OPM 1647D Local Federation Application

OMB APPROVED
No. 3206-0131

COMBINED FEDERAL CAMPAIGN
2015 Application Instructions for
Local Federations
Documents that did not exist at the time of the
application deadline will not be accepted during
the appeals process.

BACKGROUND
Enclosed is the model application for use by local
federations applying to participate in the Combined
Federal Campaign (CFC). A federation is a group
of voluntary charitable human health and welfare
organizations created to supply common fundraising, administrative, and management services
to its constituent members. A federation must
have at least 15 member organizations, in addition
to itself, that individually meet all of the CFC
eligibility criteria. If your organization does not
have 15 member organizations that meet the CFC
eligibility criteria, it must apply as an independent
organization using the independent organization
application.

Federations 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 federation 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 insure that their appeals are
complete and responsive to the actual reasons for
the LFCC denial decision.
Each LFCC determines the application deadline
for federations 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.

The following instructions and form are intended
to assist charitable federations 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.

If a local application form is available, OPM suggests that federations use the local application provided when applying to the Combined Federal
Campaign (CFC).

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
ensure that its application and all required
supplemental information is received by the
scheduled deadline. Requests for consideration
after the deadline will not be considered.

The CFC will not accept application forms with
modifications to any of the certification statements.
In order to determine whether a federation may
participate in the campaign, the LFCC may request
evidence of corrective action regarding any prior

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OPM Form 1647-D
Rev. August 2014

violation of regulation or directive, sanction, or
penalty, as appropriate. The LFCC will decide
whether the federation has demonstrated, to the
LFCC’s satisfaction, that the federation 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 that OPM withdraw
federation status. The Director’s decision will be
communicated in writing to the federation.

Contact Address Contact person’s
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
number.
Fax Contact person’s fax number.

DEFINITIONS

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

Federation Name of the applicant federation, as
it appears in the IRS Business Master File. If the
name of the federation is different from the name
which appears on the IRS determination letter, IRS
Form 990, audited financial statements, or annual
report, official documentation from the IRS or a
state government authorizing use of this name must
accompany the application. The EIN must be
included.

Federation Website Address List one complete
Internet address of the applicant federation (no email 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.

Employer Identification Number (EIN) The
nine-digit EIN assigned by the IRS and appearing
on the IRS Form 990 submitted with this
application.

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.

5 Digit CFC Number
The 5 digit number
assigned to the federation by the CFC. Federations
that did not previously participate in the CFC
should leave this field blank.
Mailing Address A physical street address must
be provided - Post Office Box addresses will not
be accepted.

Certifying Official The certifying official is the
individual who has the authority to affirm that all
statements in the application are accurate.

Check the box below the address to denote that it
is different from the address submitted with the
2014 CFC application.

INSTRUCTIONS
For details regarding CFC eligibility requirements
for local federations, refer to CFC Guidance
Memoranda on the CFC website at
www.opm.gov/cfc.

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

Applicants must check the box next to each
certification statement to demonstrate agreement to
comply with the statement and to certify it meets
the requirement. Failure to provide a check mark
for each of the statements will be considered as a

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OPM Form 1647-D
Rev. August 2014

refusal to certify and will result in the denial of the
application.

ible for incorrect Internet addresses. E-mail
addresses are not accepted.

A New Federation Applicant must submit, along
with its application, the complete applications of
all member organizations.

Special design text used to draw attention to a
federation or member organization’s 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.

A Currently Participating CFC Federation
Applicant must submit a complete application for
itself as well as each member that is new to the
federation (regardless of whether it participated as
an independent organization or member of another
federation in the 2014 CFC) and each member
denied participation in the 2014 CFC.

The physical mailing address of the federation and
each member organization applying for participation in the CFC must also be included in
Attachment A.
All of the above information must be provided in
an Excel spreadsheet sent to the local CFC office
via email. A model spreadsheet and information
on where it should be sent can be obtained from
the local CFC office.

