K Food, Agriculture, and Nutrition

L Housing, Shelter

M Public Safety, Disaster Preparedness & Relief

N Recreation, Sports, Leisure, Athletics

O Youth Development

P Human Services – Multipurpose and Other

Q International, Foreign Affairs, National Security

R Civil Rights, Social Action, Advocacy

S Community Improvement, Capacity Building

T Philanthropy, Voluntarism & Foundations

U Science & Technology Research Institutes,

Services

V Social Science Research Institutes, Services

W Public, Social Benefit: Multipurpose, Other

X Religion Related, Spiritual Development

Y Mutual/Membership Benefit Orgs., Other

Z Other

Special design text used to draw attention to an organization title, such as special fonts, capitaliza­tion, quotations, and underlining, are not accepted. Any statement that uses special features, or exceeds 25 words will be edited by the LFCC. Organizations will be listed by their legal IRS recog­nized name as it appears on the IRS determination letter only unless the appropriate legal documentation permitting otherwise is provided with the application. See Item 2. The format is as follows:

0000 Name of Organization (legal name of organization, if applicable) (202) 555-1234 www.opm.gov/cfc EIN#12-3456789 The description will contain no more than 25 words. It should be worded so the donor understands the program ser­vices provided. 0.0% B,V,O

Local CFC applications must be sent to the local campaign office. Do not send applications to the Office of Personnel Management. Note that each campaign area sets its own application deadline. For more information on the local application deadlines and addresses, please contact the Principal Combined Fund Organization (PCFO) representative in your area. Contact information can be found at www.opm.gov/cfc/Search/Locator.asp.

OMB APPROVED

NO. 3206-0131

Combined Federal Campaign

2010 2011 Application for

Family Support and Youth Activities

Organization:

Employer Identification Number (EIN): __ __ - __ __ __ __ __ __ __ __ __

5 Digit CFC Number (If a previous participant in the CFC): ___ ___ ___ ___ ___

Organization Address:

____________________________________________________________

(Post Office Box addresses are not accepted and may result in automatic disqualification.)

Telephone: ( ___ ) _________________________________________

Contact Person:

Contact Title: _________________________________________________________

Contact Address:

(If different from the above address – Post Office Boxes are acceptable for the Contact Address. All CFC correspondence will be sent to this address.)

Contact Telephone: ( ___ )________________ Fax: ( ___ )_____________________

Contact E-Mail Address: _________________________________________________________

Website Address (required, if available): ________________________________________

Disbursement Address: _________________________________________________________________ (This is the address where paper checks will be sent.)

Electronic Funds Transfer (EFT) information (Optional):

Routing Number (9 digits): __ __ __ __ __ __ __ __ __

ACCT: ___________________________________________

Financial Institution: _________________________________

1) 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 Operations immediately.

2) Include as ATTACHMENT A the letter from the commander of the military installation or the head of the Federal facility where the organization is located certifying that the organization meets the eligibility criteria outlined in 5 C.F.R. §950.204(d) (see application instructions for a list of the eligibility criteria).

3) Include as ATTACHMENT B a 25-word statement for listing in the campaign charity list. (See Instructions Item 3 for additional required information on the optional taxonomy codes.)

Certifying Official

I, ____________________________________, am the duly appointed representative

(Print Name)

of ____________________________________ authorized to certify and affirm all statements

(Print Organization Name)

enclosed in this application. I certify that I have read all the certifications set forth in this document and affirm their accuracy. In addition, by checking the box next to the certification, the organization named in this application acknowledges and agrees to comply with that certification.

______________________________

(Signature)

______________________________

(Typed or Printed Name)

______________________________

(Title)

Date Completed ______________________ ______________________________

NOTE: Applications will not be accepted if submitted electronically or by facsimile. The certifying official’s signature must be original. Automatic pens and/or signature stamps may not be used.

Public Burden Statement

We think this form takes an average of 3 hours to complete, including the time for getting the needed data and reviewing both the instructions and completing the form. Send comments regarding our estimate or any other aspects of this form, including for reducing completion time to Office of Personnel Management (OPM), CFC Operations (3206-0131), Washington, DC 20415-7900. The OMB number 3206-0131 is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.

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OPM Form 1647-E

Rev. November 2009