Item 1
Include as Attachment A a list of the federation
and all member organizations applying for
participation in the CFC which meet all local
eligibility criteria of 5 CFR §§§ 950.202, 950.203,
950.204, and 950.401(i) for participation.

Taxonomy Codes The federation and each of its
member organizations applying for participation
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 the
organization’s listing in the CFC charity list 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:

The list must include the following information for
the federation and each of its member
organizations applying for participation in the
CFC: five-digit CFC code previously assigned to
the applicant (leave blank if the applicant is new);
legal name; telephone number; website address;
EIN; statement of 25 words or less that describe
the applicant organization’s program activities;
administrative fundraising rate; taxonomy codes
(see instructions below), and; the local presence
category under which each member organization is
eligible for participation in the local campaign
The federation is not required to indicate a local.

A
B
C
D
E
F
G

Arts, Culture, and Humanities
Education
Environment
Animal Related
Health Care
Mental Health & Crisis Intervention
Voluntary Health Associations & Medical
Disciplines
H Medical Research
I Crime & Legal Related
J Employment
K Food, Agriculture & Nutrition
L Housing & Shelter
M Public Safety, Disaster Preparedness & Relief
N Recreation & Sports
O Youth Development

The legal name that is registered with the IRS must
be provided for each applicant. If the applicant
solicits funds using a different name, it should
enter that name in the “DBA” (“Doing Business
As”) column. All applicants must include their
EIN regardless of whether or not they are operating
under a "DBA". See Item 2 for more information
on the requirements for “DBAs”.
The 25-word statement should not repeat the
applicant’s name. The legal name, DBA (if applicable), telephone number, website address, EIN,
and taxonomy codes will NOT count toward an
applicant’s 25 words. OPM will not be respons-

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OPM Form 1647-D
Rev. August 2014

P
Q
R
S
T

Human Services
International, Foreign Affairs, & National Security
Civil Rights, Social Action & Advocacy
Community Improvement & Capacity Building
Philanthropy, Voluntarism & Grantmaking
Foundations
U Science & Technology
V Social Science
W Public, Societal Benefit
X Religion-Related
Y Mutual & Membership Benefit
Z Unknown

each of its member organizations as well as DBA
(“Doing Business As” documentation, if
applicable.

Special design text used to draw attention to a
federation 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.

Bona-fide chapters or affiliates of a national
organization that do not have an IRS determination letter for the local organization must
provide a certification signed by either the Chief
Executive Officer (CEO) or CEO equivalent of the
national organization, dated on or after October 1,
2014, stating the local charitable organization
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 must accompany the
CEO’s certification.

Organizations that are part of an IRS group
exemption must provide a copy of the IRS letter
granting the group exemption, as well as the
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.

Item 2
Include as Attachment B a copy of the
federation’s most recent IRS determination
letter. If the name of the applicant organization
differs on the IRS determination letter, the IRS
Form 990, or audited financial statements,
documentation from the IRS or state government
authorizing this name change must accompany the
application.

Item 3
Self-explanatory

Please review CFC Memorandum 2009-4 for more
information on this requirement and examples of
supporting documentation (www.opm.gov/cfc).

Item 4
Check the appropriate box. The federation’s
certifying official must certify the federation
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 by an
independent certified public accountant in
accordance with Generally Accepted Auditing
Standards (GAAS). No other basis of accounting
is acceptable under Generally Accepted Accounting Principles (GAAP). The cash basis, modified
cash basis, and modified accrual basis are not
acceptable methods of accounting under GAAP.

Each local federation and federation member’s
501(c)(3) status will be verified with the IRS.
Federation applicants and federation members
whose current 501(c)(3) status cannot be
confirmed by the IRS will be denied participation.
OPM encourages organizations to verify their
current tax-exempt status prior to submitting a
CFC application. This can be by done contacting
the IRS at (877) 829-5500.
Attachment B must include the IRS determination
letter and/or other supporting documentation (e.g.
page from the Catholic Directory or letter from a
bona-fide chapter’s or affiliate’s national
organization stating that it is covered by the
national organization’s tax-exemption and is in
good standing with the national organization) that
verifies the tax-exempt status of the federation and

Include as Attachment C a copy of the auditor’s
report and the federation’s complete audited
annual financial statements. The audited
financial statements must cover the fiscal period
ending not more than 18 months prior to the

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OPM Form 1647-D
Rev. August 2014

January 2015 (i.e. ending on or after June 30,
2013). The audited financial statements must
verify the federation is honoring designations
made to each member organization by distributing a proportionate share of receipts based
on donor designations to each member.

and submit a pro forma IRS Form 990 (see
instructions below). IRS Forms 990EZ, 990PF,
and comparable forms will not be accepted.
Organizations not required to file the IRS Form
990 (long form) must submit a pro forma IRS
Form 990.

The audited financial statements must include all
statements and audit notes as required by GAAP.
The Independent Auditor’s Report must include
the signature of the auditor or the auditing firm.

Pro forma IRS Form 990 Instructions – The
IRS Form 990 can be downloaded from the IRS
website (www.irs.gov). The following sections
must be completed: Page 1, Items A-M; Part I
(Summary), Lines 1-4 only; Part II (Signature
Block); Part VII (Compensation section A only);
Part VIII (Statement of Revenues); Part IX
(Statement of Functional Expenses), and; Part XII
(Financial Statements and Reporting).

Newly created federations operating for less than
one year (as determined from the date of the IRS
determination letter to the closing date of the CFC
application period) are not required to submit
audited financial statements.

The IRS Form 990 and audited financial statements must be prepared using the accrual method
of accounting and cover the same fiscal period
ended not more than 18 months prior to January
2015 (i.e. ended on or after June 30, 2013).

Item 5
Check the appropriate box.
Include as
Attachment D a copy of the complete, signed
IRS Form 990 for a period ended not more
than 18 months prior to January 2015. The IRS
Form 990 must include a signature in the block
marked “Signature of officer”; the preparer’s
signature alone is not sufficient. Organizations
that file the IRS Form 990 electronically may
submit a signed copy of the IRS Form 8879-EO or
IRS Form 8453-EO in lieu of a signature on the
IRS Form 990.

Item 6
Calculate and enter the federation’s annual
percentage for administrative and fundraising
expenses. This percentage is computed from the
IRS Form 990 submitted with this application.
Add the amount in Part IX (Statement of
Functional Expenses), Line 25, Column C
(Management and General Expenses) to the
amount in Line 25, Column D (Fundraising
Expenses), and divide the sum by Part VIII
(Statement of Revenue), Line 12, Column A (Total
Revenue).

The CFC will compare the number of voting
members disclosed in Part I, Line 3 with the
number of individuals that have the ‘individual
trustee or director’ position selected in Part VII,
Column C. If the number in Part I is more than the
number in Part VII, the organization must provide
an explanation for the difference. Failure to clarify
the difference or to timely file an amended IRS
Form 990 with the IRS may result in the denial of
the application. Please review CFC Memoranda
for additional information on the IRS Form 990
requirements, including the presentation of the
governing body and expenses.

No other methods may be used to calculate this
percentage. All percentages must be listed to the
tenth of a percent (e.g. 15.7%).
Charities which do not reflect administrative and
fundraising expenses in the Statement of
Functional Expenses of the IRS Form 990,
resulting in a 0% rate, but show such expenses on
the audited financial statement will be denied
unless the audited financial statements specifically
state that these services were donated.
Item 7
Each federation must include as Attachment E

A complete IRS Form 990 is required including all
supplemental statements and Schedule A, if
applicable, for the applicant federation to be
eligible for the CFC. If the IRS does not require
the federation to file a Form 990 it must complete

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OPM Form 1647-D
Rev. August 2014

The annual report or more frequently published
document must also include an accurate
description of the federation’s membership dues
and/or service charges received by the federation
from the charitable organizations participating as
members. The information must clearly present
the amounts raised, the sources of contributions,
the cost of fundraising, and how costs are
recovered from donations.

a complete listing of the federation’s board of
directors and the beginning and end dates of
each individual’s current term of office (e.g.
John Smith, 2009-2015). Attachment E must
also list the board’s meeting dates and locations
for the previous calendar year (2014).
The CFC uses Part VII of the IRS Form 990 to
verify that a majority of the governing body served
without compensation. The IRS Form 990
instructions define a director/trustee as member of
the governing body with voting rights. These are
the individuals that will be reviewed. Cases where
50% of the board received compensation and 50%
of the board was not compensated will be denied,
regardless of the amount of the compensation.

Reproductions of annual reports that are available
on a federation’s website are acceptable. The
annual report must be clearly marked as such on
the website and must include all of the criteria
outlined in the CFC regulations (see above). OPM
will not accept miscellaneous pages from the
federation’s website that provide this information
in lieu of an annual report document. A printed
copy of the report must be included in the CFC
application.

Item 8
Self-explanatory
Item 9
Self-explanatory

Item 13
Each federation and independent organization
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 10
Self-explanatory
Item 11
Self-explanatory
Item 12
Include as Attachment F a copy of the federation's most recently completed annual report.
The annual report must cover the fiscal year ending
not more than 18 months prior to January of the
campaign year to which the federation is applying
or the preceding calendar year. A more frequently
published document, such as a quarterly
newsletter, may be substituted so long as it meets
the requirements for the annual report.
The annual report or more frequently published
document must contain a full description of the
federation’s activities and supporting services
during the year covered by the report and identify
its directors and chief administrative personnel.

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OPM Form 1647-D
Rev. August 2014

Local CFC applications must be sent to the local campaign office. Do not send applications to the U.S.
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.

REQUIRED ATTACHMENTS (failure to provide any of these may result in a denial)
 Attachment A – federation membership listing (See Item 1)
 Attachment B – IRS determination letter (See Item 2)
 Attachment C – Audited Financial Statements (if required -- See Item 4)
 Attachment D – IRS Form 990 (See Item 5)
 Attachment E – Board Members’ Current Terms of Office and Meeting Dates and Locations
(See Item 7)
 Attachment F – Annual Report (See Item 12)

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OPM Form 1647-D
Rev. August 2014

OMB APPROVED
NO. 3206-0131

COMBINED FEDERAL CAMPAIGN
2015 APPLICATION FOR
LOCAL FEDERATIONS
Federation:

_________________________________________________________________

Employer Identification Number (EIN): __ __ - __ __ __ __ __ __ __
5 Digit CFC Number (If a previous participant in CFC):

___ ___ ___ ___ ___

Mailing Address:
__________________________________________________________________
(Post Office Box addresses are not accepted and may result in automatic disqualification.)
Check this box if the above address is different from the address submitted with the 2014 CFC application:

Telephone Number

_

_____________________________________________________________

Contact Person:
Contact Title:
Contact Address:
__________________________________________________________________
(If different from the above address – Post Office Box Addresses are acceptable for the
Contact Address. All CFC correspondence will be sent to this address.)

Contact Telephone:

____________ __

Contact E-Mail Address:

Fax:

________________________

_________________________________________________________

Federation Website Address (required, if available): ______________________________________
Disbursement Address: _________________________________________________________________
_________________________________________________________________
(This is the address where paper checks will be sent.)
Electronic Funds Transfer (EFT) information (Optional):
RTN (9 digits): _____________________
ACCT: _____________________
Financial Institution: _________________________________

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OPM Form 1647-D
Rev. August 2014

1)

I certify that the federation named in the application has ________ (enter number)
member organizations that individually meet all local eligibility criteria of 5 CFR §§§
950.202, 950.203, 950.204, and 950.401(i) for participation in this campaign by having
either a substantial local presence in the geographic are served by the local campaign.
Include as ATTACHMENT A a list of the federation and all member organizations
that meet this requirement. See instructions for additional information.

2)

I certify that the Internal Revenue Service recognizes the federation 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). Include as ATTACHMENT B a copy of the federation’s
most recent IRS determination letter and the IRS determination letter and/or other
supporting documentation that verifies the tax-exempt status of its member
organizations. See instructions for additional information.

3)

I certify that the federation named in this application is a human health and welfare
federation and either it or its member organizations provide services, benefits, or assistance
to, or conduct activities that directly or indirectly affect, human health and welfare. The
services, benefits, assistance, or program activities affecting human health and welfare were
provided in calendar year 2014.

4)

Place a check in the one appropriate box:
I certify that the federation named in the application 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). (Include as ATTACHMENT C a copy of the auditor’s report and the complete audited financial statements
for a fiscal period ending not more than 18 months prior to January 2015 which verifies
that the federation is honoring designations made to each member organization by
distributing a proportionate share of receipts based on donor designations to each member.)
- OR I certify that the federation named in the application accounts for its funds on an accrual basis
in accordance with generally accepted accounting principles (GAAP), but has been operating
for less than one year and therefore is not required to submit audited financial statements.

5)

Place a check in the one appropriate box:
I certify that the federation named in this application prepares and submits to the IRS a
complete copy of the federation’s IRS Form 990. (Include as ATTACHMENT D a copy
of the complete IRS Form 990 for a period ending not more than 18 months prior to
January 2015, including signatures in the box marked “Signature of Officer” or in IRS
Forms 8879-EO or 8453-EO. The preparer’s signature alone is not sufficient. IRS Forms
990EZ, 990PF, and comparable forms are not acceptable substitutes.)
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OPM Form 1647-D
Rev. August 2014

- OR I certify that the federation named in this application is not required to prepare and submit an
IRS Form 990 to the IRS. (Include as ATTACHMENT D a pro forma IRS Form 990 for a
period ending not more than 18 months prior to January 2015. See application instructions
for pro forma IRS Form 990 requirements. IRS Forms 990 EZ, 990PF, and comparable
forms are not acceptable substitutes.)
6)

I certify that the administrative and fundraising rate for the federation named in this
application is __ __ . __%. This percentage is computed from the IRS Form 990 submitted
with this application. See the application instructions for the formula.

7)

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
federation named in this application. (Include as ATTACHMENT E a list of the federation’s
board of directors with the beginning and ending date of each board member’s current term
of office and the board’s meeting dates and locations for calendar year 2014.)

8)

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

9)

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

10)

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

11)

I certify that the federation named in this application does not employ, in its CFC operations,
the services of private consultants, consulting firms, advertising agencies or similar business
organizations to perform the policy-making or decision-making functions in the CFC.

12)

I certify that the federation named in this application prepares and makes available to the
public an annual report that includes a full description of the federation's activities and
supporting services, member fees and/or service charges, and identifies its
directors/governing body and chief administrative personnel. Include as ATTACHMENT F
a copy of the most recently completed annual report. See Instructions Item 12 for
additional information.

13)

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
OPM Form 1647-D
10
Rev. August 2014

certification occur at any time, the organization will notify OPM's CFC Operations
immediately

CERTIFYING OFFICIAL
I, ____________________________________, am the duly appointed representative
(Print Name)
of ____________________________________ authorized to certify and affirm all statements
(Print Federation certification)
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 federation
named in this application acknowledges and agrees to comply with that certification.
______________________________
(Signature)
______________________________
(Typed or Printed Name)
______________________________
(Title)
Date Completed ______________________

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 suggestions for reducing completion time to Office of Personnel Management (OPM), OPM Forms Officer,
Paperwork Reduction Project (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-D
Rev. August 2014